Highlights. 1. Humanitarian situation. SOUTH SUDAN Emergency preparedness and Humanitarian Action (EHA) Week 19 (7th 13th May) 2012.

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1 Humanitarian Action (EHA) 1. Humanitarian situation Highlights Humanitarian partners made arrangements with the Governments of Sudan and South Sudan to transport between 12,000-15,000 returnees stranded in Kosti, Sudan, by air to South Sudan. An assessment of six potential settlement sites was conducted by the key humanitarian agencies. As of 08 th May 2012, a total of 376,226 returnees from Sudan were reported to have settled across all the 10 states of South Sudan (OCHA Report) And this has continued in to this reporting week. Over additional returnees are expected in Juba during the week of 14 th May It was reported that approximately people were reported in Kosti in Sudan, while others were stranded in 4 transit sites in Renk ( Mina, Abayok, Agani and Payeuer (new site). In Jammam and Doro, the health and humanitarian situation continues to worry many humanitarian partners. As a result, Aid agencies are stepping up efforts to increase water supply and mitigate the risk of water-borne diseases. In the meantime, partners like WHO prepositioning medical supplies, establishing treatment units and drawing contingency plans to respond to any disease outbreak. There were also reports of Anuak refugees reported to have arrived the Alari camp, in Pochalla County, Jonglei State this reporting week. Reports obtained from the state indicated that the movements follow violence in Ethiopia between the government and Anuak opposition forces. The majority of new arrivals are located at Alari refugee camp. It s feared that this will negatively impact on health and services for the population in this area. WHO team conducts an assessment of health service delivery for emergency in Ngorom PHCC in Central Equatorial state to in lieu of the arrival of over 10,000 returnees In week 19, WHO; 1. Supported the State Ministry of Health in Unity to conduct a measles assessment in Wangkei and Mankein areas of Mayom counties. 2. Supported the Central Ministry of health to organize for an emergency preparedness and meeting to plan for returnees from Sudan. 3. Participated in an Interagency Assessment for the potential settlement of returnee sites in Juba, Central Equatorial state. 4. Prepositioned emergency kits to boost preparedness of health emergency response in Unity state and Central Equatorial state (CES). 5. Finalized the emergency response plan for CES MoH to support the response of the returnees form Khartoum. 1

2 2. Public Health threats and concerns 1. Following the increased number of measles cases reported in the past week from Gogrial West in Warrap state, WHO, SMoH and other partners conducted mass measles campaigns in Akon South and North of Gogrial West. Of the targeted 37,820 children, approximately over children were vaccinated from Akon north and South and Gogrial. 2. Two suspected Acute Flaccid Poliomyelitis cases were reported this week. Two were from Warrap state (1 from Agok and the other from Gogrial West) and one was reported from Upper Nile state, Acute AFP detailed Case Investigation (DCI) was also conducted in Upper Nile state. 3. The population movement of returnees from Sudan into South Sudan continues to worry many actors as this is feared to insert more pressure on the already fragile and overwhelmed health service provision in the area as this may come with many other public health threats. Limited space for the enormous population of returnees coming remains a major public health risk/concern. 4. Poor sanitation and limited access to water points in Maban county remains a huge challenge leading to increased numbers of Acute Watery Diarrhea (AWD) cases. This makes it potential risk for an outbreak of cholera 3. Coordination, Emergency Preparedness and Response In week 19; 1. Following information of over 10,000 returnees from Sudan into South Sudan, WHO supported the Central Ministry of Health to convene a series of Emergency Preparedness and response meetings to discuss health support for the returnees. During the meeting, it was agreed that immunization on arrival be conducted for all returnee children. Working groups were formed to ensure nutrition, EPI, clinical management and referrals for patients are done. WHO committed to ensuring a regular drug supply/pipeline and to support communicable disease surveillance, provision of technical guidelines and support of mobile health clinics. Similarly WHO supported the State Ministry of Health, Unity state to organize and hold a health cluster meeting, during which discussions on a visit to Wangkei and Mankein areas of Mayom Counties to verify reported measles were held.the team Health Cluster in a planning meeting to discuss health support for returnees who were scheduled to return to South Sudan the following week. 2

3 resolved to strengthen case management at the facility level as one of the most viable strategy to control the current threat of measles in the state. 2. Following the influx of returnees in the country, WHO supported Upper Nile state with emergency drugs and supplies to enable the health cluster prepare and respond adequately to the influx of the people in Renk and Maban camps, Malakal transit area and way station. Adequate Emergency Response Health Kits, drugs and supplies were prepositioned at the SMoH and Bentiu hospital stores. In Lakes states reports of 44 household with 186 individuals in Rumbek way station all returnees was received. And in Shambe way station in Lakes states where returnees were expected to arrive, WHO prepositioned emergency drugs and about 1000 mosquito nets to prepare all necessary arrangements if returnees arrive as informed by the South Sudan Relief and Rehabilitation Centre. WHO staff offloads emergency drug pre-positioned to Shambe. 3. WHO also supported a mobile clinic at Way Station in Upper Nile state. Following this support, two hundred and thirty one (231) consultations were conducted by the mobile clinic teams at the way station and transit site. Of these, 152 were children and, 11 referral including 2 women were made. The most common diseases reported were Malaria, ARTI, eyes, skin infection and bloody diarrhea. 4. As part of preparation for over returnees from Sudan, WHO participated in an inter agency assessment. The assessment was conducted with an objective of establishing the health suitability of the designated area where the returnees were to be resettled. Six venues were identified and the teams agreed on the way station as the potential site for the first rotation. In Unity state, a similar exercise was conducted in Koch County to verify the Internally Displaced Persons. The team established that over 3930 individuals from 786 HHs and IDPs lacked food, NFIs and basic health services. These people were displaced from Norbor, Gany,Ganglet and Patiet caused by cattle raiders from Warrap state. In addition to the nutritional supplement to the affected children, A WHO staff conducts a 60 day Follow-up investigation in Rubkona. 3

4 the team through the MOH ensured that health services in the area were strengthened to enable accessibility by IDPs. 5. In Unity state, WHO together with the SMoH conducted an assessment mission to Mayom County to conduct further investigation on reported Measles cases and verify rumors of measles cases. As result it was established that six cases had been reported in Mankein Primary Health Care Unit. The response team conducted an on job training for the health workers in a bid to strengthen case management of reported cases so as to reduce and avoidable mortality. WHO will continue supporting the case based surveillance system in the states as one of the measures of control of the current measles threat. 6. In Western Bahr El Ghazal state, WHO supported the response of returnees who arrived at the state from Upper Nile. In a concerted effort with other partners emergency health services are being offered to the first batch of people who are currently accommodated in the eastern bank of Jur river. The Eexpanded Programme of Immunization services were offered and screening done to establish that all the under fives were vaccinated in Renk by the WHO state team. A temporary clinic has been established at the site to manage common illnesses with disease surveillance enhanced. WHO also supported the MOH-Western Bahr El Ghazal state to conduct an emergency planning meeting for the response of the increasing number of measles cases in the state. The meeting recommended the development of a micro plan for the vaccination of children 6-15years and strengthening of post campaign evaluation to improve the quality of responses. 7. An estimated 320 Returnees arrived in Unity State in this week by boat from Malakal the capital of Upper Nile State. The SMoH organized a team to vaccinate all children under 5 years of age. WHO also supported the SMoH with incentives to ensure continuity of mobile teams that conducted the vaccination exercises for the returnees and further asses the health status of the returnees. 4. Communicable Disease updates This week s IDSR focuses on Upper Nile state. During this reporting period; 1. A total of 10 counties out of 13, 10/13 (75%) and 49 health facilities out 122 submitted their weekly reports on time. From Nasir county completeness was reported at 37%, Maban at 23%, and Lunguchug was at 16%. Completeness from other were; Pashoda was 45%, Makal at 33%, Mauwt at 42%, Maluth at 100%,, Baliet at 57%, Ulang at 25% and Renk at 44%. Panykang, Manyo and Akoka counties had 0.0% completeness of reporting. Seventy five percent (75%) of the counties (49/122) and 40% of the health facilities from 10 counties submitted their reports on time. 2. During the week, health events with no death were reported from all the health facilities in the states. Malaria accounted for 1536 (58%), Acute Watery Diarrhea AWD accounted for 700 (27%) while Bloody Diarrhea accounted for 385 ( 15%).There was only one (1) measles case reported. 4

5 3. A total of 231 consultation were conducted by the supported WHO/SMoH mobile clinic at the way station and transit site, 152 were children,(11) referral including 2 women,the common reported diseases were Malaria, ARTI, eyes,skin infection and bloody diarrhea. Table one shows morbidity and mortality data from Mina clinic supported by WHO. 5. Capacity building During the week, WHO conducted on the job training for health workers in Akoka County for 3 health facilities on how to report timely. A total of 8 health workers were trained from the facilities of Akoka Primary Health Care Centre, Bientenj Primary Health Care Unit (PHCU) and Rom PHCU. It s expected that this improve timelines of IDSR from these facilities. 6. Partnerships MORBIDITY MORBIDITY < 5 years >= 5 years MORBIDITY < Male 5 years Female TOTAL >= Male 5 years Female TOTAL GRAND TOTAL % MORBIDITY Upper Respiratory Tract Infection Male42 Female 46 TOTAL 88 Male50 Female 67 TOTAL 117 GRAND TOTAL 205 % 33.1% Upper Suspected Respiratory Viral Tract Haemorhagic Infection Fever % 0.0% Suspected Viral Cholera Haemorhagic Fever % 0.0% Suspected Acute Watery Choleradiarrheoa % 14.5% Acute Acute Watery Bloody diarrheoa % 3.2% Acute Acute Bloody Jaundice diarrheoa Syndrome % 0.0% Acute Suspected Jaundice Measles Syndrome % 0.0% Suspected Measles meningitis % 0.0% Suspected Acute Flacid meningitis Paraliysis (AFP) % 0.0% Acute Malaria Flacid Paraliysis (AFP) % 5.0% Malaria Community Death % 0.0% Community Yellow Fever Death % 0.0% Yellow Neoanatal Fever Tetenus % 0.0% Neoanatal Suspected Tetenus Kala azar % 0.0% Suspected Infleunza Kala like azar Illneses % 0.0% Infleunza Obstetrical like Illneses cases/gynaecological cases % 0.0% Obstetrical Sexual violence cases/gynaecological cases % 0.0% Sexual Otitisviolence % 1.6% Otitis UTI % 7.9% UTISTI/HIV % 0.0% STI/HIV Mental Health Disorder % 0.0% Mental Skin Health disease Disorder % 2.9% Skin Animal/Snake disease bites % 0.0% Animal/Snake Accidental traumas bites % 1.1% Accidental Eye infection traumas % 6.3% Eye Others infection % 24.4% Others TOTAL % 100.0% TOTAL % 1. In partnership with Relief International in Maban county, WHO finalised preparations for the training of health workers on control and management of cholera in refugee settings. This training is preparation for the potential outbreaks and upsurge of Acute Watery Diarrhea (AWD) case in Maban county. In the past weeks the trend of AWD has been on the increase following shortage of adequate water in the county mainlyin the areas recording high number of refugees. 2. WHO also held a consultative meeting and received a delegation from the ICRC who paid courtesy call to the WHO Malakal office. Cooperation and coordination issues surrounding emergency care services were discussed with emphasis on the health information and referral management at the state level.icrc is the major actor that supports Malakal hospital in Upper Nile state with the provision of emergency surgical care 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 5