More than three years after warring factions in Sudan signed a peace agreement, “health needs in southern Sudan remain critical, and simmering tensions create a precarious security situation,” Médecins Sans Frontières said last week. Its report was issued to coincide with a conference in Norway bringing together countries and organisations that donate to Sudan.
The charity says that it is “struggling to maintain its primary healthcare services while reinforcing secondary care and emergency outbreak response. People continue to die from preventable diseases or curable conditions because of the shortage of clinics, trained medical staff, and medicines.”
The report continues: “Diseases like tuberculosis, malaria, and visceral leishmaniasis (kala-azar) continue to take a heavy toll. Outbreaks of meningitis, measles, and cholera are all too common, and maternal mortality rates are among the highest in the world, the result of years of war and no development.”
It says that in southern Sudan 2053 mothers die in every 100 000 live births. This maternal mortality rate is four times higher than in northern Sudan, where it is estimated at 512 in every 100 000 live births, twice as high as in the Darfur region (994 per 100 000 live births), and 300 times higher than in the Netherlands (seven per 100 000 live births).
The charity’s health coordinator for Sudan, Koert Ritmeijer, said that international relief agencies were still responsible for most health care in the area, as there was almost no local capacity, and “a viable health system for southern Sudan’s estimated eight million people will take years and significant investment, while acute health needs remain unmet.”
The slow release of funds for longer term development is hampering the maintenance and improvement of existing health structures, he said, so “the few emergency medical organisations that remain in southern Sudan are shouldering an impossible burden trying to meet basic health needs.”
The report says, “It is impossible to apply conventional notions of ‘post-conflict’ to southern Sudan, which in many ways is starting from scratch. Before the war the region had a severe lack of general infrastructure and health systems, and decades of conflict destroyed what little existed. Today, there are few roads, a crippling absence of healthcare staff and health structures, and limited investment from the government.”
The donors’ conference pledged almost $5bn (£2.6bn; €3.2bn) in aid for reconstruction across Sudan for the next three years, although donors were warned that more than 90% of the reconstruction funding received in the previous three years had actually been spent on emergency aid rather than development and that it was largely diverted from southern Sudan because of the ongoing crisis in Darfur.
Last weekend the Foreign Office issued emergency advice warning against all travel to Sudan, after thousands of Darfuri insurgents launched an attack on Khartoum. As the BMJ went to press the capital was under a 24 hour curfew.
Greater Upper Nile, Southern Sudan: Immediate Health Needs Remain Amid a Precarious Peace is available at www.msf.org.