Violence in South Sudan overwhelms an already fragile health system

The United Nations is calling for $1.27 billion to support humanitarian efforts in South Sudan, where increasing violence paired with an already weak health system has created an incubator for disease.

Nearly two months after fighting erupted between supporters of President Salva Kiir and former Vice President Riek Machar, more than 3 million South Sudanese are in acute need of food, the UN reported Tuesday. An estimated 900,000 people have fled their homes in the country, which declared its independence from Sudan in July of 2011.

The UN is sheltering some 85,000 in crowded displacement camps on former peacekeeping bases, and about 123,000 have fled to neighboring countries. Most, though, are living in spontaneous settlements in the bush, where, without food, clean water, sanitation or shelter, aid workers say they are particularly vulnerable to communicable diseases like malaria, measles and diarrhea. 

NGO offices, hospitals and health clinics across the country have been looted and damaged, forcing many to close. Thieves have made off with trucks and more than 4,700 tons of donated food. Even members of South Sudan’s own military have been accused of stealing aid supplies intended for children. 

A ceasefire deal designed to open up supply routes for humanitarian aid went into effect January 24, but the fighting hasn't quieted — particularly in Unity state, in the northern part of the country. Since fighting broke out mid-December, the state, which accounts for a significant portion of the country’s oil-based economy, has been caught in a tug-of-war between government and rebel forces. 

More than a week into the agreed upon ceasefire, French medical charity Médecins Sans Frontières (MSF) shut down its hospital in the Unity state town of Leer, said Christopher Lockyear, the organization’s operational manager in South Sudan. MSF, which is also known as Doctors Without Borders, evacuated 12 staff members January 21, but 30 local personnel opted to stay, Lockyear said. The fighting continued to inch closer, though, and, last week, the remaining medical staff loaded several dozen of the sickest patients into MSF vehicles and fled into the bush. More than 200 patients hiked out on foot.

“We are pretty used to working in conflict, but we have to weigh the risks and the benefits,” Lockyear said. “In South Sudan this time, it’s been a very big challenge to ensure our teams will be safe.”

By Sunday, the town of Leer, which is the former vice president’s birthplace, had been destroyed. South Sudanese rebels have accused government forces of razing the town, massacring women and children as they fled. 

Leer Hospital, which served more than 270,000 people, was the only fully functioning hospital in the southern part of Unity state, Lockyear said. It is one of several operations across the country that MSF has shut down in response to growing violence. The charity also suspended operation in the cities of Bor, Akobo and Malakal.

“The hospital saw hundreds of patients every day,” Lockyear said. “We treated people for trauma, malnutrition, malaria, tuberculosis — everything. Without the hospital running, pregnant women have nowhere safe to deliver.”

For now, MSF’s staff in Leer have used their vehicles and plastic sheeting to set up a makeshift “bush hospital” a safe distance from the remote town, Lockyear said. Supplies, though, are running out and MSF has determined that it is no longer safe to fly medicine into the area.

Even before the conflict, South Sudan’s health system was fragile, said Elke Leidel, country director in South Sudan for the international charity Concern Worldwide. Few clinics had trained staff and stocked medicine cabinets. As of 2012, babies born in the country had a 1 in 10 chance of dying. Life expectancy was less than 55 years. 

In the UN’s displacement camps, water is short and the malnutrition rate is rising, Leidel said. As the rainy season approaches, aid workers are anticipating a rise in disease. Diarrhea spreads quickly in close quarters. People living outdoors, away from their protective nets, are more susceptible to diseases that are carried by insects, such as malaria and and kala-azar, a deadly parasitic disease that attacks the internal organs. 

NGOs like Concern Worldwide are screening children in UN camps for malnutrition. In hopes of curbing the spread of illness, the nonprofit, along with other major players like Oxfam, is building latrines, setting up hand-washing stations and teaching hygiene classes.

But, Leidel said, security conditions are keeping aid agencies from delivering food and supplies to many of the hardest-hit parts of the country. If the fighting continues, she said, “it will negatively impact the upcoming planting season because farmers will not be able to work in their fields.”

“We urgently need humanitarian access to be restored in order to reach the most vulnerable,” she said. 

Editor's Note: This story has been modified to correctly identify Elke Leidel. 

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