SOUTH SUDAN Emergency and Humanitarian Action (EHA) Week 4 (23rd 29 th January 2012) 1. Humanitarian situation. Highlights

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1 1. Humanitarian situation The security situation remains fluid and tense in the border areas in the southern state as there are rumors of possible retaraitory attacks between the Lou Neul and Mrule. Highlights Bombing in the border area of Upper Nile State s Maban County took place on 23 January causing 5,000 refugees from Sudan s Blue Nile State to flee south. To date over 28,000 refugees are registered in Doro, about 20,000 in Elfuj and another 5500 refugees in Dajo and Jamam camps in Maban Couty Upper Nile state WHO and State Ministry of Health team, hold discussions with a Community Health Worker at Gogrial Primary Health Care unit in Gogrial East during support supervision visit. Emergency health response continues in the states of Unity supporting over22,000 refugees in the Yida Camp,Pariang Couthy It s also estimated that another 110,000 persons in the Agok area continue to receive humanitarian assistance from relief agencies and development partners. Renk County is still harboring returnees who are waiting transportation to their final destination. During this weeks, WHO Supported the MoH with support supervision activities in Warrap State,Gogrial East Counties Supported partners in Jiec,Old Fangak with supplies for the Khalazar response Participated in the Inter agency assessments in the Akobo AND Pibor Counties Investigated a suspected outbreak of a febrile illness in Parkeer payam Twic East county,jonglei state As part of resource mobilization, the organization developed a response strategy for the next one year. Revised the health sector strategies, response plans for Jonglei and the interagency contingency plan. Supported the State Ministry of health (SMoH) of Central Equatorial state with an outbreak investigation of suspected cases of cholera in Juba county.

2 2. Public Health Concerns 1. The detoriating sanitation conditions in most refugee settlement and IDPs camps remains a public health threat. 2. Sporadic cases of anthrax continue to be reported in Gogrial West County,Warrap State and Jur county in Western Bahr El Ghazal state. To date (since jan 1 st 2012, a total of 16 cases have been reported in Western the state. 3. A rising number of acute watery diarrhea in Kuda and Sure bomas/dollo payam were also seen this week. 4. A considerable number of malnutrition cases were reported in the areas of Lekuangole, Pibor and Akoba. 5. Twenty six thousand, six hundred and ten (26,610) health events including seven (7) deaths were recorded this week, with malaria taking lead as the major health followed by acute watery diarrhea and bloody diarrhea. 3. Coordination, Emergency preparedness and response During week 4; 1. WHO deployed two technical officers to Jonglei (Bor and Pibor) to support the response to the victims of the inter-tribal conflicts. The technical officers supported the emergency health reponse by strengthening activities in the area of; coordination of health services and ensuring the affected population have accesses to health services. Five hundred and sixty nine consultations were recorded in Boma Primary Health Care Center (PHCC) and treatment sites, while in Pibor were recorded. Disease surveillance activities were also strengthened. WHO in collaboration with the County Health Department (CHD) have developed an operational plan to extend services to communities in Dorian and Yathek in Pibor as a result the organization supported outreach services to these places. A total of 2195 have attended OPD services through mobile clinics in Pibor and Gumuk payams. The WHO team, Ministry of health, Republic of South Sudan and other partners participating in an interagency assessment in Pibor

3 2. Supported the SMoH in Upper Nile to conduct a task force to meeting to discuss the Maban and Renk emergency health responses. To date there are returnees in Renk, Upper Nile state and about refugees in the Maban area. WHO continued to support these areas with emergency supplies and offer leadership in health emergency response. The programme has recommended Surveillance strengthening in the two counties given the dry season which in turn may lead to high risk of meningitis outbreak. 3. WHO conducted health assessments in Akobo and Pibor counties where the affected populations are displaced. The displaced are currently living in Dengjok payam head quarter in Thokliel; others are displaced in Burewil, Dilule, Wech Pal and Thokwaath Villages. Twenty three (23) people were killed during the attack and six (6) were treated in Akobo County hospital. Many patients are being attended to at Thokliel PHCC in Dengjok and there are limited medicines to treat and support the affected community and IDPs. Most patients preferred to be treated at Akobo County Hospital. Many IDPs are suffering from diarrhea; These women were displaced and were on transit to Pibor town from the bushes where they had fled following the inter-tribal clashes between the Lou Neur and Mrule. They lost all their children and livelihoods. Malaria; Respiratory Tract Infection; skin disease; and eyes infection (conjunctivitis). Recommendations to provide medicines and medical supplies to the affected community specifically anti malarials, antibiotics and ORS to the Akobo County Hospital and to Thokliel PHCC was made by the assessment team. There is a need to conduct a rapid nutrition assessment in Dengjok payam to confirm malnutrition status of the community there. 4. During the week, WHO supported health partners in greater Jonglie state with emergency supplies for the Khalazar response. The organization was also able to issue 1200 SSG, 1500r K39, 2000 Paromomycin, 1720 Ambisome, 2-mecaptoethanol and V-shape microtitration plates to Od Fangak, Jiech, Cosv and Mathiang. 5. The WHO state team in Jonglei also visited Pakeer Payam to investigate rumours of a suspected case of measles. The team visited three health facilities of Patiou Primary Health Care Unit (PHCU), Maar PHCC, Paliau PHCU and reviewed the facility documents like register books and interviewed health workers. Most reviewed cases did not have signs and symptoms of measles, dispelling rumors that there was a measles outbreak in the area.

4 6. The organization also supported the MoH response team to verify and investigate a suspected outbreak of acute watery diarrhea in Kuda Payam. During this week, a Rapid Response Team (RRT) supported by WHO was sent to Kuda to investigate the outbreak. The team met with health workers and members of the two communities of Sure & Kuda including the patients caretakers. The investigation team established that the index case was reported on 2/1/2012 and visited Sure PHCU on 3/1/2012. Thirty six (36) suspected cases of AWD were line listed, 22 of them were admitted to Kuda PHCC with 25 suspected cases coming from Sure Boma. Three (3) Bomas with a total of 34 suspected cases were affected thus among them Sure with 69% of the cases, Kuda with 19% of the cases and Serimon with 6% of the cases. WHO further supported the response with sundries (gloves), transport media-cb, in addition offered technical support. Fourteen (14) samples were collected and sent for analysis to. The community leader initiated a health promotion activity and surveillance guidelines were distributed to the facility to enhance surveillance. A follow up visit by the team to the area was conducted the same week and nothing significant was established. 4. Communicable Disease updates 1. In week 4, 38 counties (48%) out of 80 submitted their weekly reports. Three hundred and fourty nine (35%) of 993 health facilities from 38 counties submitted their reports. Twenty six thousand, six hundred and ten (26610) health events including 7 deaths were reported under surveillance week 4, across South Sudan as compared to health events reported in week 3. The majority of the reported events were malaria, followed by acute watery diarrhea and bloody diarrhea. Western Equatoria State (WES), Central Equatoria State (CES) and Lakes States had the best reporting performance with over (50%) completeness of reporting from the health facilities. 2. A total 8, 975 malaria cases and 7 deaths were reported. Four thousand and twenty one cases (45%) cases and 4 death (57%) were reported among children under five. The graph below shows the comparisons of malaria cases by States as per Epi Week Acute Watery Diarrhea had 2,743 cases and 0 deaths (in adults) reported during this week across South Sudan. The majority these cases 1,648 were reported in children less than five year of age while dysentery related cases were 1,574 cases.

5 4. There were 6 suspected measles cases. One was from WES, three from Lakes, one from Northern Bahr El Ghazal and one from Western Bahr El Ghazal state. Investigations have been conducted by the State Rapid response teams (RRTs). There were no reported cases of Meningitis, Acute Flaccid Paralysis (AFP), Acute Jaundice Syndrome, VHF, Influenza like Illnesses (ILI) and Guinea Worm. 5. Capacity building activities During the week, the WHO Warrap team conducted support supervision in the counties of Gogrial East and Tonj North counties. A total of 10 health facilities were visited across all the payams. Among some activities conducted were; the distribution of surveillance case definitions, surveillance tools and on job service training. Support supervision is a support function of disease surveillance and improves the quality of the implementation of the programme. 6. Partnerships The WHO and SMoH team, conduct an on Job training for healh workers in Gogrial East health facility. 1. Together with other agencies, WHO participated in an interagency assessment in the areas of Dengjok Payam In Akobo County. There is an Estimated 550 household with 3300 persons who were directly affected by the attack launched by armed murle who destroyed their livelihood by raiding their cattle and looting property. The facilities supporting the Households recorded low level of essential medicines and WHO through the MOH replenished the supplies with donation of two PHC kits of medicines 2. Other Assessments conducted during this period include; the Interagency assessment in Lekuangole, Gurmuk,Vathek and Pibor,Dorion. An estimated 120,000 are believed to be affected as a result of the tribal clashes and conflicts in Jonglei state. Key findings showed a tin critical mass of health workers in the PHCCs visited and limited stock of drug stock supplies in the health facilties. WHO in collaboration with the health partners on ground and in Bor have maintained the regular supply of emergency drugs in the affected areas. A similar assessment was also conducted in waac waat deng and deng chok in Akobo counties. 7. 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, mpairwea@nbo.emro.who.int or Ms Pauline Ajello, Communication Officer, ajellop@nbo.emro.who.int