Emergency preparedness and Humanitarian Action (EHA), SOUTH SUDAN,, Office for the Republic of South Sudan Week 44 (29 th Oct -4 th Nov) 212 Inside this publication: 1. 2. 3. 4. 5. Public health threats Coordination, Emergency Preparedness and Response Communicable disease updates Capacity building Partnerships A team of WHO staff load supplies on to a baot for transportation to Nasir and Ulung A mother waits for help at a health facility in Juba town In Upper Nile state Humanitarian situation in South Sudan 1. The security situation remained stable this week. There however remains a lot of tension in Pibor and Lekuangole in Jonglei state due to the presence of the Rebel Militia Groups (RMGs) of David Yau Yau. This threat levels have however reduced. Following the attacks by the group, an estimated 5,6 people were confirmed as displaced in Pibor. Equally in Lakes state, tribal conflicts seem to be escalating and tensions building in Luakachok cattle camp in Rumbek center County. One hundred and seventy thousand seven hundred and nine (17,79) persons have newly been displaced due to conflict. 2. Emergency returns continued this week with a number of flights and barge movements shipping in returnees to Juba and the greaterr Bahr el Ghazal region. An IOM supported Barge departed Renk during the week carrying over 88 returnees to Juba. In the reporting week 741 returnees were tracked heading to their final point of destination. 3. In Pariang and Maban Counties, the influx of refugees continues. According to UNHCR most of the new arrivals are in poor health condition and have no belongings. The camp currently houses 64,773 refugees with the majority leaving in dire conditions of water and sanitation. In Maban County, Over 111,254 refugees are registered and receiving humanitarian assistance. The refugees are leaving in extremely poor water and sanitation conditions, thus posing a public health threat to both the refuge and host community. 4. The surface floods reduced this week but most counties continue to be cut off. In most counties, the water and sanitation levels are likely to deteriorate due to contamination of the surface floods from the open faecal disposal as the rainy season comes to an end. Over 2, people have been affected by floods across the ten states. During this week, WHO; 1. Supported the implementationn of the 3 rd round of National Immunization Days across the ten states. 2. Supported the State Ministry of Health (SMOH) Warrap state with training of health workers on emergency surgical care. 3. WHO continues to support MoH with data collection, analysis, investigation of rumours where necessary and dissemination of diseases surveillance information. 4. Investigated an outbreak of suspected Measles in Tonj East county,warrap State. 5. Confirmed Hepatitis E as the causative agent of the Acute Jaundice Syndrome cases in Yida Camp. 1
Public Health threats and concerns 1. The continued influx of refugees continues to strain the humanitarian operations. Water and sanitary conditions aggravated by floods, pose a huge and major concern and public health risk. WHO continued to support the county health department to enhance disease surveillance. The sanitation in the host community remains poor as open defecation continues to widely be practiced. Hepatitis E outbreak is being contained in the refugee settlement. 2. Warrap state reported 15 suspected cases of measles in Tonj East County. The SMOH and WHO are planning an intervention as investigations go on. 3. Persistent insecurity in Jonglei State continued to hamper humanitarian access as 5,6 displaced people arrive in Pibor town following threats by the RMGs hence making it difficult for the partners to deliver humanitarian assistance. 4. The chronic shortage of anti malaria drugs and basic essential drugs to key health facilities across the ten states remained a huge challenge and concern. WHO team assess the health status of returnees in Malakal port. A WHO staff vaccinates a child at Juba county during the NIDS. Coordination, Emergency Preparedness and Response 1. In Upper Nile state, WHO provided Emergency response to flooded areas in Nasir and Ulang counties. Nassir and Ulang County is known as a flood prone area with limited local response to health emergencies. The WHO office supplies are intended to mitigate health challenges especially case management of malaria and upper respiratory infections among inhabitants of the affected communities. These counties were reporting acute shortage of drugs as well as increased morbidity mainly due to acute watery diarrhea, malaria and respiratory tract Infections. As a response WHO supplied 5 basic kits and 4 Malaria modules with assorted drugs and sundries to support 5 persons over three months. 2
2. WHO continued to fill the gaps in the provision of medical and emergency supplies to returnees transported by IOM to their respective home-states. This reporting week, eight hundred and eighty two (882) returnees from Renk transiting via Malakal to Juba were provided with medical supplies including antimalarials, antibiotics and infusions by WHO. The supplies were adequate for an extra 3 weeks of the journey to their destinations. The returnees were managed by a medical team. Malaria and upper respiratory infections were found to be the major disease affecting returnees. 3. In Warrap state, WHO, SMOH and Partners conducted an inter-agency assessment following reports of floods in Tonj South county. The findings established that Manyangok, Wanhalel and Mabior Yar were largely affected. About 3 households submerged in water and owners left homeless and displaced. Health, shelter and nutritional services were conspicuously compromised in the affected areas. The threat of water borne diseases is high as toilets were equally submerged; this makes the possibility of contamination high. WHO and the SMOH have embarked on health Education and provision of emergency supplies to the County to support common diseases being reported. Access to clean water is being advocated for to prevent a potential cholera outbreak. 4. The organization also continued to provide support for two mobile clinics in Warlang and Apada in Northern Bar al Ghazal state. These mobile clinics provide much needed care to families displaced by floods as well as insecurity. To date a total of 2,822 IDPs have accessed treatment in the WHO supported clinics. 5. In addition, WHO convened and supported an emergency task force meeting in Western Bahr el Ghazal state to discuss the progress of the containment of the anthrax disease. The cases had reduced however data shows an upsurge in the past month as shown in the graph. A combined team of SMOH,WHO and Axis Title 5 4 3 2 1 Anthrax cases by months Jur River212 Jan Feb Mar Apr MayJune Jul Aug Sep Oct cases ministry of animal resources have revised the response strategy and will conduct a verification visit in the most affected payams to initiate health education and promotion activities. 6. In Warrap State, WHO supported a verification exercise and mission to Kacuat Payam,Tonj East County to verify reported cases of suspected febrile illness. The Rapid Response Team established that the patients that presented with signs and symptoms of measles and were line listed 15 cases fitted the case definition and preventive 3
measures were put in place. The County surveillance team has commenced active tracing and line listing of all possible contacts believed to have been exposed. They will be monitored for any occurrence of signs and symptoms. Communicable Disease updates Hepatitis E Outbreak 1. In week 44 Hepatitis E outbreak was confirmed in Yida camp Unity state. The camp which is home to over 64,773 people line listed 19 cases and 2 cumulative deaths since week 35. Ten samples were sent to reference CDC laboratory. Eight of the samples tested positive for Hepatitis E 1 8 6 4 2 AJS Trend In Yida from Week 35-44 (MSF F) 1 1 5 2 2 8 3 wk wk wk wk wk wk wk wk wk wk wk wk wk 35 36 37 38 39 4 41 42 43 44 45 46 47 virus. A multi-sectoral containment plan and strategy is being implemented to address the hygiene and sanitation situation in the camp. So far all the WASH indicators are below the international accepted levels for emergency settings. 2. The trend of acute watery diarrhea slightly increased while that of Acute bloody diarrhea (ABD) and malaria reduced in Yida camp. The low level of ABD and the fact that the proportion of AWD among those above 5years of age is at 4% a good indicator given the poor hygiene situation in the camp. More however has to be done to ensure these figures remain low. AJS 3. While in Maban camps, the hepatitis E cases have continuously declined. In week 43, 59 cases and one death were reported. The total cumulative cases now stand at 1,79 with 3 deaths. Most of the cases (49%) were reported in week 43 from Yusuf Batil camp, followed by Jamam Hep E cases Figure 2: Epi-Curve of Acute Jaundice Syndrome cases in th Refugee camps and host 5 2 25 3 35 4 45 5 Epi week 212 Camp. No cases have been reported from the host community and the fourth camp of Doro. Health actors in Maban have intensified hygiene promotion as well as active case findings with support of community leaders. 4
4. With improvement in reporting from health facilities in Maban, the malaria cases and acute watery diarrhea seem to be on the increase, however the bloody diarrhea trend decreased. Many facilities in Batil have been reporting an increase in respiratory tract infections with some facilities run by GOAL indicating as high as 6% of outpatient cases. Participant trained by WHO poss for a picture in Warrap state Health cluster partners hold a meeting during one of the health cluster meetings in Warrap state Capacity building 1. In Warrap state WHO/SMOH conducted a workshop for health workers on management of trauma and surgical emergencies. Participants came from all the 6 counties of Warrap and the Abyei Area Administration. The training targeted Doctors, Clinical officers, Nurses and Midwives who work in a team and provide life saving interventions for victims of trauma, as well as improve care of trauma patients in the state to prevent disability and deaths. It is hoped that the training will build skills of health workers and improve case management of potential mass casualties in the state. Warrap state is one of the high risk states and is prone to conflict due to its proximity with the states bordering with Sudan. 2. In Maban County, WHO conducted support Supervision for EPI (Routine) Activities in Gendrassa and Batil Camps managed by IMC and GOAL partners respectively. Among the activities conducted were stock taking of the current stocks and discussions with the data management regarding vaccines based on the previous reports received. Data management remains a challenge in the EPI program. Partnership 1. WHO participated in Raja monthly partners meeting held on 31 November 212 coshared by Relief and Rehabilitation Program and county Relief and Rehabilitation 5
Commission Secretary. The meeting addressed the current health emergency issues of returnees, NGO partner s progress and updates from UN agencies. 2. In addition, the WHO coordination team participated in the humanitarian coordination forum. The meeting was held on 31 st Oct, 212 at the UNHCR compound in Kuajok. All UN agencies, INGOs and CBOs based in Warrap state attended the meeting. The meeting was chaired by RRCC and co-chaired by UNOCHA. The meeting was held with the following objectives; find out achieved tasks as recommended following an inter- as per the agency assessment during the floods in September, share achieved targets contingency plan which wass agreed on by all agencies early this year, assess the level of preparedness towards thee incoming returnees from Sudan and share results of floods assessment conducted recently in Tonj South County. 3. Finally, the programme participated in the Health and Nutrition cluster meeting in Kuajok and the national level. All health partners operating in Warrap attended the meeting. Implementation of November National Immunization Days dominated the discussion. Partners pledgedd their support towards the planned implementation. Acknowledgments: The progress achieved by WHO/EHA South Sudan was made possible through contributions from the following partners: For further information, please contact: Dr. Allan Mpairwe, Emergency Coordinator, Email: mpairwea@nbo.emro.who.int or Ms Pauline Ajello, Communication Officer, Email: ajellopa@nbo.emro.who.int 6