Gulu-Nairobi — Disease burden is growing among people who fled their homes following the outbreak of conflict in South Sudan.
The mid-December eruption of fighting between army forces loyal to President Salva Kiir and those supporting former vice-president Riek Machar has adversely impacted the already weak health system.
"Even before this crisis, South Sudan's health system was extremely fragile - 80 percent of the health services were provided by international organizations," Raphael Gorgeu, the Médecins Sans Frontières (MSF) head of mission for South Sudan, told IRIN in an email. "So for MSF, the current conflict exacerbates an already dire situation."
He added: "In addition to treating the war-wounded directly affected by the violence, we're also concerned for those who have been indirectly affected - for the displaced, for those hiding in the bush, too afraid to go in search of care, and for those who have zero access to healthcare given the high level of insecurity in many areas."
According to the UN Office for the Coordination of Humanitarian Affairs, around 575,500 people are internally displaced in South Sudan, and another 112,200 people have fled to neighbouring countries.
"Most fled with nothing, and the conditions in the displaced camps are very difficult, without enough water, food or shelter. Disease outbreaks in the camps are of serious concern. In many areas, the healthcare system has collapsed due to the conflict - the clinics have not be re-supplied and the medical staff have fled, leaving women without a safe place to give birth [and] sick children with nowhere to turn," Gorgeu said.
"We also see that host communities are increasingly affected by the huge numbers of displaced that have arrived in their areas - for example Awerial in Lakes State was home to 10,000 people, and now more than 85,000 displaced from the violence in Bor [the capital of Jonglei State] now call it their home too."
Concern over health worker safety
MSF has had to evacuate staff on five separate occasions due to insecurity, and two facilities in Bentiu Malaka have been looted, leaving thousands of people without desperately needed healthcare.
"We need respect from all warring parties for the neutrality of health facilities, and the safety of patients and staff," he said.
In Bor, as elsewhere in South Sudan, the health infrastructure has largely been destroyed or supplies looted, added the UN Children's Fund (UNICEF) in a 26 January statement, which warned that without humanitarian aid, the risk of preventable deaths "will increase dramatically".
About 30 child deaths have so far been recorded in the Protection of Civilian (PoC) centres at the UN Mission in South Sudan (UNMISS), according to UNICEF. "Few humanitarian agencies have been able to gain access to the population of Bor, who fled the fighting to seek protection in the PoC centre in Bor. Grave insecurity means only a limited number of aid workers are able to operate within the centre," the agency added.
UNICEF and its partners are hoping to reach 180,000 children younger than 15 in ongoing measles and polio immunization campaigns.
Fears of disease spread
The health situation in South Sudan is sparking fears of cross-border disease spread into neighbouring Uganda.
"We are not certain what might happen tomorrow, but we hope that the government and humanitarian agencies will be in a position to respond in time in case of any disease outbreak," Avuntia Patrick, a resident in northern Uganda, said.
On 20 January, Makerere University's Refugee Law Project (RLP) convened a meeting in Gulu District, in northern Uganda, with government officials, civil society organizations and aid agencies. The meeting aimed at fast-tracking the protection response for the South Sudanese refugees and the Ugandan host communities.
At the meeting, the government was urged to step up border surveillance. "In Lamwo District, refugees are crossing into Uganda without being documented," noted Stephen Oola, the head of research and advocacy at RLP.
James Otto, the Action Aid board chairperson, added, "It will be unfortunate if leaders in the district [of Gulu] are going to sit and wait for the central government in dealing with the [South] Sudan issue, so there is a need to make a functional district disaster committee to help monitor the situation."
Stretched health services
A displaced South Sudanese refugee girl prepares a meal at the Elegu reception centre in Amuru, northern Uganda
"The situation requires [an] urgent response. The capacity of Adjumani Hospital needs to be strengthened in order to manage referrals from the three health centres serving the refugees," Roselidah Ondeko, the UN Population Fund's (UNFPA) senior coordinator on gender-based violence issues in Uganda, told IRIN in an email.
"We need more blood supplies at the hospitals and ambulance[s] for referrals to the regional referral hospital in Arua," added Ondeko. Staff and medical supplies are inadequate, too.
South Sudanese refugee children are also missing out on immunizations due to the lack of a link between registration and medical screening, according to an analysis provided by Uganda's Office of the Prime Minister, which is leading the coordination response to the refugees' protection concerns.
The management of child malnutrition and births at Dzaipi Health Centre III and at the Adjumani Hospital also remains a challenge. Between 11 and 21 January, 10 refugee children were diagnosed with severe malnutrition and another 15 were found to have moderate malnutrition out of 714 children under age five who were screened at the Dzaipi health centre.
Basic supplies are needed for child deliveries, Beatrice Masudio, a midwife at the centre, told IRIN. "With help of UNFPA and other agencies, we hope the situation will get better, but [it] is not good yet." UNFPA is providing medical tents for antenatal care and outpatient services in Dzaipi and at Nyumanzi Health Centre III in Adjumani.