south sudan - who · south sudan emergency ... (390 hhs) are currently ... managed in bor state...

South Sudan Emergency humanitarian situation report

Issue 10 25 March – 31 March 2013

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HIGHGLIGHTS

Humanitarian Situation

WHO supported the State Ministry of Health to provide emergency surgical care to over 54 patients with Gun short wounds at Bor State hospital.

Conducted and supported the verification of suspected measles outbreak in Lauro Payam, Budi county.

The organization also supported Unity state with medical

supplies including assorted antibiotics and essential drugs donated to THESO an NGO operating in Guit County.

WHO also supported a training of 40 health workers on

communicable disease control in Yei County, Central Equatorial state.

During the week, the Head of WHO South Sudan Office and the Resident Coordinator-Humanitarian Coordinator

a.i, chaired the bi-weekly Humanitarian Coordination Team (HCT-Donors,UN agencies and NGOs).

The security situation in Jonglei remains precarious especially in Pibor and Akobo Counties. Currently insecurity is restricting the delivery of humanitarian assistance in most parts of Pibor county. Thus the humanitarian capacity to respond to the displaced remains extremely limited as most insecure places are remote and have no aid agencies on the ground. Humanitarian actors are concerned by the build up and presence of troops and the ongoing military offensive on the non state armed actors and the impact this has on the humanitarian operations.

Returnees continue to cross into South Sudan. A total of 1,303 individuals (497 Households) were transported by the African Inland Church from Khartoum to Malakal, Upper Nile state, in this reporting period. Returnees whose final destination was not Malakal were received at Malakal way station. An additional 26 individuals (19 households) heading to Ulang and Nasir counties were also received at the way station. Approximately 1,023 individuals (390 HHs) are currently living at the way station in Malakal County. Two hundred and twenty five returnees were tracked to be heading to their final destinations this week.

Over 180,000 refugees are currently living in Maban and Yida Refugee camps in Upper Nile and Unity states respectively. The pace of the refugees crossing into South Sudan however slowed down in the past weeks. On the other hand, partners continue to respond to the hepatitis E outbreak in the two camps.

There is a significant increase in the population numbers in the Abyei Area. The increase is partly due to the southward movement of the nomadic population and the returnees coming back to Abyei Area. In addition, the population increase in Abyei town could partly be due to secondary movements to Abyei town by Internally displaced people persons who returned to areas north of Abyei town like Noong, Dokura and Todach but are now retreating to Abyei town and other areas considered/perceived as safe. More returnees are expected to arrive the Abyei Area in the coming months.

Affected population (Consolidated Appeal Process Projections) Total target for health 2,900,000 Newly Internally Displaced Persons 200,000 Refugees in South Sudan 350,000 Returnees from Sudan 158,810

WHO staff conducts routine support supervision for Acute Flaccid Paralysis in a community in Unity state Photo: WHO



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Public Health Concerns

Health Situation

With continued reports of insecurity in Pibor, Jonglei State, a number of displaced persons and mobile

populations have been cut off from accessing health services. The current insecurity is restricting the delivery of health assistance in most parts of Pibor county.The emergency health capacity to respond to the displaced remains extremely limited as most insecure places are remote and have no health partners on the ground.

Hepatitis E outbreak continued in the refugee camps of Maban and Yida. In the reporting week, a total of 394 cases were recorded in the two refugee camps. Health Partners continue to carry out interventions to contain the outbreak. Both Yida and Maban counties host over 180,000 refugees that fled from the north.

Communicable Diseases

The overall completeness of reporting from health facilities across the country remained high in week 12. The average completeness rate of reporting was at 70% (693 out 993 facilities), while average timeliness was at 40% (400 out of 993 facilities). The timeliness rate in week 12 decreased significantly compared to that of week 11 from 40% to 56%. Lakes, Western Equatoria, Upper Nile and Unity states recorded the highest number of health facilities reporting in week 12, while Central Equatoria State and Eastern Equatoria State performed poorly this week.

Two Hundred and forty six

(246) suspected Acute Jaundice Syndrome (AJS) cases and eight (8) related deaths were recorded from Maban County and Yida in week 12. Of these cases, over 45% were reported from Yusuf Batil, 21% from Doro (21%, 15% from Gendrasa, 13% from Jamam and 3% from Yida. Of the Eight reported deaths, three were from Yusuf Batil, one from Doro camp, two from Jamam, and two from Yida camps. Figure 1 and 2 shows the cumulative AJS cases recorded from Maban refugee camps was 9026 and 158 related deaths, while 215 AJS cases and deaths recorded in Yida since the beginning of the outbreak untill week 12. New cases recorded in Maban refugee camps continued to decline for the seventh week as compared to the previous weeks. Compared to the previous weeks cases from Batil reduced significantly although it still reports the highest number of cases in comparison to other camps. Cases from Gendrassa and Doro are still high compared to the previous weeks. In general the epidemic is on the decline. However, awareness, and good sanitation and hygiene practices need to be stepped up in areas where WASH standards are still low.Thirty (30) suspected measles cases (incidence rate of 0.34 per 100,000 populations) with zero related death (CFR 0.0 %) were reported in week 12. Children below five years of age accounted for 86% of all the cases. The suspected measles cases were reported from Yambio, Ibba, Juba, Terekeka Budi, Maban and

People in need of humanitarian support 4,600,000

Source: UNOCHA



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Yirol West counties. A total of 24,405 suspected malaria cases (incidence rate of 295.4 per 100,000 populations) with sixty (60)

related deaths (CFR 0.25%) were reported in week 12. Of these, 43% and 70% of deaths due to malaria were in children below five years of age. The overall incidence rate decreased in week 12 as compared to week 11 but the Case Fatality Rate doubled. Upper Nile, Western Bahr el Ghazal State, Warrap and Unity states reported the highest malaria incidence rate in week 12, while sixty deaths were reported from Rumbek Center, Rubkona, Yirol West and Maban Counties. The malaria cases recorded in the refugee camp in Yida decreased this week while those from camps in Maban remained relatively stable.

One suspected meningitis case and

with no related death was recorded from Abyei County. State Rapid Response team in Warrap state is investigating these suspected meningitis cases and CSF specimen once collected will be send to the reference laboratory for analysis.

Response In response to the continued fighting along Kong Kong river, WHO through the Health cluster closely coordinated

with other medical partners in Pibor and Akobo counties to ensure that the response capacity including surgical capacity for the injured persons was strengthened. A total of 54 causalities were given life saving surgery and managed in Bor State hospital with the support of WHO. A trauma kit and infection materials were donated to the hospital to support the response.

WHO team together with the State Ministry of Health team conduct supervision visits in Unity state for children immunized against polio Photo: WHO

A child suspected to have measles lying at a hospital in Eastern Equatoria state Photo: WHO



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WHO backstopped THESO, a national NGO supporting health services in Guit County with basic unit kits for the

management of common illnesses. This follows reports of repeated drug shortages and stock outs in health facilities in the remote county of Guit. The donated drug supply will support the management of an estimated 5,000 persons in the coming three months.

In addition, the agency supported Yida refugee response by backstopping MSF health facilities with emergency drugs. Among the items supplied were; 20,000 tablets of Paracetamol, 3,000 tablets of 250mg and 500mg of Amoxicillin tablets, 50,000 tablets of IBUPROFEN,5,000 each of small and medium sized examination gloves, 3,000 large examination gloves and 1,000 viral of ampicilline. Currently Yida is hosting over 65,000 refugees

To support the response in Jonglei state, WHO prepositioned essential life saving drugs and medical supplies,

among them; Antibiotics; Anti-Malarials and essential Trauma Kits (Type A and B). This follows continuous attacks and instability in the state resulting in to huge numbers of causalities. The preposition was also done following a request by the State Ministry of Health to health partners to support the Ministry of Health fill some critical gaps in drugs by ensuring that this is available at all health facilities in need so as to support urgent medical interventions.

In response to the continued new arrivals/returnees from Kotsi, WHO state team continued visiting the way station in Malakal and held discussions with the health workers on the availability of health services, drugs and medical equipments. Shortage of drugs was noted at the way station as a major gap. A gap in the referral of the severely ill patients to Malakal hospital was also note and, it was agreed that an ambulance of the SMOH be provided to support the transportation of patients who are referred to Malakal. WHO through the core pipeline will support with the provision of the emergency drugs and strengthening case management at the way station.

In preparation for the upcoming wet season in Upper Nile state, WHO completed the exercise of prepositioning emergency supplies to state. The supplies prepositioned included; One Interagency Emergency Health Kit,Two Diarrhea Disease Kits and one Trauma kit. Upper Nile is one of the six states that is usually worst hit during the rainy season cutting off the population of social services like health.

On job training for health workers was conducted in Lauro and Budi County Health Department during this reporting period. The training was conducted during a measles investigation of measles at the health facility. The State Ministry of Health together with WHO visited Lauro Primary Health Care Centre after receiving rumours of an outbreak. During the visit, health facility staff were given line list and case base investigation forms and were trained on how to use them during the investigations of any suspected disease outbreaks in the payam.

The program also conducted training for health workers on integrated disease surveillance and data

management in Yei town. The participants were selected from silent health facilities from different counties in Central Equatoria state. Silent health facilities are those not submitting their weekly surveillance reports to the state and central ministry of health as required. A total of 40 health workers from these health facilities in the counties of Morobo,Lanya and Yei County were trained. It is hoped that the health facilities will start sending in their weekly to enable timely detection of any potential outbreaks.

Coordination

In this reporting period, the Head of WHO South Sudan Office and the Resident Coordinator-Humanitarian Coordinator a.i, chaired the bi-weekly Humanitarian Coordination Team (HCT-Donors,UN agencies and NGOs). The meeting took place on 27 March.

During this reporting period, WHO participated in an emergency coordination meeting in Wau. During which discussions on the possible verification mission to Era payam following reported displacement was agreed. One challenge that humanitarian actors still faced is the inability to access the affected population.

WHO supported the Ministry of Health to convene the weekly Epidemic Preparedness and Response meeting at

Juba level to discuss the response and other disease surveillance strategies in the ten states of South Sudan.



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WHO also continues to lead the coordination of the humanitarian health response in Jonglei State by convening the week Emergency preparedness and review meeting to discuss the Jonglei and Upper Nile crisis?

Together with other health partners and UNHCR, the programme finalized a three month Action Plan for hepatitis

E Outbreak Response in Maban and Yida camps. The action plan is aimed at strengthening and improving coordination, communication, WASH, hygiene, social mobilization, surveillance, and laboratory services.

Assessments

In Eastern Equatorial State, WHO conducted a outbreak response by investigating suspected measles outbreak in Lauro Payam, Budi county. The team established that there was no active outbreak in the area as reported. The team however noted that besides the polio National immunization Days, no other vaccination in Lauro town centre and nearby villages including Taala and Kibongorok has been conducted since the start of March 2012. The Primary Health Care Centre has no cold chain capacity and no outreach or mobile services. The available solar fridge was found not to be functional. Other findings were that; since the beginning of 2013, health facility staff and community members in the town estimated that between 30 to 50 may have died due to measles related complications. However no records were available from the health facility register or the weekly reports to verify these claims.

The agency also participated in the interagency Assessment mission to Jaac/Aweil North. The objective of the mission was to verify the arrivals of newly displaced persons and assess the health service gaps in the Internally Displaced People’s camps. It was noted that there are no new arrivals of Internally Displaced Persons but relocation of one camp to new site was observed. In addition, it was evident that the displaced population are still vulnerable and require humanitarian support. The work load in Jaac Primary Health Care Unit and Warapei Primary Health Care Unit increased due to the additional attendance to the Displaced Persons. Partners covering these health facilities need to supply additional drugs. Lack of plumpynuts in both health facilities was noted. Concern worldwide agreed to provide nutrition supplies covering the two facilities.

Two experts from WHO Collaborating centers in Spain and USA conducing entomology study for Visceral Leishmaniasis in Old Fangak, Jonglei State. Photo: WHO

A team from the WHO office Regional Office and WHO South Sudan country office conduct Kala azar investigation in Old Fangak Photo: WHO

For more information contact:

WHO Country Office:Dr Abdi Aden Mohamed, Head of Office WHO South South, [email protected] Or Ms Pauline Ajello, Communication Officer. [email protected] WHO Regional Office for the Eastern Mediterranean: [email protected] Website: www.who.int\emro\eha

south sudan - who · south sudan emergency ... (390 hhs) are currently ... managed in bor state...

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