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Southern Sudan - A Crisis Worse than Darfur

04/21/2009

IRC's Joanne Offer on the worsening conditions for people in southern Sudan.

Photo by Joanne Offer

Where in the world can have a worse health-care situation than war-torn Darfur, west Sudan? Sadly, the answer lies just a couple of hundred kilometers down the road in the south of the same country.

While the north and south of Sudan may now be at relative peace with each other - more than two decades of civil war having ended in 2005 - the nascent southern Sudanese government has struggled to deliver for its people. Many hundreds of thousands still lack the very essentials for life such as clean water, food and basic health-care.

Consequently the statistics make grim reading. One out of every seven mothers-to-be will probably die from pregnancy-related causes. The infant mortality rate is 102 per 1,000 live births and one in seven children won't reach their fifth birthday.

For a lay person like myself, it's often hard to put these kind of figures into context. But spend just a short time in southern Sudan's health posts and villages and you soon understand all too well the reality on the ground.

Akuol Ayong Anei lives in a village about an hour and a half's drive from Aweil town, Northern Bahr el-Ghazal state. The drive there is harsh; we're thrown from side to side and soon covered in dust as we make our way through the desolate countryside. But we're lucky. Most of the people here don't have transport and have to walk long distances in the baking sun.

Anei doesn't know how old she is. She does know that she's given birth to six children. Four have died. Anei doesn't know why. One day they became sick. Then they died.

Today, her remaining son has gone to market and her daughter is out collecting water. In the dry season, both mother and daughter must walk a fair distance to a borehole twice a day, carrying back heavy containers. When the rains come, the family takes water from the ponds that spring up in the dirt around the small plot where they grow crops.

About 30 minutes drive away in Malualkon primary health-care center, we find a recently-arrived pregnant lady in distress. She has some kind of infection and is clearly in pain. She tells me that she's already lost one child. "One other remains" at home.

The good news is that just 30 minutes later, with the help of on-duty health worker Abraham Kuan, she delivers a health baby boy. Amazingly, she is walking home just an hour after that!

The matter-of-fact way these women talk about the loss of a child shows that their stories are far from unusual here. In Darfur, it's estimated that 46 percent of deliveries are attended by a skilled health worker. In Southern Sudan, it's nearer 10 percent. Aid agencies are trying to assist, but the challenges are immense.

"More than 2 million people have returned to southern Sudan following the peace agreement of 2005," says Julie Dargis, country director for the International Rescue Committee (IRC). "There simply aren't enough health centers, boreholes and sanitation facilities to cope, and the end result is an ideal environment for disease to thrive."

IRC is currently helping more than 2 million people in southern Sudan with essential services including medical care, special health-care services for children under-five, protection and measures to tackle gender-based violence.

Dargis adds: "This is 2009, but we're seeing people die from the likes of malaria, pneumonia and diarrhea - illnesses that we know how to prevent and treat. It's hard to keep your family healthy when there isn't enough clean water to drink and you can't afford a nutritious diet. The reality is that as much as 90 percent of the population here lives on less than $1 per day and they need more support."

Photo by Joanne Offer Things may soon come to a head when the rainy season begins in earnest. A few showers have already started, but the months of June, July and August frequently bring catastrophic flooding to this part of the country. Villagers are further cut off from aid, people will drink the readily-available dirty rainwater unaware of the illnesses this causes, and standing water will prove a breeding ground for pests.

"One extra pressing concern this year, however, is the situation in northern Sudan," says Dargis. "Since 13 aid agencies - including the IRC - were expelled in early March, aid flow has deteriorated substantially. Remaining agencies are doing their best to plug the gaps in Darfur but people may begin to move elsewhere if they can't get what they need. We are constantly monitoring the situation for any influx into southern Sudan. If it happens, that could push already stretched resources to bursting point."

While watching out for this scenario, agencies continue to build health capacity on the ground. One method that's proving particularly successful is training villagers to treat three common and potentially fatal diseases in children under five - malaria, pneumonia and diarrhea. The IRC runs a seven-day course to train villagers to recognize the symptoms, administer the appropriate treatment and refer more complicated cases to the nearest health facility. We call them "community-based distributors" but their neighbors just call them "doctor".

The scheme is well-suited for the rural Southern Sudanese environment. Worried parents can bring their sick child to the "doctor's" house and there and then receive free advice and treatment. There are no long walks to a health facility, no costs, and their child can be treated by someone they know and trust from their own village. All the training and treatment materials are pictorial, so villagers don't have to be literate to take part.

Akuol Ayong Anei - the lady who lost four of her six children - has recently passed the training course and is treating children in her village. She says: "I feel bad that I lost my children but it was God's plan. Now I am helping other children. I feel good."

Joanne Offer is regional media manager for the International Rescue Committee.