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Crisis info #2: Impact on population

On 30th October, the government of South Sudan declared a state of emergency across 27 flood-affected areas. Severe flooding, beyond what is seasonally expected, is affecting hundreds of thousands of people. Many people have had their homes destroyed and are now displaced in search of shelter, or are stranded in outlying areas and cut off from accessing life-saving basic services. The worst affected areas are spread across six counties; Ayod, Maban, Mayom, Nyirol, Pibor and Uror in the Greater Upper Nile Region.

Immediate needs are for safe drinking water, plastic sheeting to be used for shelters for families with damaged or destroyed houses, basic drugs like anti-malarials and food and non-food items.

The South Sudan Meteorological Department (SSMD) and the US National Oceanic and Atmospheric Administration (NOAA) forecast rains to continue through December. In some Pibor and Ulang’s outlying areas water levels are not receding and we are extremely concerned for the communities we are here to support, but also for those we cannot reach. Floods are cutting off peoples’ access to basic services and are restricting the ability of humanitarians to assess and respond to needs.

Map of flooded areas: 

MSF, Doctors Without Borders, South Sudan, Flooding

For those that can reach us for healthcare, we are seeing an increase in water-borne and vector- borne-diseases like acute watery diarrhea, respiratory tract infections and malaria, which are already three of the biggest killers in South Sudan for children under five. We also know that with rising and contaminated water sources comes the risk of outbreaks of deadly diseases like cholera and Hepatitis A. 

It’s not just outbreaks of water-borne diseases like cholera we are concerned about, but also for measles. Up until the week ending 13th October, there were 15 cases of measles reported at Pibor PHCC and now due to the floods, with no cold chain capacity and deteriorating and congested living conditions, the area is a breeding ground for cases to increase.

Impact on population and MSF response

PIBOR

MSF primary healthcare centre with surgical capacity in Pibor town (OPD, IPD, ER, maternity, sexual and reproductive healthcare and laboratory) and support to the MoH with vaccinations. For ease of understanding for broader audiences, it’s OK to use hospital instead of PHCC in our public comms. As a reminder, this PHCC is flooded and is no longer functional. 

Additionally, in two outreach locations in Gumuruk and Lekongole, which are both situated between 30-50 km outside of Pibor town respectively, MSF runs primary healthcare units with referrals to Pibor town and Juba.

MSF, Doctors Without Borders, South Sudan, flooding
Rising waters in MSF’s primary healthcare centre and compound in Pibor town forced us to reduce life-saving activities and discharge patients. Photo: MSF

 

Impacts on Population:

Living conditions for the displaced population continue to deteriorate. The immediate needs identified in mid-October still apply: safe drinking water, shelter, food, and adequate healthcare.

  • With their homes completely destroyed, much of the population is living in makeshift structures, and have been displaced multiple times due to the rising waters.  Up until the week ending 13th October, there were 15 cases of measles reported at Pibor PHCC. Since the flooding, we have seen an additional four cases. With limited cold-chain capacity, and deteriorating and congested living conditions, we cannot exclude the possibility of the number of measles cases increasing.
  • Throughout the area many dead animals are decomposing in water, which has the potential to spread water borne disease, as the same water is used by the population for bathing, washing, or drinking.
  • In many places where water once reached chest-level, it is now at shin-level, and stagnating. This provides a breeding ground for mosquitos and related diseases. MSF fears in the coming weeks the population will experience an increase of malaria above the normal seasonal peak, which already account for 77% of admissions in the Pibor facility during the past four weeks.
  • The flooding has had an immense impact on the population’s livestock. In Pibor, many people have lost their cows, goats, sheep, and other animals, which MSF fears could have a huge impact on this population’s level of nutrition in the coming dry season.
  • The only functioning borehole is the one MSF set up. Access to clean drinking water remains a major concern.
  • Many people outside of Pibor town are stranded on newly-formed islands in the Lekongole area where the water has not receded, or behind chocked river-beds in Gomuruk where aquatic plant life is clogging safe passage.
MSF, Doctors Without Borders, South Sudan, Flooding
An MSF worker paddles a boat through floods in Pibor, Boma state, in the Greater Upper Nile region of South Sudan. Photo: Samir Bol / MSF

Impact on Operations:

Six weeks on, Pibor and surrounding areas are still flooded. The riverbank itself has not receded, the MSF hospital is still underwater and will require serious rehabilitation. The water is not yet receding in Lekongole and many villages in the surrounding areas.

Though water is receding in Pibor town, forecasts predict more rains in Boma State and southern Ethiopia in December and flood risks remain high.

  • After our hospital became flooded in mid-October, we relocated some of our activities to a temporary tent structure on higher ground, providing primary healthcare and maternal healthcare in a 14-bed tent structure protected by a community-built wall to keep flood-water from breaching the last strip of dry land. We are now continuing our reduced activities in a slightly larger tent facility.
  • Initial plans to set up a modular field hospital (MFH) flown in from Brussels to Juba have still not materialized, as the constantly evolving situation on the ground meant identified locations became water-logged, and an MFH was no longer a viable response. We have still not been able to locate a suitable dry space with enough room for the hospital.
  • Maria Teresa de Magalhaes, an emergency coordinator who has been present in many dire floods contexts over her twenty-five years with MSF, says that she has never experienced such extreme constraints on physical access and space.
  • Pervasive black cotton soil has severely impacted movements both impeding access, and creating an impossible situation for the tented hospital: “Access is the biggest issue, cleanliness is almost an impossibility," Tyson Hegarty, MSF nurse activity manager, says of the plastic flooring in the facility.
  • The water level has not significantly receded in Lekongole town and area. There, the population is stranded, oftentimes with their surviving livestock, on small islands peeking out of the flooded land. MSF is deeply concerned about these individuals’ access to food, water, and healthcare, as they are accessible only by boat, along highly congested river bed full of vegetation.
  • Flourishing aquatic grasses now clog the river between Pibor and Gomuruk, and make it nearly impossible to navigate. While there is enough room to land a helicopter, many actors are not able to reach the stranded communities.
MSF, Doctors Without Borders, South Sudan, Flooding
On an aerial assessment from Bor to Pibor, areas can be seen completely submerged by flooding. Photo: MSF

MSF response:

  • MSF’s initial response involved relocating activities to another location on higher ground in a temporary tented facility.
  • As of 03/11/2019, the MSF team set up a water station so access to clean drinking water has improved. 
  • In the last weeks, MSF expanded their tent camp from the initial 14-bed set up to a 27-bed tented operation (16 in the IDP, 1 delivery bed, 5 post-partum, 2 in maternity, 2 in isolation) and currently sees 80 OPD consolations per day, plus an average of 10 antenatal health patients, about half the weekly OPD consultations at the Pibor PHCC. This can both be attributed to access constraints on the part of our patients, and limitations in space. Our national staff have been running the Pibor response with incredible energy and resilience.  Many of whom have been displaced themselves three or four times during this flooding. 
  • Mobile outreach activities continue in Lekongole and Gomuruk, but the number of patients being seen is still much lower than the pre-flood average, indicative of people being cut off of care, or MSF not being able to operate at its full capacity

LANKIEN

MSF hospital in Lankien, including inpatient and outpatient care, maternal care, obstetric ward, treatment of HIV, TB, and Kala azar. Primary healthcare clinic in Pieri, Maudit and Yuai. Sexual and gender-based violence programme. Vaccinations. For ease of understanding for broader audiences, it’s OK to use “hospital” instead of PHCC in our public comms.

Impact on population:

The assessments carried out around Lankien (10km catchment area) at the beginning of the month had identified 2,000 households needing urgent non-food items, and estimated 50-60% of the population was displaced and living amongst the host community.

  • Many houses have collapsed, or are partially damaged, resulting in displacement of the population
  • Major destruction of crops
  • People being forced to drink stagnant water, due to lack of access to alternative sources of clean water
  • Access to health facilities is greatly compromised, as is access to the population for mobile outreach teams who now carry out their assessments on foot
  • Malaria and respiratory tract infections are on the rise
  • The waters have been constantly receding since the beginning of the month, and some internally displaced people (IDPs) have started to return home.
MSF, Doctors Without Borders, South Sudan, Flooding
The local population in Lankien help MSF put together and distribute nonfood item (NFI) kits for those affected by the flooding. Photo: Arie Van der Stel/MSF

Impact on operations: 

  • Luckily, the flooding has had no physical impact on the MSF hospital in the compound. The Lankien airstrip is always problematic in the rainy season, but access is still possible via helicopter.
  • Walking is the only way to reach the most vulnerable people for assessment, planning, and response.

MSF response:

  • The teams distributed 1,958 nonfood items (NFI) kits to the most affected by the flooding, including those already living in tented IDP camp.
  • Now that the NFI distribution is completed, teams are focusing on medical needs, WatSan (water and sanitation) as well as surveillance.
  • Last week, the medical teams conducted 220 consultations in Thol and Majok, mainly treating malaria, lower respiratory tract infections, acute watery diarrhea, eye and skin infections.
  • Assessments on the needs of the population in other areas around Lankien continue.
  • WatSan teams have repaired one non-functional borehole to ensure access to water for the population, and are planning to repairs others
  • Community based surveillance and mobile clinic activity is rolling out this week to be able to monitor the health status of communities with no or hindered access to health services due to flood disaster.

 

ULANG

MSF secondary healthcare facility. 24/7 inpatient department services, 24/7 emergency room. Maternity 24/7. HIV/TB/KA program.  Emergency referral for urgent medical cases to Malakal, Juba and other facilities. Active disease surveillance and scanning of possible emergencies. For ease of understanding for broader audiences, it’s OK to use “hospital” instead of PHCC in our public comms.

Impact on population:

According to IRNA, more than 25,000 people in the Greater Ulang area were affected by the floods, and around 15,000 were displaced. Many families have lost cattle, livelihoods, houses and are now mostly relying on fishing for food.

  • Communities along the Sobat River, outside of Ulang, have been the most severely impacted.
  • Despite it hasn’t rained for more than two weeks, the water level keeps increasing in many of the villages due to heavy rains in neighboring Ethiopia.
  • The river has flooded and created a big swamp. Some villages remain surrounded by water and unreachable by boat due to high grass in the water. Communities have concentrated in small elevated areas that can host just a few hundred people.
  • Many people are drinking contaminated water from the river or stagnant waters.
MSF, Doctors Without Borders, South Sudan, flooding
A flooded village along the Sobat river. Photo: Nicola Flamigni/MSF

Impact on operations:

The MSF hospital in Ulang was temporarily flooded, but this did not affect our operations and water was pumped out within one day.

  • Water remains dangerously close to the hospital. On 25th November, the distance was approximately 10 meters.

MSF response:

  • The team distributed a total of 748 NFI kits in the villages of Pobor, Wechnyath, Wechkoari, Wechlita.
  • They installed two 15,000-liter bladders for water treatment in Pobor and Wechkoari, and are planning to install a third one.  
  • Two mobile clinic teams are carrying out daily consultations along the Sobat river reaching villages as far as 3-hour by boat away. Activities include treatment for malaria, respiratory tract infections, diarrheal diseases, vaccination, Mid-Upper Arm Circumference (MUAC) screening for malnutrition and health promotion for hygiene and prevention of water-borne and vector-borne diseases.
  • The mobile teams are also doing referrals of critical cases to the MSF hospital in Ulang
  • MSF is also offering mental health support as many people have lost everything they had.