This monthly digest comprises threats and incidents of violence affecting the delivery of humanitarian assistance. It is prepared by Insecurity Insight from information available in open sources.

Global

13 November 2017: Save the Children announced that it had fired 16 staff over reports of sexual violence in the past year. Source:Thomson Reuters Foundation

13 November: Oxfam announced that it had dismissed 22 staff over reports of sexual violence in the year ending April 2017. Source:Thomson Reuters Foundation

Highlights
- WFP aid convoy from El Obeid reaches Aweil in South Sudan bringing food for 30,000 people.
- In Sudan, malaria cases have fallen since a spike of 1.2 million in 2014 to nearly 900,000 this year.
- Food security improves throughout most of the country, due to good harvests, FEWS NET.
- In East Jebel Marra locality, about 4,000 children under five receive routine vaccines.
- UN SC Working Group on Children and Armed Conflict commends government efforts to ensure no child is recruited in the armed forces.

Figures
- # people in need in Sudan (2017 HNO): 4.8 million
- # people in need in Darfur (2017 HNO): 3 million
- GAM caseload (2017 HNO): 2.2 million
- South Sudanese refugees since 15 December 2013 registered by UNHCR as of 31 October 2017: 453,258
- Other refugees and asylum seekers registered by UNHCR as of 30 June 2017: 167,784

WFP expands the delivery of food through Sudan to people in need in South Sudan

The World Food Programme (WFP) has successfully sent the first aid convoy to deliver food assistance from Sudan to the South Sudanese city of Aweil in Bahr El-Ghazal, the organization said in a press release on 29 November. In 2018, WFP plans to send 30,000 metric tons (MT) of life-saving assistance down the new route to feed about 1.7 million people in South Sudan for 10 months.

It took five days for the 19 WFP-contracted truck convoy, carrying 500 MT of sorghum, to travel 830km from Sudan’s El Obeid town (North Kordofan State) to Aweil in South Sudan. The 500 MT of sorghum is enough to meet the emergency food needs of 30,000 people for one month.

WFP is now able to reach three locations in South Sudan by road from Sudan, including Renk, Bentiu and now Aweil. This enables WFP to deliver life-saving assistance more swiftly and efficiently and makes it easier to pre-position food before the rainy season, which cuts road access to many communities.

In 2014, WFP and the governments of Sudan and South Sudan signed a memorandum of understanding (MoU), which designates WFP as the sole agency responsible for the transportation of humanitarian cargo from Sudan to South Sudan. This 2014 MoU reopened the humanitarian corridor for the first time since the two countries separated in 2011.

So far in 2017, WFP Sudan has delivered about 42,600 MT of food - out of 97,260 MT over the past three years - to over 1.2 million conflicted-affected people facing acute hunger in South Sudan. The current MoU has been extended until June 2018.

EDWARD BENJAMIN KARGBO

Internally displaced people living in the United Nations protection site in Bentiu are claiming back their human rights.

A workshop organized by the United Nations Mission in South Sudan and partner organizations for women who have sought sanctuary in the protection site in the Unity region is equipping the women with knowledge of their basic human rights.

Mary Nyanyok Wuar, a leader for a woman’s group in the UN protection site, said the training has taught them a lot about human rights and domestic violence.

Mary fled her home in Nihaldu village three years ago to escape violence.

“When we first arrived here, we did not know about human rights and domestic violence. But through workshops and other engagements with the UNMISS’ Human Rights team and other organizations, we now know what our rights are and where to report if anything happens,” said Mary.

As a leader, one of Mary’s roles is to support and advise other women in the protection site. She says they have been able to work together to form groups that provide support to women.

Domestic violence remains a concern in the UN protected site which is currently home to more than 114,000 internally displaced people – the majority of which are women.

Mary said she believes that men also need to be continuously informed and educated about human rights and abuses against women.

“The men need to be fully onboard when it comes to domestic violence and other forms of abuse,” she said.

While there has been progress in sensitizing men about domestic violence, Samuel Luny, an officer at Women Aid Vision, a local organization that supports women in the protection site says it is still difficult to get some of the men to understand.

“Some men are getting it and over time they will serve as mentors to other men. Change takes time, but we will get there,” he said

The training and engagement have however enabled women “to claim their rights, said Luny.

“Through workshops and training, we have got them to learn about their rights and report abuses,” said Luny. “They have also formed groups to support each other.”

JAMES SOKIRI

Army officers serving in the troubled Yei region are being urged to respect the rights of children so that South Sudan can be removed from the international list of countries that recruit and use child soldiers.

United Nations Mission in South Sudan child protection officer, Nora Pendaeli, said the Sudan People’s Liberation Army is listed in a UN report as a perpetrator of four of the six grave violations against children. This includes killing and maiming, recruitment and use of children in armed forces, rape as well as occupation of, and attacks on, schools, hospitals and places of worship.

“Our role as child protection professionals is to engage all parties to the conflict…to increase their knowledge and awareness about what the protection of children entails, and explore together with them the six grave violations so that they can help avoid falling victim to them,” said Nora Pendaeli.

“Children are especially vulnerable during armed conflict because they are easy to manipulate, are very obedient to their masters, and have a lot of needs like food and shelter and if they are manipulated in the name of meeting these needs, they can easily fall prey to it,” she said.

“Once social fabrics disappear, including families and communities, it leaves children at the mercy of those who hold guns…yet all fighters have to understand their roles and responsibilities in protecting children.”

At the opening of an UNMISS workshop in Yei, the security advisor to the Yei Governor, Muki Batali Buli, said the culture of killing and maiming of children, including rape is not typical of traditional South Sudanese inter-clan disputes.

The head of the SPLA’s child protection unit in the capital Juba, Brigadier General Khamis Edward, said the SPLA was about to be declared a childfree army had it not been for the outbreak of civil war in December 2013.

“It is our ultimate duty as a national army to clear our image before the international community, so that we can assure everybody that we are capable of removing all children within our ranks in order to help them start new life without the gun,” he said.

The Brigadier said the army’s duty is to defend the country’s constitution - its sovereignty - as well as its citizens and their properties, but that this requires true patriotism to achieve.

“It is in our best interest to protect the future of South Sudan, and the future of South Sudan belongs to children. If you do not protect them, then there is no future for this country,” said Anthony Nwapa, UNMISS Human Rights Officer.

“Gathering the knowledge is one thing, yet using the knowledge to advance the course of protection of children during armed conflict is paramount,” he said.

The two-day training brought together 54 senior SPLA officers, including Brigadiers, Majors, Lieutenants and Captains.

JAMES SOKIRI

A wide spectrum of youth living in Yei are exploring ways to end ethnic division and build unity in a forum to promote peace in the south-western region of South Sudan.

Organized under the theme “promoting peace, social cohesion and peaceful co-existence”, the forum has been organized by the Civil Affairs division of the United Nations Mission in South Sudan in collaboration with a local faith-based group, Augustine Family Organization.

“Some politicians want to divide you along tribal and ethnic fault-lines, and because the youth are not educated about the consequences of their actions, they always bear the brunt of the war for a cause very peculiar to them,” said Alfred Kenneth Duku, the Yei Minister of Information, Culture, Youth and Sports.

Arkolano Lado Tombe, Bishop of the Catholic Diocese of Yei agrees.

“South Sudan will perish if the youth never wake up now and reject any manipulation by politicians in order to achieve their individual political interests,” he said.

Bishop Arkolano said that Yei has experienced the consequences of a broken relationship between the military and the civilians. This makes the local community afraid to approach military personnel during times of need.

“The army is very harsh on its people, and the people have become very scared of the army now, so they run away from them even during times that they are needed most.”

While it was okay to identify as Bari, Kakwa, Kuku, Dinka or a Nuer, the Bishop said the different tribes making up the country must project unity through its diversity rather than using ethnicity as a dividing factor.

The origins of peace should start in Yei so that other regions could then emulate the process, he said.

“Peace in our state means peace in other states, and war in one state is calling for war in other states, too,” said Bishop Arkolano. “Let us stay together as one people, so that we can sow seeds of peace in the other states, and when all the other states are in peace, then South Sudan will be peaceful and prosperous for today’s youth, including the youth yet to come.”

UNMISS staff member, Mawa Moses Alafi, urged the forumparticipants to strive for peace by embracing the culture of social cohesion and peaceful co-existence.

“The potential of the youth in bringing peace and harmony is paramount to the success of any political dialogue, because they make up the greatest percentage of the South Sudan population,” he said.

The forum, which brought together about 91 youth comprising the Sudan People’s Liberation Army, National Security, Prisons, Police, Boda Boda Associations, Women’s Association, religious groups, and Scouts identified some of the factors causing inter-ethnic polarity in Yei as impunity among elites, the historical background of conflict among superior tribes, tribal pride, as well as tribal and political hegemonies.

Juba 11 December 2017: In South Sudan, cholera continues to hit communities already made vulnerable by disasters such as conflict and hunger catastrophe.

In 2017, South Sudan braced the most protracted and biggest cholera outbreak. The outbreak was first detected in July 2016 and since then over 21 000 cholera cases and 462 deaths (CFR 2.14%) have been reported from 27 Counties countrywide.

To avert the speed at which cholera was spreading among the population who have suffered from the consequences of conflict and worst food crisis, WHO’s famine incident management team and the national cholera taskforce have managed to contain the cholera outbreak with sporadic transmission reported in two counties, Juba and Budi.

To further reinforce these gains, WHO in collaboration with partners supported the Ministry of Health to enhance capacities for emergency and outbreak preparedness and response through a series of activities undertaken from 27 November to 7 December 2017. The activities included: a refresher training for a multi-sectoral rapid response team followed by a review of the national program for integrated disease surveillance and response (IDSR) and an after-action review (AAR) of the cholera response.

Honorable Dr Riek Gai Kok, Minister of Health, expressed gratitude to donors, WHO and partners for their commitment to supporting the efforts of the Government of South Sudan to improve health services. He also urged the rapid response team to cascade the knowledge and skills to the lower levels.

Addressing the needs of the affected population in remote areas

Across the country, an integrated rapid response mechanism is in place to reach desperate people in remote areas of South Sudan where vulnerable populations like children and pregnant women are at risk of death from preventable and malnutrition-related causes has increased dramatically and a hunger catastrophe is looming.

In light of increasing risks of emerging and re-emerging disease outbreaks and epidemics, the Ministry of Health with support from WHO trained 45 multidisciplinary experts drawn from the national Ministry of Health, Ministry of Humanitarian and Disaster Management, Ministry of Water Resources and Irrigation, Ministry of Petroleum, and Juba City Council to enhance the capacity to effectively respond to cholera and other public health hazards.

“Integrating the overall International Health Regulations (2005) core capacities and building the capacity of rapid response teams are vital to provide life-saving health services and respond to public health threats,” said Mr Evans Liyosi, WHO Representative a.i. to South Sudan. The rapid response teams are providing timely and appropriate treatment to people who have had little or no access to health care services.

To offer experiences throughout the training process, simulation of outbreak scenarios were integrated into the training to provide the rapid response teams with opportunities for functional capacities of outbreak investigation and response as well as cascading the training to the lower levels to ensure corresponding capacities at the sub-national level.

Improving reporting performance and capacity to detect outbreaks

Whenever a disaster or emergency impacting health occurs, the period of time between the crisis and the response is critical in saving lives.

To contain disease outbreaks more quickly, rapidly and effectively through efficient surveillance and laboratory work, effective coordination, and a strong workforce, the Ministry of Health, along with WHO, the state Ministry of Health directors general and state surveillance officers and partners, reviewed the IDSR progress and achievements in 2017, with the aim of improving the performance of surveillance in 2018.

The IDSR system in South Sudan has been instrumental in identifying and responding to disease outbreaks. In 2017, the IDSR system helped in identifying, investigating and responding to 839 alerts of suspect cholera, measles, bloody diarrhoea, Guinea worm, and malaria from multiple locations. However, more effort is required to attain the national target of at least 80% or above reporting rate.

"Our target is to have more than 80% timely reporting," said Dr Matthew Tut, the Director of Emergency Preparedness and Response (EP&R) Department in the Ministry of Health. To enhance capacities for disease surveillance and response, Dr Tut pleaded states and counties to work towards attaining the optimal surveillance performance level of more than 80%.

“Rapid case detection and response are key to save lives and protect people from health threats,” said Dr Wamala Joseph, Epidemiologist at WHO South Sudan. The effectiveness of emergency response interventions is a function of advance planning and initiation of preparedness activities including strengthening the implementation of IDSR strategy, Dr Wamala added.

At the end of the review, a new plan for improving surveillance performance in both stable and conflict-affected areas was endorsed by the Minister of Health. To achieve this, the Ministry of Health is committed to double efforts towards enhancing capacities for disease surveillance and response through the rollout of mobile reporting and community-based disease and event surveillance to the health facility and community levels.

Preventing cholera recurrence

To reverse the current cholera trend in South Sudan, the AAR of the cholera response endorsed the global roadmap of attaining a 90% reduction of cholera deaths by 2030. Consequently, the National cholera response strategy has been updated to achieve these ambitious targets.

The strategy entails three core axes of implementation: enhanced coordination and leadership through the establishment of a multisectoral National Control Program that reports to the office of the President; enhancing capacities for early detection and rapid initiation of a multi-sectoral, multi-disciplinary response to rapidly contain and prevent widespread outbreaks as well as implementing long-term and sustainable interventions to prevent the recurrence of cholera outbreaks in cholera transmission hotspots.

Since the onset of the 2013 crisis, cholera outbreaks have been confirmed every year and have increasingly become bigger and more protracted, says Dr Wamala. As a result, the number of cases and deaths have increased every year affecting the vulnerable populations living in urban slums, rural populations, cattle camp and island dwellers, and communities along the River Nile. Sustainable collaboration and commitment are required to ensure effective support for surveillance, outbreak investigation, and disease prevention and control.

“We appreciate the support from our partners especially the United States Agency for International Development (USAID), the European Civil Protection and Humanitarian Aid Operations (ECHO) and the Government of Japan that provide funding support in those areas,” says Mr Liyosi.

WHO is committed to support the Ministry of Health to enhance the effectiveness of the national surveillance system guided by the IDSR strategy and the International Health Regulations (2005). WHO is also committed to providing the required technical support to develop a costed national cholera prevention and control plan for eliminating cholera deaths by 2030.

ZENEBE TEKLEWOLD

Victims of human rights violations and abuses committed during the South Sudanese civil war should not lose hope that the perpetrators will be held accountable, says the chair of the Human Rights Commission in South Sudan, Yasmin Sooka.

Members of the Human Rights Commission are on a fact-finding mission to Wau in the north-west of the country to collect and preserve evidence and service the hybrid court when it is established as well as other transitional justice mechanisms. They are also engaging with local communities to understand the current security situation and their experiences since conflict broke out in the country in 2013.

Yasmin Sooka acknowledged the frustration of communities who want justice for crimes committed against them.

“This will take a long time but do not lose hope because what we are going to try and make sure the voices of people are heard by the international community,” said Yasmin Sooka.

In the short-term, findings will be shared with the United Nations Mission in South Sudan and the international community.

Yasmin Sooka urged people to come forward and share information about their experience with the Commission’s investigative team or with UNMISS’ Human Rights Division.

The Chair of the Commission met with the Wau Governor, community leaders at a camp for internally displaced people in the town as well as those living at the UN protected site next to its base.

Fellow Commissioner Andrew Clapham undertook a similar mission to Akobo and will then visit refugee camps in Uganda and Ethiopia.

The Commission is an independent body mandated by the UN Human Rights Council to determine and report the facts and circumstances of alleged gross violations and abuses of human rights. It has 16 people on the ground in South Sudan.

JANET ADONGO

A new team of community leaders has been elected to the Peace and Security Council (PSC) at the Protection of Civilians site next to the United Nations base in Malakal, in the Upper Nile region of South Sudan.

The team is responsible for representing the nearly 25,000 internally displaced people who’ve sought sanctuary at the site and ensuring they live peacefully with each other. Of the 41 elected officials, 12 are women, including a new female Treasurer.

“I must caution you to remain apolitical and to act as binders among communities and work for all regardless of ethnic backgrounds or any other factors,” said acting Head of Field Office Anthony Agyenta in his opening remarks at an induction training session for the PSC. He urged the leaders to reach beyond the POC to explore opportunities for the displaced people to return to their homes and appealed to them to work in the best interest of the community.

The Civil Affairs Department in Malakal, Relief, Reintegration and Protection as well as camp managers from the Danish Refugee Council, conducted the one-day induction training to brief the new leaders on their expected roles and responsibilities.The Civil Affairs team made presentations on the terms of reference document, which was collaboratively developed with sections and humanitarian partners to guide the operations of the PSC.

Anthony Agyenta said the seamless election of a new PSC was a positive development and testimony to the improvement of intercommunal relationships and social cohesion. The team is expected to officially assume office on 1 January and they will play a lead role in assisting UNMISS and humanitarian partners to better coordinate activities at the POC site.

Introduction

Following the outbreak of violence in Juba in July 2016, the South Sudanese civil war spread from its historic epicentre in Greater Upper Nile to Greater Equatoria (Central, Eastern and Western Equatoria states). Insecurity caused widespread displacement and rendered much of Greater Equatoria largely inaccessible to humanitarian actors. As a result, only limited information is available on the humanitarian situation outside of major displacement sites.

In order to fill information gaps and facilitate humanitarian programming, REACH began collecting data on hard-to-reach areas in Greater Equatoria in January 2017 on a monthly basis. This data was collected primarily through interviews with new arrivals to Juba PoC1 and PoC3 sites (109 Key Informants (KIs) and 210 KIs respectively) and was supplemented by phone calls with 148 KIs residing across Greater Equatoria. Between 15 March and 18 June 2017, REACH interviewed a total of 467 KIs displaced from 233 settlements: 139 settlements in all six counties of Central Equatoria, 59 settlements in all eight counties of Eastern Equatoria and 35 settlements in all eight counties of Western Equatoria.

This Situation Overview provides a summary of key findings across Greater Equatoria aggregated across four months (March to June 2017). The first section analyses displacement and population movement in all three states of Greater Equatoria, with the second section evaluating access to food and basic services for both IDP and non-displaced communities.

Population Movement and Displacement

The conflict in Greater Equatoria has driven displacement on a massive scale, with 81% of assessed settlements reporting that at least half of local community members had left. Relatively low reported IDP populations in Central and Eastern Equatoria (23% and 29% of assessed settlements respectively reported the presence of IDPs), indicating that displaced populations continue to leave the country rather than settle nearby. These findings are supported by the high number of South Sudanese refugees arriving to Uganda, totalling almost 300,000 in the first half of 2017 : the largest refugee crisis in Africa in over 20 years.

However, the rate of displacement appears to be gradually slowing. In Uganda, the number of arrivals has gradually decreased since its peak of 85,395 in September 20163 . Moreover, settlements across all three states reported the presence of returnees in their communities (57% of assessed communities host returnees), mostly arriving in March 2017 (as reported by 36% of assessed settlements), likely because March signals the start of the rainy season and corresponding cultivation period. This suggests that displacement in the Equatorias peaked in intensity and will remain stable for the next few months, while still remaining at extremely high levels.

Individuals that remain, or have returned to Greater Equatoria, face increasing risks to food security. In Western Equatoria and Eastern Equatoria, the majority of assessed settlements reported that most IDPs resided with local community members (78% and 87% respectively). With only 32% of assessed settlements across Greater Equatoria reporting adequate access to food, IDP presence is likely to strain already stretched resources.

Men and women in Greater Equatoria experienced displacement in different ways.
IDPs in Greater Equatoria were predominantly female, with 76% of assessed settlements reporting that over half of IDPs were women.
KIs in Juba reported that this was because men had greater security concerns, such as violence from armed actors and forced recruitment, or greater financial responsibilities, such as working in Juba or tending to land or livestock, which kept them apart from family members.

CONTEXT

Akobo Town is located in the eastern side of Akobo County, Jonglei State, close to the land and river border crossings with Ethiopia. Akobo is a key point of trade and transit between South Sudan and Ethiopia.
Since the beginning of the crisis, this route has been used by South Sudanese heading to or coming back from refugee camps in Ethiopia. In two locations,
Tirgol Port and Market Port, REACH staff has recorded arrivals and departures of South Sudanese on a daily basis since May 2015. In order to provide an indication of wider trends, data is collected on the volume of movement, as well as the motivations and intentions of those travelling.
The following findings are based on primary data collected between 1 and 30 November 2017. REACH teams attempt to interview all arrivals and departures at the household (HH) level using a contextualized survey. During November, REACH interviewed 119 HHs who were arriving in and 106 HHs who were departing from Akobo Town. These HHs interviewed were selected amongst those arriving to or leaving from Akobo Town by boat.

This is post is part of our climate campaign in Africa. The story has appeared in several news outlets including Associated Press, the New York Times and others.

Earlier this year, South Sudan fell victim to the first famine declared since 2011. Almost six million people are still at risk of starvation. Over 1 million displaced Sudanese are migrating to neighbouring northern Uganda, where they stay in camps for internally displaced people fleeing conflict.

Yet, resources to feed the influx of people fleeing South Sudan are scarce. The World Food Programme has reported overwhelming demand for food aid, which has recently been cut due to funding delays. To avoid increasing unrest and migration, a long-term food security solution for the region is urgently needed.

Ugandan farmers can be part of the solution

In the Gulu district of Northern Uganda, communities have slowly returned after fleeing the Lord’s Resistance Army rebel group three decades ago. Despite little farming experience, technology and resources, they now have a major task on their hands: supplying food for their own families and communities, and also to those escaping war and hunger-stricken South Sudan.

Together with Uganda’s National Agricultural Research Organisation (NARO), CIAT and partners including the International Institute of Tropical Agriculture (IITA) and The World Agroforestry Centre (ICRAF), have been working together to supply farmers with high yielding, drought and disease resilient beans to boost production and improve nutrition among vulnerable refugees and communities in northern Uganda.

Despite persistent drought, farmers are now increasing their bean yields for their families to eat – and to sell traders who demand particular types of beans – for example NABE varieties, from the term NAROBEAN – considered tastier and more resilient to climate stresses, pests and disease than local varieties.

Relief agencies of the United Nations and other organizations are buying the resilient seeds from private sector companies like Equator Seeds Ltd., to provide to communities in refugee camps along the border with South Sudan, where hunger levels are critical.

An African-led solution to end hunger

Many of the improved varieties developed for farmers using conventional methods in Northern Uganda came from the Kawanda Genebank. It protects and stores around 4,000 thousand types of beans.

Many these were sourced from CIAT’s genebank in Colombia – which houses the largest collection of common beans in the world. Led by a pioneering team of African breeders, this storage facility is a refuge for a series of resilient beans sent to countries across Africa, to boost local supplies of improved, hardy bean seeds, and alleviate reliance on food imports.

In recent months, Ethiopia, Tanzania, Rwanda and Burundi have received different types of heat and drought tolerant beans. Four micronutrient rich bean varieties – high in iron and zinc to tackle malnutrition – were released in Kenya and five were released in Uganda in 2016. Researchers are exploring sending more climbing beans for Rwanda and parts of Uganda – where they help farmers on smaller plots of land increase their production.

Yet this refuge for seeds could be under threat, with dwindling funding and fewer resources to support vulnerable national research programs – for example those in South Sudan. Researchers are under more pressure than ever to beat increasing weather extremes: such as drought and flooding – with fewer resources and less capacity. This could critically affect the supply of nutritious beans, an affordable, major staple and source of protein for many countries across Africa.

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This research is carried out under the project, ‘Increasing Food Security and Farming System Resilience in East Africa through Wide-Scale Adoption of Climate-Smart Agricultural Practices’, with support from the International Fund for Agriculture Development. It is a collaborative effort between Uganda’s National Agriculture Research Organisation (NARO) and CGIAR Research Programs and Centers, including: the International Center for Tropical Agriculture (CIAT); the International Institute of Tropical Agriculture (IITA); the World Agroforestry Centre (ICRAF), under the CGIAR Research Program for Climate-Change, Agriculture and Food Security (CCAFS).

Global organization Mercy Corps calls for urgent cease-fire

JUBA, SOUTH SUDAN – On the fourth anniversary of the start of the conflict in South Sudan, Mercy Corps is calling for an immediate cease-fire, which the global organization says is urgently needed to save lives in the country.

In four short years, four million civilians out of a population of 12 million have been forced to flee their homes, with 2.1 million made refugees in other countries in what is now Africa’s largest refugee crisis.

“The situation in South Sudan is deteriorating faster than we thought possible. The most vulnerable South Sudanese continue to bear the brunt of the conflict and economic decline in the country. More than half of the population is in dire need of humanitarian assistance,” says Francesco Lanino, Mercy Corps’ Acting Country Director for South Sudan.

Mercy Corps is working in South Sudan to meet the urgent needs of families displaced by fighting with emergency cash payments, by providing water and hygiene support to stave off disease such as cholera, and supporting 80,000 children through school feeding and education activities.

In Uganda, where more than one million South Sudanese have sought refuge, Mercy Corps is supporting farmers with seeds and other agricultural inputs to enable them to plant and harvest food to feed their families.

According to the United Nations this week, which published its Humanitarian Response Plan for 2018, the situation in the country is expected to continue to deteriorate next year. The UN called for $1.7 billion in funds to meet humanitarian needs in the country.

“Despite a famine declaration earlier this year, which highlighted the imminent starvation of tens of thousands of people, the international community continues to neglect the situation in South Sudan” says Lanino. “We need renewed attention on this crisis and an urgent cease-fire. Millions of people hang in the balance and we cannot allow more lives to be lost.”

Join us and support Mercy Corps’ work in South Sudan and elsewhere in the world.

Juba, 11 December 2017: With the aim to achieve the target of zero transmission, the South Sudan Guinea Worm Eradication Programme (SSGWEP) was established in 2006 with 20 581 cases reported from 3 320 endemic villages. In November 2017, the country celebrated its first full year with no indigenous cases of the disease.

‘A terrible itching, blister formation and emergence of a long worm are the first signs and symptom of Guinea worm disease,’ says Mr Evans Liyosi, WHO Representative a.i. for South Sudan.

Guinea worm disease is a parasitic worm infection that has been endemic in the world affecting more than 20 countries mostly in the African region. In 1986, there were an estimated 3.5 million people infected annually in 21 endemic countries, the number declined to 25 confirmed cases from Chad, Ethiopia and South Sudan. By the end of November 2017, only 26 cases have been reported from two countries namely Chad and Ethiopia.

Although insecurity and the emergence of Guinea worm disease in animals are the challenges facing the eradication of the disease, globally, the disease stands on the brink of eradication with the goal of interrupting transmission by 2018, Mr Liyosi emphasized.

Since the systematic interventions commenced in 2006 in South Sudan and were gradually intensified until the final indigenous case occurred in December 2016 from Roc-Roc Dong Payam in Jur River County, former Western Bahr El Ghazal State, dedicated leadership by government officials and strong support from the Carter Center, WHO, UNICEF, other partners and the community were key to this program's dramatic success says Mr Makoy Samuel, the SSGWEP Director.

Honorable Dr Riek Gai Kok, Minister of Health, commended the support provided by The Carter Center, WHO, UNICEF and WFP in complementing the efforts of the South Sudan Guinea worm eradication program in interrupting transmission of Guinea worm disease from the county.

While South Sudan continues with pre-certification surveillance for Guinea worm disease over the remaining two years so that it can be officially certified by the World Health Organization as free of the disease, the SSGWEP with support from the Carter Center, WHO, UNICEF and partners conducted the 12th annual review meeting from 11 to 12 December 2017 at Crown Hotel in Juba. The objective of the meeting was to review the progress and performance of the programme in 2017 and scale up the fight against the disease to maintain the free status.

“This is the most rapid reduction of Guinea worm disease in the history of the Guinea Worm Eradication Programme (GWEP)compared to other eradication programs in the world,” said Mr Craig Withers, Senior Director, Office of the International Support, The Carter Center. The SSGWEP was also recognized world-wide and has received five awards during the years for the excellent contribution of individuals and the programme for making history in eradicating the disease from over 20 000 cases in 2006 to zero in 2007.

In 2012, there were 542 cases of Guinea worm reported globally, of which 521 (96.1%) were reported from South Sudan. In the history of the SSGWEP, South Sudan, the youngest nation in the world to record zero cases for one year, should be commended for its success, says Mr Liyosi. WHO’s support to the SSGWEP has focused on strengthening country-wide (including IDP and Refugee camps) and cross-border surveillance, advocate for access to safe drinking water in endemic villages, raising public awareness of the disease, the cash reward offered for voluntary reporting as well as preparing the country for certification, Mr Liyosi emphasized

“This momentum might not be lost”, says H.E. Gen. Taban Deng Gai, the First-Vice President, Republic of South Sudan. For the certification process to continue successfully, he urged the participants to deliberate the recommendation for the country to be certified Guinea Worm free.

Despite the huge challenges, The Carter Center, WHO and UNICEF have stepped up support to SSGWEP through establishing a community-based surveillance system capable of detecting all cases and effective intervention to break the transmission.

The review meeting concluded that the SSGWEP should be strengthened through the increase of resources, enhanced surveillance, increased public awareness on the newly launched cash reward for reporting Guinea worm cases as well as monitoring and evaluation at all levels.

The meeting was graced by the presence of H.E. Gen. Taban Deng Gai, the First-Vice President, Republic of South Sudan, Honorable Dr Riek Gai Kok, Minister of Health, Republic of South Sudan, Honorable Jemma Nunu Jumba, Minister of Wildlife Conservation and Tourism and acting Secretary General of SPLM Party, Mr Craig Withers, Senior Director, Office of the International Support, The Carter Center, Dr Ernesto Ruiz-Tiben, Mr Evans Liyosi, WHO Representative a.i. for South Sudan, Mahimbo Mdoe, UNICEF Country Representative,Ms Lillian Okwirry, Acting Deputy Representative of UNICEF, Dr Makur M. Kariom, the Undersecretary at the Ministry of Health, State Ministers, Directors General and officials of the Ministry of Health, Representatives from the Ethiopia Guinea Worm Programme among others.

SC/13119

SECURITY COUNCIL
8135TH MEETING (PM)

Presidential Statement Endorses Intergovernmental Authority’s High-Level Revitalization Forum on Peace Accord

After extending the mandate of the United Nations Mission in South Sudan (UNMISS) until 15 March 2018, the Security Council today endorsed a new initiative to revitalize the stalled peace plan for the strife-torn country.

Unanimously adopting resolution 2392 (2017), the 15‑member organ authorized the Mission to use all necessary means to carry out its tasks as set out in resolution 2327 (2016), which had extended its mandate through 15 December 2017 (see Press Release SC/12634). The Secretary-General’s most recent report on UNMISS (document S/2017/1011) recommended that the mandate be extended for two months, awaiting the completion of an ongoing strategic review of operations.

After the adoption, Yasuhisa Kawamura (Japan), Council President for December, read out a statement in support of a High-Level Revitalization Forum sponsored by the Intergovernmental Authority on Development (IGAD) to be convened by the end of December.

By the statement, the Council, acknowledging that the conflict in South Sudan continued to cause great suffering, expressed deep regret that the parties had not heeded its calls for a permanent ceasefire or unhindered delivery of humanitarian assistance. It demanded that all parties immediately do so and, noting the Government’s ceasefire initiative, called for it to stand by its ceasefire and for the opposition to reciprocate.

In addition, the Council cited findings that the parties had failed to implement important elements of their peace accord, known as the Agreement on the Resolution of the Conflict in the Republic of South Sudan, and that conditions for credible elections did not presently exist.

The Council therefore strongly supported the convening of an inclusive Forum as proposed by IGAD to get the Agreement back on track and aim for substantive progress on the initiative when it convenes at the end of December. For that purpose, it called for strong, coordinated, and cohesive regional support. Meaningful participation of women, youth and the broader South Sudanese civil society should be ensured, it added.

The Council strongly urged all parties to engage constructively in the process without preconditions. As a first priority and a sign of commitment, the Council called on all parties to end hostilities as they had pledged.

Referring to a briefing received from IGAD Special Envoy Ismail Wais on pre‑Forum consultations, the Council also urged the parties to agree to an implementation timeline, monitored arrangements to stop the conflict, steps to improve the human rights and humanitarian situation, inclusive governance arrangements and a political process with an agreed path to viable elections.

The Council further urged the parties to agree on strong monitoring and enforcement mechanisms for whatever was agreed through the Forum, to ensure that “there is cost and consequence for those who violate the agreement”.

Calling on the Government of South Sudan to honour its commitment to cooperating fully with UNMISS and condemning actions against United Nations and humanitarian workers and civilians, the Council highlighted the UNMISS mandate to investigate abuses of human rights and humanitarian law. It reiterated that perpetrators of violations must be held accountable.

The meeting began at 3:05 p.m. and ended at 3:15 p.m.

Resolution

The full text of resolution 2392 (2017) reads as follows:

“The Security Council,

“Recalling its previous resolutions 1996 (2011), 2046 (2012), 2057 (2012), 2109 (2013), 2132 (2013), 2155 (2014), 2187 (2014), 2206 (2015), 2223 (2015), 2241 (2015), 2252 (2015), 2302 (2016), 2304 (2016) and 2327 (2016), and statements by its President S/PRST/2014/16, S/PRST/2014/26, S/PRST/2015/9, S/PRST/2016/1, S/PRST/2016/3 and S/PRST/2017/4,

“Determining that the situation in South Sudan continues to constitute a threat to international peace and security,

“Acting under Chapter VII of the Charter of the United Nations,

“1. Decides to extend the mandate of the United Nations Mission in South Sudan (UNMISS), as set out in resolution 2327 (2016), until 15 March 2018, and authorizes UNMISS to use all necessary means to carry out its tasks;

“2. Decides to remain actively seized of the matter.”

Presidential Statement

The full text of presidential statement S/PRST/2017/25 reads as follows:

“As the conflict in South Sudan enters its fifth year, the Security Council expresses continuing deep concern at the political, security, humanitarian, human rights, and economic situation in South Sudan and is deeply concerned about the actions of all parties to the conflict that are perpetuating this, with 7.6 million people now in need of aid, 4 million displaced and 6 million lacking enough food to feed themselves. The Security Council deeply regrets that the parties have not fully taken the steps called for in the Security Council’s 23 March 2017 presidential statement (document S/PRST/2017/4), most notably the adherence to the permanent ceasefire and allowing the unhindered delivery of humanitarian assistance to those in need, and demands that all parties immediately do so. The Security Council takes note of the ceasefire initiative by the Government, calls on the Government to adhere to its ceasefire, and urges the opposition to reciprocate.

“The Security Council takes note of the September 2017 mid-term implementation status report of the Joint Monitoring and Evaluation Commission and its findings that the parties to the conflict have failed to implement substantive elements of the Agreement on the Resolution of the Conflict in the Republic of South Sudan (the Agreement), and that conditions for credible elections do not presently exist.

“The Security Council expresses its strong support for the Intergovernmental Authority on Development’s (IGAD) High-Level Revitalization Forum for the Agreement and looks forward to the convening and full inclusivity of such a forum and substantive progress on the initiative by the end of December. The initiative will need strong, coordinated, and cohesive regional support and the Security Council urges IGAD to continue efforts in this vein. The Security Council strongly urges all parties to engage constructively in the process to revitalize the Agreement, underlines that no party should set pre-conditions to participation, and that there must be cost and consequences for those who undermine the HLRF process. The IGAD High-Level Revitalization Forum should be truly inclusive, in particular with meaningful participation of women, youth, and the broader South Sudanese civil society. The Security Council takes note of the African Union Peace and Security Council’s communique of 20 September 2017 and agrees that the IGAD High-Level Revitalization Forum is a unique window of opportunity, but equally a last chance for the parties to achieve sustainable peace and stability in South Sudan. The Security Council also takes note of other potentially complementary regional initiatives.

“The Security Council welcomes the briefing by IGAD Special Envoy Ismail Wais on the report of the pre-Forum consultations on the High-Level Revitalization Forum and his briefing on the important and constructive contributions made by a diverse range of South Sudanese stakeholders as summarized therein, and fully supports his role in the process. As a first priority, the Security Council calls upon all parties to end hostilities as a sign of commitment to the High-Level Revitalization Forum — as they have pledged to do. Given the briefing by the IGAD Special Envoy the Security Council further urges the parties to agree to monitored, effective, and durable security arrangements to stop the conflict; specific steps to improve the human rights and humanitarian situation, including safe and unhindered access for humanitarian actors; the governance arrangements so that all voices in South Sudan are represented; a political process that produces an agreed path to viable elections, including improved security; and timelines for the implementation schedule of the Agreement to reflect the need for a conducive environment for post-transition elections. The Security Council further urges the parties to agree on strong monitoring and enforcement mechanisms so that whatever is agreed through the High-Level Revitalization Forum is able to be effectively implemented, and there is cost and consequence for those who violate the Agreement.

“The Security Council reminds the Government of South Sudan of its stated commitment to cooperating fully with the United Nations Mission in South Sudan (UNMISS), and calls on the Government to honor that commitment. The Security Council notes with deep concern the continuing obstacles that hinder the delivery of vital lifesaving assistance to the South Sudanese people; the Council condemns attacks on national and international humanitarian personnel and compounds, and actions by all parties which have targeted United Nations and humanitarian workers.

“The Security Council condemns all instances of attacks against civilians and the military use of hospitals and schools, and recalls that the UNMISS mandate includes monitoring, investigating, verifying, and reporting publicly and regularly on abuses and violations of human rights and violations of international humanitarian law, including those that may amount to war crimes or crimes against humanity. The Security Council reiterates that perpetrators of violations of international humanitarian law and violations and abuses of human rights must be held accountable, in order to break the prevailing cycle of impunity.”

In South Sudan, “childhood under attack” as country enters fifth year of fighting

JUBA/NAIROBI, December 15 2017 - South Sudan is in the throes of a tragedy for children that affects more than half the child population - victims of malnutrition, disease, forced recruitment, violence and the loss of schooling - UNICEF said in a report released today.

Years of insecurity and upheaval have had a “staggering impact on children”, threatening an entire generation, the report, Childhood under Attack, says.

The numbers tell a grim story:

• Almost three million children are severely food insecure;

• more than one million are acutely malnourished;

• 2.4 million have been forced from their homes;

• two million children out of school, and if the current situation persists, only one in 13 children are likely to finish primary school;

• an estimated 900,000 children suffer from psychological distress;

• more than 19,000 children have been recruited in the ranks of armed forces and armed groups;

• and more than 2,300 children have been killed or injured since the conflict first erupted in December 2013, with hundreds of incidents of rape and sexual assault against children having been reported.

“No child should ever experience such horrors and deprivations,” said Leila Pakkala, UNICEF’s Regional Director in Eastern and Southern Africa, “and yet children in South Sudan are facing them on a daily basis. The children of South Sudan urgently require a peaceful and protective environment. Anything less places children and women at even greater risk of grave violations and abuse.”

Getting assistance to those most in need continues to be a challenge in many insecure areas of the country. Humanitarian organisations in South Sudan are looking for the full implementation of a recent Presidential order calling for unrestricted access to those in urgent need of aid.

UNICEF has been delivering lifesaving assistance to children across the country since the crisis started in December 2013, including: treatment of more than 600,000 for severe acute malnutrition, vaccination against measles for more than 3.3 million children, the provision of primary health care services to more than 3.6 million children, and supporting the access to safe water supply for 1.8 million people. This has been done despite the huge challenges faced in a country that ranks among the world’s most dangerous for aid workers. Since the conflict started in 2013, 95 aid workers have been killed, including 25 killed so far this year.

In releasing Childhood under Attack, UNICEF warned that new funding is essential in order to provide critical assistance to children and women. In 2018 UNICEF requires $183 million, and currently has a funding gap of 77 per cent (or $141 million).

Notes for editors:

Photo and video assets are available for download here:

https://weshare.unicef.org/Package/2AM40800PZIM

About UNICEF

UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. Across 190 countries and territories, we work for every child, everywhere, to build a better world for everyone.

For more information on UNICEF's work in South Sudan, visit www.unicef.org/southsudan Follow UNICEF on Twitter, Facebook and Instagram

For further information, please contact:

Tim Irwin, Chief of Communication, UNICEF South Sudan: +211 912 162 888, tjirwin@unicef.org James Elder, Regional Chief of Communication, UNICEF Eastern & Southern Africa: +254 715 581 222, jelder@unicef.org

Joe English, Communications Specialist, UNICEF New York, +1 91 893 0692, jenglish@unicef.org Patsy Nakell, Chief of Communications, UNICEF Africa Services Unit, Johannesburg, South Africa; +27 79 495 5938, +27 76 87 22 147

Sustained international action is urgently needed to end the horrific human rights violations taking place in South Sudan, said Amnesty International today as the country’s armed conflict entered its fifth year.

Tens of thousands of people have been killed, thousands more subjected to sexual violence, and close to four million displaced since the conflict began on 15 December 2013.

“Coordinated and sustained international action is needed now more than ever to end the suffering in South Sudan, especially as the rainy season ends and the dry season begins, heralding an escalation in fighting,” said Sarah Jackson, Amnesty International’s Deputy Regional Director for East Africa, the Horn and the Great Lakes.

“Regional states and the international community must work together to find a lasting solution to this crisis and put an end to the litany of human rights violations.”

The last four years of fighting have had a devastating impact on civilians. Thousands of men, women and children have been subjected to unimaginable acts of violence, including sexual assault, by government and opposition forces, some of which could amount to crimes against humanity or war crimes.

In the Equatoria region, Amnesty International found that government and opposition forces cut food supplies to certain areas, systematically looted food from markets and homes, and targeted civilians carrying even the smallest amount of food across frontlines.

“Food has been used as a weapon of war, and as a result today approximately 4.8 million people are considered to be food insecure. This state of affairs will continue, unless speedy action is taken to end the humanitarian crisis,” said Sarah Jackson.

“Efforts to end the conflict must also include imposition of an arms embargo on all parties to the conflict and concrete measures to deliver justice to victims of grave human rights violations, chiefly through the setting up of the much-delayed Hybrid Court for South Sudan.”

During the prolonged conflict, journalists, human rights defenders, and opposition supporters have been harassed, arbitrarily arrested and in some cases tortured, and humanitarian workers have been prevented from carrying out their duties.

“The South Sudanese authorities must restore unfettered access to aid agencies to distribute much-needed food and medical supplies to victims of this conflict. They must also allow civil society actors to operate freely.”

Four Years Into Conflict, Rampant Abuse

(Nairobi) – South Sudan’s top officials have failed to make good on promises to establish an African Union-South Sudanese hybrid court to try international crimes committed during the country’s civil war, Human Rights Watch said today. Four years into the conflict, both parties continue to commit grave human rights crimes against civilians.

Despite the August 2015 Agreement on the Resolution of Conflict in South Sudan (ARCSS), which envisioned the hybrid court, abuses by all parties persist as the conflict continues to spread. South Sudan’s transitional government has neither ended violations by its army nor made progress toward setting up the court. The lack of progress points to the need for measures like targeted sanctions against officials responsible and an arms embargo, Human Rights Watch said.

“The government has consistently let deadlines slip while its forces commit crimes with impunity” said Mausi Segun, Africa director at Human Rights Watch. “The people of South Sudan deserve justice, not a chain of broken promises, and so the international community should impose consequences.”

In September 2017, the AU Peace and Security Council issued a communiqué on South Sudan, warning that it would consider necessary steps, including sanctions, should the South Sudanese parties continue to delay implementing the peace agreement in full. The United States ambassador to the United Nations, Nikki Haley, during a visit to South Sudan in October, similarly warned of sanctions if the government did not live up to its pledges.

South Sudan’s civil war began on December 15, 2013, when troops loyal to president Salva Kiir – a Dinka – clashed with those of then-Vice-President Riek Machar – a Nuer – in the capital, Juba. Within hours, mainly Dinka government troops carried out large-scale targeted killings, detentions, and torture of mainly Nuer civilians in various parts of Juba, while thousands of Nuer soldiers defected to an opposition army. In the following months, fighting spread to Bor, Bentiu, Malakal, and across the Greater Upper Nile region. As towns changed hands, soldiers on both sides killed thousands of civilians, often based on their ethnicity, and destroyed and pillaged civilian property.

In late 2015, conflict spread to the Equatorias, as new rebel groups claiming an affiliation formed, and government forces carried out deadly counterinsurgency campaigns in previously stable regions southand west of the capital. Government soldiers and allied fighters have attacked civilians sheltering inside the UN bases in Malakal and Juba, in blatant violation of international law. In July 2016, government and opposition forces fought in Juba and government forces attacked, killed, and raped civilians, including displaced people and foreign aid workers. Since the Juba crisis, government forces have continued to fight rebels in Central and Western Equatoria, Unity, and northern Jonglei.

The impact of the violence and abuses is devastating. More than 4 million people have fled their homes, with more than 2 million now refugees in neighboring countries. In February, the UN declared a famine in parts of Unity state, and almost half the country’s population faces acute food shortages.

In October 2015, the AU released the final report of the Commission of Inquiry on South Sudan (AUCoISS), which found that the warring parties had committed grave human rights abuses and war crimes. The commission’s findings were largely consistent with Human Rights Watch reporting, and proposed creating an AU-led process to bring those with the greatest responsibility for the atrocities to account.

Despite the August 2015 Agreement on the Resolution of Conflict in South Sudan (ARCSS), which envisioned the hybrid court, abuses by all parties persist as the conflict continues to spread. South Sudan’s transitional government has neither ended violations by its army nor made progress toward setting up the court. The lack of progress points to the need for measures like targeted sanctions against officials responsible and an arms embargo, Human Rights Watch said.

“The government has consistently let deadlines slip while its forces commit crimes with impunity” said Mausi Segun, Africa director at Human Rights Watch. “The people of South Sudan deserve justice, not a chain of broken promises, and so the international community should impose consequences.”

In September 2017, the AU Peace and Security Council issued a communiqué on South Sudan, warning that it would consider necessary steps, including sanctions, should the South Sudanese parties continue to delay implementing the peace agreement in full. The United States ambassador to the United Nations, Nikki Haley, during a visit to South Sudan in October, similarly warned of sanctions if the government did not live up to its pledges.

South Sudan’s civil war began on December 15, 2013, when troops loyal to president Salva Kiir – a Dinka – clashed with those of then-Vice-President Riek Machar – a Nuer – in the capital, Juba. Within hours, mainly Dinka government troops carried out large-scale targeted killings, detentions, and torture of mainly Nuer civilians in various parts of Juba, while thousands of Nuer soldiers defected to an opposition army. In the following months, fighting spread to Bor, Bentiu, Malakal, and across the Greater Upper Nile region. As towns changed hands, soldiers on both sides killed thousands of civilians, often based on their ethnicity, and destroyed and pillaged civilian property.

In late 2015, conflict spread to the Equatorias, as new rebel groups claiming an affiliation formed, and government forces carried out deadly counterinsurgency campaigns in previously stable regions southand west of the capital. Government soldiers and allied fighters have attacked civilians sheltering inside the UN bases in Malakal and Juba, in blatant violation of international law. In July 2016, government and opposition forces fought in Juba and government forces attacked, killed, and raped civilians, including displaced people and foreign aid workers. Since the Juba crisis, government forces have continued to fight rebels in Central and Western Equatoria, Unity, and northern Jonglei.

The impact of the violence and abuses is devastating. More than 4 million people have fled their homes, with more than 2 million now refugees in neighboring countries. In February, the UN declared a famine in parts of Unity state, and almost half the country’s population faces acute food shortages.

In October 2015, the AU released the final report of the Commission of Inquiry on South Sudan (AUCoISS), which found that the warring parties had committed grave human rights abuses and war crimes. The commission’s findings were largely consistent with Human Rights Watch reporting, and proposed creating an AU-led process to bring those with the greatest responsibility for the atrocities to account.

Dear Friends,

This edition of Alert features some of the most powerful images from the past year documenting our medical humanitarian work in the field and providing a glimpse into the lives of our patients.
In today’s evolving media landscape, a picture often speaks much more than a thousand words. Photography captures vivid scenes of conflict, natural disaster, and massive displacement as events unfold in real time. Powerful images can humanize crises in ways the written word often cannot.
For Doctors Without Borders/Médecins Sans Frontières (MSF) the medical act is paramount, but it is not our only goal. We also work to raise awareness about the realities faced by our patients through our commitment to témoignage, or “bearing witness.” This founding principle means that we speak out about what we see happening in the places where we work, and that we help expose the medical consequences of abuse and neglect that might otherwise escape the headlines.

We are using photography to shine a spotlight on the longstanding suffering of the Rohingya people, who have been violently uprooted from Myanmar yet again. Since late August, more than 615,000 Rohingya have fled targeted violence in Myanmar to seek safety in neighboring Bangladesh. They join hundreds of thousands of other Rohingya already there, living in dire conditions in makeshift camps. Many of the photographs in this issue come from MSF’s archives, the earliest from 1978, chronicling a decades-long cycle of persecution and displacement.

MSF is rapidly scaling up its response to meet the medical needs of the Rohingya and prevent a wider public health disaster in Bangladesh. Efforts range from treating survivors of sexual violence and trauma-related injuries to building latrines and distributing water filtration devices to prevent the spread of cholera and other diseases. After visiting the camps in Bangladesh in October, MSF international president Dr. Joanne Liu said it was hard to comprehend the magnitude of the crisis, calling it “a public health time bomb.” We are doing what we can to help and calling on the international community to do much more.

This issue also presents images that underscore the value of our advocacy work through MSF’s Access Campaign to secure medications and vaccines at affordable prices for patients who otherwise would not be able to obtain them. We are among the largest non-governmental providers of care for tuberculosis (TB), the world’s deadliest infectious disease. MSF is using newer medications and new treatment regimes to support patients with drug-resistant forms of TB, and urging world leaders to implement the latest international treatment and testing standards. In Cambodia, hepatitis C patients receiving care in our projects can now access free screening and treatment at a cost to MSF that is slightly over $100— less than one-hundredth the price typically charged for a treatment regimen here in the United States.
These are just some of the many measures MSF is undertaking globally to make the provision of health care more equitable.

Finally, this issue of “the year in photos” highlights other important contexts that figured prominently in MSF’s work in 2017. In Yemen, MSF helped fight a massive cholera epidemic and continues to provide lifesaving medical care in some of the most volatile parts of this war-torn country. In Democratic Republic of Congo, we responded to a measles outbreak by vaccinating more than a million children against this highly infectious and potentially deadly disease. And in Mexico, MSF deployed a team of psychologists and social workers within 24 hours of a major earthquake to help counsel families who had lost their homes.

We hope that these images will help you to see what we see and to gain a better understanding of the essential medical humanitarian aid your generous support helps us provide. These photographs provide striking visual evidence of the impact our supporters can have to improve the health of millions of people around the world. They also show the incredible strength and resilience of our patients.
On behalf of all of us at MSF-USA, I’d like to thank you for your tremendous support, and to wish you a happier and healthier new year ahead.

Sincerely,

John P. Lawrence, MD
President, MSF-USA Board of Directors

Juba, 14 December 2017: Cholera in South Sudan remains an important public health problem which has affected 21 571 people and resulted in 462 deaths since the onset of the outbreak on 18 June 2016. This has been the longest and largest outbreak in magnitude and geographical extent, its impact exacerbated by the protracted crisis, insecurity, displacements and declining access to safe drinking water and sanitation. Access to improved sanitation facilities across South Sudan remains at less than 10% while access to safe drinking water from improved water sources is estimated at 60%.

As part of the ongoing cholera response, the Ministry of Health of South Sudan with support from WHO and partners has deployed cholera vaccines to complement traditional cholera response strategies in several high-risk populations and locations. From the 2 178 177 doses secured by WHO in 2017, a total of 1 133 579 doses have already been deployed with 879 239 doses used during the first round and 254 340 doses utilized in second round campaigns in 16 cholera-affected and high-risk populations countrywide.

“When used alongside other interventions for improving access to safe water and sanitation, oral cholera vaccines are very effective for cholera prevention and control, giving protection to those at risk, especially when the recommended two doses are administered,” emphasized Dr Pinyi, Director General for Preventive Services at the Ministry of Health of South Sudan.

The most recent consignment of 737 819 doses, requested by WHO from the Global Task Force on Cholera Control (GTFCC) stockpile was in Juba by 11 December, 2017. The vaccines have been deployed to areas and counties with pending second round vaccination campaigns and these include Kapoeta South, Kapoeta East, Tonj East, Aburoc and Malakal Town.

The campaigns in Kapoeta South, Kapoeta East, and Tonj East are already underway from 12 to 17 December, 2017. The success of the ongoing round of campaigns is attributed to collaborative efforts of the Ministry of Health, WHO, Health Cluster, United Nations Children Fund (UNICEF), International Organization for Migration (IOM), American Refugee Committee (ARC), Comitato Collaborazione Medica (CCM), Médecins Sans Frontières (MSF) and other partners. Currently, the WHO teams in the field are supporting the campaign including training of vaccinators and supervising the process to foster compliance to oral cholera vaccine protocols.

According to the WHO Epidemiologist Dr Joseph Wamala, the use of Oral Cholera Vaccine will bridge the transition from cholera treatment and emergency WASH interventions to multi-sectoral interventions including long-term WASH interventions to prevent recurrence of outbreaks in cholera hotspots.

In its continued efforts to fight cholera, the Ministry of Health, in collaboration with WHO and partners, recently resolved to develop a revised cholera response strategy that is aligned with the Global Cholera Roadmap 2030. The strategy will aim to reduce cholera deaths by 90% before 2030 in South Sudan. To attain this target, the overall leadership and coordination of cholera prevention and response activities will be enhanced through the formation of a multi-sectoral cholera control program. This will entail improving case detection, rapid response to prevent widespread outbreaks, prevention of avoidable cases and deaths, as well as implementing multi-sectoral interventions including water and sanitation hygiene (WASH) measures to prevent recurrent cholera outbreaks in cholera transmission hotspots.

For Additional Information or to Request Interviews, Please contact:
Dr Wamala Joseph Francis
Tel : +211 955 036 445
Email: wamalaj@who.int
Ms Luwaga Liliane Christine
Communications Officer
Mobile: +211 (0) 954800817
Email: luwagal@who.int