South Sudan

SOUTH SUDAN

With the civil war entering its fifth year, the UN Office for the Coordination of Humanitarian Affairs estimates seven million people in South Sudan need humanitarian assistance.[1] Continued food insecurity, currently affecting 5.69 million people in South Sudan, and the threat of a repeat famine further compound this ongoing humanitarian crisis.[2]

Only roughly a quarter of health facilities in South Sudan have infrastructure that can be considered in good condition, and NGOs facilitate the provision of the majority of health care in the country.[3] Basic health indicators are either extremely poor or are missing entirely due to lack of reporting. Maternal mortality is one of the highest in the world, and the risk of outbreak of diseases such as measles and cholera is imminent due to crowded living conditions in displaced persons camps and lack of access to routine health care.[4]

In 2017, there were at least 37 events that affected health care—including 20 attacks on health workers and 11 on health facilities. In addition, provision of services was affected through staff evacuation and program suspensions due to the security situation. Two specific access constraints were reported. In the majority of cases, there is no information on the perpetrators of these attacks, although they include both state actors and non-state armed groups. Perpetrators attacked health workers and facilities all over the country, including in Unity, Upper Nile, Western Bahr el Ghazal, Jonglei, Eastern and Western Equatoria, and Eastern and Western Lakes states.

Perpetrators looted 11 health facilities, totally destroyed two, and damaged three. In addition, armed actors entered a health facility in at least one instance.

Perpetrators kidnapped, assaulted, arrested, intimidated, injured, and murdered health workers in South Sudan in 2017. Six health workers were kidnapped, 11 injured or assaulted, six arrested, and there were three instances of health workers being threatened or intimidated. However, the most prevalent attacks on health workers were those resulting in their death: perpetrators killed a total of 12 health workers.

On September 8, gunmen shot and killed Lukudu Kennedy Laki Emmanuel, an ICRC staff member. The gunmen ambushed and fired at a convoy delivering essential aid in Western Equatoria state, hitting the vehicle he was driving despite it being clearly marked with the Red Cross emblem. As a result of the attack, the ICRC suspended operations across one-third of the country, the largest shutdown in operations by any aid group since the start of the civil war. Over 22,000 people in desperate need of aid were affected.[5]

In a separate event characterizing the nature of attacks on health care in South Sudan, an MSF clinic in Pibor was violently attacked for the second year in a row. In the early morning of July 13, six to ten men armed with guns stormed a 36-bed health facility that provides over 6,300 consultations a month to people needing outpatient, inpatient, and maternity care, as well as laboratory services. This attack resulted in two staff members being injured and forced the evacuation of other staff. Despite being the only organization providing health care in the area, MSF was forced to reduce services. “We are doing our best to provide essential medical care to people in Pibor who desperately need our assistance, but we need to be able to work in a safe environment,” said Fernando Galvan, deputy head of mission for MSF in South Sudan. “We also need our patients to feel safe when they come to the clinic. They should never have to worry about violent attacks happening within a medical facility. Hospitals must be safe places for patients and for medical workers providing them with healthcare.”[6]