South Sudan Emergency humanitarian situation report Issue No. 28 Reporting Period: 11 November 17 November 2013

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1 HIGHGLIGHTS In this reporting period, WHO; Conducted an annual review meeting for integrated disease surveillance and response. This drew surveillance officers from all the state ministries of health, selected country surveillance officers, WHO state teams and NGO partners working in the area of surveillance. Provided medical supplies and drugs to Aweil State hospital to support treatment of returnees who newly returned to the Northern Bahr el Ghazal state from Kotsi in Sudan. Continued prepositioning medical supplies and filling in critical gaps in health in the states affected by floods. Participated in preparatory meetings for the upcoming National Immunization Days in all the 10 states. Humanitarian Situation The number of people returning from Sudan into South Sudan continued to be reported in this period. An estimated 900 returnees headed to Western Bahr el Ghazal state were tracked to Alel Chok Way Station. While individuals arrived Northern Bahr el Ghazal in this period from Sudan. The returnees will be transported to their final destinations by state humanitarian partners and the State goverment. African Inland Churches faciliated the transportaion of the returnees from Kostsi. WHO and other health partners supported the immunization of all children under-five aganist measles and polio on arrival and provided referal for patients who needed medical attention to Aweil State hospital. Reports from Unity state, report an additional 56 individuals to have been registered in Yida refugee camp. As of this reporting period, the cumulative population in Yida camp had reached individuals. The number of new refugees registered in the area since January to this reporting period is ; of them new born. In Ajwong Thouk the cumulative population has reached individual, as new refugees. With the exception of sporadic measles outbreaks reported from various states, no other new outbreaks have been reported in the country in this reporting period. Responses however continued in Maban and Yida camps to contain Hepatitis E, and in Yirol, Lakes states the response to measles outbreaks was initiated. Key planning figures for CAP 2014 Population type Population figures People in need 4.4M People targeted overall 3.1M People in need of health 3.9M People targeted health 2M Refugees in South Sudan 2.7M Returnees from Sudan Source: UNOCHA 1

2 Public Health Concerns Cases of yellow fever continue being reported from the neighbouring South Kordofan state of Sudan. Following a declaration of the outbreak of yellow fever, South Sudan remained at risk of importation of the outbreak given population movement between South Kordofan and Yida/Maban. Surveillance efforts have been heightened at the two refugee camps and at the border with South Kordofan to enable timely and early detection of any cases into the country in the event of importation. In this period, 36 cases and 10 deaths were reported from Sudan. With the high number of returnees entering South Sudan coupled with low and weak coverage of routine immunization in the states, the lives of hundreds of children continue being at risk of immunizable diseases. In the reporting period, cases of measles continued to be reported from Lakes, Unity, Northern Bahr el Ghazal, Upper Nile and Central Equatoria states, thus endangering the lives of children not immunized children. Eighty eight (88) suspected cases of measles (incidence rate of 1.07 per 100,000 populations) with one related death were reported across the country in this reporting period. The overall incidence rate increased in week 45 as compared to week 44 from 0.85 in week 44 to 1.07 in week per 100,000 populations. The suspected measles cases were reported from: Lakes (19), two from Central Equatoria state, two from Western Bahr el Ghazal state six from Upper Nile State and 59 from Unity state. As the numbers of people affected by floods continued to increase in most parts of the country, affecting up to , threats of water borne and vector borne diseases continued in areas where floods occurred. Partners however continue putting in place response efforts to minimize any likely occurrence of water borne and vector diseases. Health Situation The data in this section of the report focuses on week 45. In this reporting period, a total of health event and ten (10) deaths were reported from 58% of all the functional health facilities in the country. Malaria accounted for 81% of the reported health events followed by acute watery diarrhoea. Completeness and timelines of reporting in this period was at 58 % and 30% compared to 65% and 44% in week 44 respectively 2

3 Acute Watery Diarrhoea (AWD) A total of 4631 acute watery diarrhoea cases (Incidence rate of 56.1 per 100,000 populations) were reported across the country during this reporting period, with 0 related deaths (CFR 0.00 %). Children below five years of age accounted were more affected. Figure 2 shows comparison of AWD cases and deaths from the ten states in Week 45. Warrap state reported the highest number of cases followed by Upper Nile, Northern Bahr el Ghazal, while Eastern Equatoria State recorded no cases. The number of cases reported this week were much lower than the number of cases reported in week 44, this could be attributed to the drop in completeness of reporting from 65% in week 44 to 58% in week 45. Maternal and child Health The construction of the new maternity theater that was launched in Wau in mid September kicked off and is progressing well. WHO with Support from the Canadian international development Agency (CIDA) is supporting the construction of the new theater as a way of strengthening Emergency Comprehensive Maternal and newborn care services in the Western Bahr el Ghazal state. In Malakal, WHO participated in a five days training on Focused Antenatal Care (FANC) for health workers of all primary health care centers in the state. A total of 20 participants benefited from this training expected to improve maternal and antenatal care services at the lower health facilities. And in Yambio, Western Equatoria State, the organization facilitated in the training of mechanism of labor. The Hon Minister of Health, Dr Riek Gai Kok, Dr Abdi Head of WHO SS Office, Dr Barnabas, UNFPA Representative, Dr Makur, Undersecretary MoH, and other government officials meeting with the Governor of Western Bahr el Ghazal state His Excellency Brigadier Zachariah Hassan and his cabinet (photo:who) 3

4 Expanded Programme on Immunization/Polio Eradication Initiative WHO continued to participate in the Expanded Programme on Immunization technical Working Group meetings. In this period, a similar meeting was held on 15 November 2013 and updates on the National immunization Days III scheduled for 19 November 2013 discussed. The final radio spot for the upcoming campaign was also reviewed and agreed on. Members in the meeting were informed that funds to support the campaign in the states were being processed and in addition to supporting other immunization activities will also be used to train over volunteers and supervisors for the campaigns for the entire country. The campaign targets over 3.3million children 0 5years with the oral wild polio (OPV) vaccine with WHO providing an operational total cost of $1,000, The annualized DPT3 coverage in this period, increased from 29% in August to 55.7% as of this reporting period. The improvement is attributed to among other things WHO s funding towards accelerated defaulter tracing in all counties of up to $500,000. Response During this period, returnees in Western Bahr el Ghazal state were tracked to Alel Chok Way Station. An estimated 900 persons were reported to have reached this destination. WHO together with the Ministry of Health conducted health needs assessment and vaccination for children less than 5 years believed to have missed vaccination was done. To respond to the needs of the returnees, WHO provided all antigen vaccination to about 70 children under-one year and Tetanus for about 30 women all of them new returnees in Aweil town. Interagency Emergency Health kits and anti-malarial kits were also given to the Aweil State hospital to support treatment of the returnees who newly arrived from Kosti as they await to be transported to their final county destinations. WHO through the State Ministry of Health, Northern Bahr el Ghazal State replenished drugs to support Warlang mobile clinic managed by IRC. The clinic supports treatment of internally displaced persons in Aweil East county. Three Interagency Emergency Health Kits and two Diarrheal Disease kits were provided targeting individuals in Maker Anei and Jar Akol. The surveillance indicators for measles in this period showed the incidence rate of 1.08/100,000 and non measles febrile rash illness of 0.75/100,000, which is below standards due to the on-going outbreaks. As a response to the outbreak WHO supported the just concluded response in Yirol East by providing operational costs worth $14,500 and technical support. As of this reporting period, a total of children aged 6 59 months were vaccinated, representing 74% coverage of the targeted population. The final results will however be communicated once compilation is complete. The campaign targeted children aged 6-59 month old. Plans are in place to conduct a measles campaign in Mayom County at the end of November Capacity Building Two trainings on guinea worm disease surveillance were conducted in Wau, Western Bahr el Ghazal state. This targeted guinea worm surveillance teams from Jur River. The training was conducted with the objective of providing updates on the state of guinea worm disease in Western Bahr el Ghazal state and to encourage integration of guinea worm disease surveillance with other surveillance activities like acute flaccid paralysis surveillance. In Torit, Eastern Equatoria State, a total of 40 national immunization day supervisors from all the counties in the state attended and benefited from training of trainers training conducted at the state in this reporting period. In Northern Bahr el Ghazal state, a total of 26 participants including nurses, clinical officers and medical assistants from the five Counties of Northern Bahr el Ghazal State were trained on on polio. In addition 30 other participants including Field Supervisors, Field Assistants and Expanded Programme on Immunization supervisors were trained. 4

5 WHO also supported the Central Ministry of Health to conduct an annual review meeting for integrated disease surveillance and response. The meeting was attended by state surveillance officers from the 10 states, county surveillance officers from selected counties in South Sudan and partners supporting disease surveillance and response at the national level like AMREF and Health pooled fund. A total of 60 participants attended the meeting. Challenges and ways to improve the surveillance system were agreed on during the meeting. As away to strengthen and improve surveillance, a team of 5 state surveillance officers will be facilitated to travel to Uganda to learn how the surveillance system there works. These will in turn share lessons learnt and best practices from the neighboring country with the other surveillance officers at both state and county levels. Coordination and partnership In this period, WHO supported the State Ministry of Health, Eastern Equatoria state to convene a health cluster meeting whose main agenda was to discuss the upcoming national immunization days. Twelve health cluster partners including WHO and other UN sister agencies like UNCIEF attended this meeting chaired by the State Director General. WHO and UNICEF presented the Mop up campaign results to the partners and shared the supervision plan for the upcoming NIDs campaigns. The health cluster partners pledged support in form of transportation and supervision of the campaigns. It was agreed that the State Ministry of Health follows up pledges before the campaign commences. WHO also supported the State Ministry of Health, Eastern Equatoria State to draft guidelines and standard operating procedures (SOPs) for private clinics. The guidelines and SOPs are expected to control the efficiency and quality of services offered at the clinics. The draft of both documents will be reviewed further by a select committee at the state before commencing with its implementation at the state level. In all the states, partners are working closely with the State Ministry of Health, WHO and UNICEF to support the national immunization days campaigns. In Aweil, Northern Bahr el Ghazal State for instance, partners like; Malaria consortium, UNMISS, Heathnet TPO, Concern, IRC pledged to provide vehicles for the campaigns and support the supervision of the NID activities. In response to flooding in Tonj East county, Warrap State, WHO participated in an interagency flood assessment mission. The assessment was conducted to establish the impact of floods on communities and the number of people in need of assistance. It was established that families had their houses destroyed with increased cases of malaria, respiratory tract infections and diahrroea as reported by communities displaced. Given the increase of the 3 conditions above, the nearest health facilities of Ngabagok and Paliang serving the affected persons reported shortage of drugs and health personnel. Plans Continue: Closely monitoring disease trends in all the counties to ensure prompt detection of outbreaks. Extending life saving services to populations of humanitarian concern in need of health assistance. Support to the Ministry of Health at all levels conduct and participate in immunization days. For more information contact: WHO Country Office: Dr Abdi Aden Mohamed, Head of Country Office WHO South Sudan, mohameda@who.int Ms Pauline Ajello, Communication Officer. ajellopa@ who.int Or WHO Regional Office for the Eastern Mediterranean: shoc@emro.who.int Website: 5