Deadliest Diseases in South SudanSouth Sudan is a country in North Africa, bordering the Central African Republic, Sudan, Ethiopia, Kenya, Uganda and the Democratic Republic of the Congo. According to the World Bank, the world’s youngest country is experiencing a humanitarian crisis and two-thirds of the 11.4 million population is in need of humanitarian assistance. Of note, the World Health Organization states the average life expectancy is only 57 years of age. The rate of maternal deaths is 789 per 100,000 live births, 37.9 for neonatal deaths and 90.7 per 1,000 live births for children under 5. Communicable diseases are the leading cause of death, with malaria, diarrhea and pneumonia being the biggest killers of children under 5. Below are the deadliest diseases in South Sudan.

The 5 Deadliest Diseases Impacting South Sudan

  1. Pneumonia. In 2019, UNICEF reported that one child dies every hour from pneumonia, leading to 7,640 deaths of children under 5. In 2018, 20% of deaths among children under 5 were caused by pneumonia. The disease causes suffocation by the lungs filling with fluids, and is caused by infection from bacteria, viruses or fungi. In places with malnutrition, inequality, high levels of air pollution and unsafe water, pneumonia is likely to be found. It can be avoided by vaccines, having safe water to drink, handwashing and treatment of antibiotics.
  2. Malaria. According to Malaria Consortium South Sudan, “approximately 95% of South Sudan is endemic of malaria, with high transmission in the country throughout the year.” This translates to 2.3 million people who are at risk of malaria nationwide. Of note, 50 to 70% of all health facility visits and hospital admissions are caused by malaria. Its symptoms appear up to two weeks later, which include having a fever, headache and chills before progressing. The disease is caused by parasites and mosquitoes through bites but can be treated and prevented by vaccines, chemotherapy and vector control.
  3. HIV/AIDS. UNAIDS states that 2.5% of 15 to 49-year-olds have HIV in South Sudan as of 2020. One in four people is knowledgeable about their HIV status, whereas only 18% of people are being treated. UNAIDS has a 90-90-90 target of supporting people with HIV, and over five years has trained 69 peer educators and navigators, given out over six million male and female condoms, and over 500,000 water-based lubricants, and has diagnosed and treated 1,271 HIV cases after thousands of gender-based screenings as of 2021. HIV could lead to AIDS if left untreated, and is transmitted by bodily fluids, childbirth and using unsafe or shared needles. There’s currently no cure, but it can be treated by antiretroviral drugs and therapy.
  4. Cholera. In 2014, South Sudan’s capital city of Juba had an outbreak of cholera that hit multiple counties. There were 586 confirmed cases with 22 total deaths. The Ministry of Health created the Cholera Response Task Force to “strengthen the coordination of the outbreak response and support the emergency response task forces in all 10 States.” Cholera is caused by unclean water in unsafe sanitation areas where bacteria cause acute watery diarrhea. It can be treated by oral rehydration solution and prevented by oral cholera vaccines. Without treatment, cholera can lead to death within hours.
  5. Hepatitis E. This disease impacting South Sudan has been on the rise since 2014, with cases increasing from 564 in 2020 to 1,143 in 2021 with five deaths. Males aged 15 to 44 years had the most cases, then male children ages one through four, and lastly, females aged 15 to 44 were also reported to have the greatest number of cases. Hepatitis E is spread through fecal-oral contact that progresses into liver disease. Internally displaced-people camps and pregnant women are most at risk in South Sudan.

Looking Ahead

To combat the deadliest diseases in South Sudan, the Ministry of Health created a five-tier plan called the “National Health Policy,” running from 2016 to 2026. The first tier reduces maternal and child death rates by introducing more technical equipment and professional staff members. The second tier is to prevent all communicable, non-communicable and tropical diseases. The third tier improves emergency management, surveillance and recovery. The fourth tier supports specific-health needs. Finally, the fifth tier reduces environmental factors and promotes awareness of social health factors.

– Deanna Barratt
Photo: Flickr

Mental Health in South SudanDecades of war have had a notable impact on mental health in South Sudan. Few resources are available to help those suffering from trauma and stigma deters people from seeking mental health assistance. Despite how dire the situation is, organizations are stepping up to improve mental health within the young nation.

A History of War

Beginning in 1955, South Sudan has fought three civil wars. The first lasted from 1955 to 1972, the second from 1983 to 2005, and the third, starting after the nation’s independence in 2011, lasted from 2013 until 2018 when warring parties agreed to peace deals. The third civil war alone led to about 400,000 deaths and 4 million displacements.

Even after the agreement, violence remains common. Communities continue to fight “over land, cattle and grazing” and the fact that “political and military leaders” provide locals with weapons further exacerbates the violence. The violence between South Sudanese communities has led to “hundreds of thousands” of deaths and displacements across the country, adding to the nation’s collective trauma.

Mental Health in South Sudan

Information on mental health in South Sudan is limited, but South Sudan Health Cluster estimates indicate that about 5.1 million of the nation’s 11 million people are affected by the war. Specifically, 204,000 suffered severe mental health conditions and 1,020,000 experienced “mild to moderate mental health conditions.” These conditions include post-traumatic stress disorder (PTSD), anxiety and depression.

In 2015, the South Sudan Law Society and the United Nations Development Programme conducted a study that found that out of a group of 1,525 individuals across six states, about 41% met the criteria for PTSD. Despite how widespread mental illness is in the country, less than 1% of people are receiving the necessary treatment, according to the World Health Organization in 2017.

The Complex Mental Health Situation

There are only three practicing psychiatrists and 29 practicing psychologists in the entire country, all of whom are positioned in the capital city of Juba.

Furthermore, stigmas and taboos stand as barriers to addressing mental health in South Sudan. Many believe mental illness “runs in the family,” so if one member is diagnosed, then the rest become social outcasts. In fact, “Most communities believe in supernatural possession or punishment by higher powers, as opposed to accepting a mental illness diagnosis,” South Sudanese psychiatrist Dr. Atong Ayuel tells Al Jazeera. A possession is preferable to mental illness, so people seek assistance from religious institutions instead of mental health care practitioners.

Some believe faith is the cause of their recovery rather than treatment. Paradise Akaag Henry, a schizophrenic patient under Dr. Atong’s care tells Al Jazeera the reasons for her recovery. “First of all Jesus, and then Dr. Atong.”

Mental Health and Poverty

Mental illness and poverty are linked in several ways. Those living without treatment may not function well in their community and receive “limited employment opportunities,” pushing them further into poverty. Adolescent pregnancy and domestic violence rates tend to increase in circumstances of poverty.

In Glasgow, Scotland, a study found that 7.3% of 4-year-olds born into poverty showed “abnormal social, behavioral and emotional difficulties” compared to 4.1% for those not born into poverty. This prevalence increased by age 7 to 14.7% for impoverished children and 3.6% for wealthier children.

Also, the stresses from poverty, like long work hours, can affect cognitive function, which can lead to poor decision-making and increased susceptibility to mental illness.

A 2013 research study published in the journal Science found that the psychological burden created by poverty is the equivalent of “losing 13 IQ points.”

Action to Improve Mental Health in South Sudan

To fight mental illness in South Sudan, Médecins Sans Frontières (MSF), a nonprofit organization started in 1971 by medical professionals, “launched an emergency intervention in Tambura County in December 2021″ after large-scale violence plagued the area.

MSF Mental Health Activity Manager Ariadna Alexandra Pérez Gudiño and a group of four counselors from Tambura set up “community-based mental health services” across displacement camps. These services included “one-to-one counseling sessions, referral pathways for those in need of further treatment or medication and group psychosocial health sessions.”

Psychosocial group sessions included creative activities such as dancing, singing, creating jewelry and drawing. The psychosocial activities are particularly helpful as the sessions give residents an opportunity to process their trauma together. Between January and July 2022, MSF held “more than 11,500 individual and group” sessions across seven projects taking place throughout South Sudan. In June 2022, with the situation improving, MSF handed over its mental health programs to local health care workers.

Healthnet TPO

Healthnet TPO, established in 1992 by MSF, aims to “bridge the gap” between emergency aid and “long-term structural development.”

Its program, called Leaders of Peace, works to provide psychosocial and self-care services for women subjected to gender-based violence, alter society’s attitude toward women to improve gender equality and increase women’s participation in “leadership, decision-making and peacebuilding processes.”

The specifics include establishing community-based mental health programs across 50 communities in five South Sudanese states and placing 50 trained individuals in 50 women groups to manage gender-based violence cases, community engagement, mobilization, mental health advocacy and more. These individuals will also “strengthen different community groups” and advocate for mental health services and the passage of gender-based violence laws. The program will last from 2021 to 2025.

Through continued mental health efforts, the conflict-affected nation of South Sudan can move past its collective trauma and look to a brighter future.

– James Harrington
Photo: Wikimedia

Poverty in South Sudan
Following nearly 50 years of civil war, the newly divided countries of Sudan and South Sudan remain in ongoing economic recovery. Although conflict sets the stage for poverty in South Sudan, the young country’s lack of educational opportunities perpetuates the problem. As of 2017, a jarring 72% of primary school-aged children in South Sudan do not attend school. Of these 2 million children, 400,000 are out of school due to displacement and chronic insecurity. Here are seven facts about education and poverty in South Sudan.

7 Facts About Education and Poverty in South Sudan

  1. More educational funding would reduce youth crime involvement. It is no secret that a quality education prevents crime activity among any youth population. However, extreme poverty in South Sudan compromises the quality of most of the country’s schools. The absence of extracurricular club offerings contributes to an ongoing cycle of violence in South Sudan. On the other hand, schools that UNICEF funded benefitted from student governments, peace clubs and organized volunteer activities. UNICEF also funded the South Sudan Youth Development Policy, which the government of South Sudan later developed. These programs effectively build peace and reduce youth crime in strained communities. More widespread funding for such programs would further prevent youth violence and armed conflict.
  2. Sudan’s distinct educational tracks limit the number of qualified teachers. To account for the poverty most school-aged children experience, South Sudan implemented an alternative education system. In an effort to reduce the long-term cost of education, this system condenses an eight-year curriculum into a four-year program. This program instructs students in English, which excludes many qualified teachers who received training to teach in Arabic. Although this program is more accessible, this exclusion compromises the quality of education students can gain.
  3. Children cannot physically attend one-third of schools in South Sudan. Long-standing political conflicts in South Sudan have damaged and destroyed over one-third of schools. These schools rely on the assistance of foreign aid organizations, such as USAID, in order to redevelop into functional institutions. USAID alone has provided more than 514,800 conflict-affected children with makeshift learning spaces since 2014.
  4. Poverty-ridden families rely on agricultural work. Many school-aged children in rural South Sudan raise cattle in pastoral communities rather than attending school. A 2013 study found that parents in cattle-keeping communities valued practical skills (such as cattle treatment and milk production) over formal education. Since agricultural income accounts for a child’s immediate needs, many families do not see formal education as a practical option. Because funding for schools often relies on attendance and retention rates, funding falls particularly low in pastoral, non-urban areas. While the education sector itself does not prioritize this problem, donors like USAID and FAO fund more flexible education options for pastoral communities.
  5. Girls have to overcome more obstacles to obtain an education. Young women living in poverty often drop out of school to pursue arranged marriages because of financial, cultural and religious obligations. As a result, only one-sixth of women are literate in comparison to two-fifths of men. However, children born to educated mothers have a 50% higher chance of survival. In turn, prioritizing young women’s education and literacy is vital. Though more work is necessary to enroll more girls in school, donor initiatives such as DFID’s Girls’ Education South Sudan (GESS) have brought more attention to the issue.
  6. Socioeconomic disparities impact access to education and future employment. In a study by Learning for Peace, representatives expressed that nepotism and tribalism often determine access to education, training opportunities and jobs. This results in unequal opportunities across states, which increases tension within the youth population. One youth representative said that “Youth who have their relatives in those places, they have those opportunities [and] it creates a gap […]. This brings conflict […], especially as a young country which has come out of war, where people have many expectations to get money to sustain themselves.” The concentration of opportunities in particular states, such as Juba, affects the cycle of poverty in South Sudan.
  7. Inclusive learning requires more funding. The government of South Sudan invests minimally in the development of education. This lack of resources prevents the implementation of an inclusive education curriculum based on the language of instruction (Arabic or English) and curriculum content (Christian or secular). Curriculum development at the state level is slowly establishing a more inclusive national identity for students in South Sudan, though more work is necessary at the county level. Such work will further increase the inclusion of different religions, cultures and histories in South Sudan’s schools.

Ultimately, funding education in South Sudan could revive the country’s economy and, more importantly, ensure that more children survive. It is imperative to support the 2 million children who cannot afford an education or who lack access to well-funded schools. In order to help break the cycle of poverty in South Sudan, foreign aid and other investments must provide much-needed educational resources.

Stella Grimaldi
Photo: Flickr

Literacy Rates in South Sudan
The Republic of South Sudan, more commonly known as South Sudan, has one of the lowest literacy rates in the world. It is a very young nation, having only declared independence from the Republic of Sudan in July 2011. However, recent data shows that only 26.8 percent of South Sudanese people aged 15 or older are literate. Additionally, while 35 percent of men can read and write only 19.2 percent of women possess these important skills. The government has created several initiatives over the past few years to improve literacy rates in South Sudan.

Factors Affecting Literacy

One reason literacy rates in South Sudan are so high is the fact that approximately 2 million, or about 70 percent of children in South Sudan are out of school, mostly young girls. Instead of attending primary school, children often work alongside their families for survival.

Implementing quality literacy programs for children is also costly, and South Sudan has been struggling to fund equal opportunities for all students. For the many who are unable to communicate via writing or consume written media, radio is often a popular alternative for getting the news.

Efforts to Improve Literacy

In recent years, the government has worked to improve literacy rates for both children and adults in South Sudan. For school-aged children, The General Education Strategic Plan, 2017-2022 has been proposed. Also referred to as the Strategic Plan, it has three primary goals: “to improve the quality of general education; to enhance the management capacity of senior staff of the Ministry, State Ministries, the County Education Department and affiliated institutions; and to promote Technical and Vocational Education and Training (TVET) to improve the employability of youth and adults in the next five years.”

According to the Strategic Plan, the government’s alternative education system (AES) has three programs working to improve literacy rates and overall educational quality in South Sudan:

  • The Accelerated Learning Program (ALP) is designed for children ages 13 to 17, but people up to age 25 are allowed to attend.
  • The Community Girls’ School (CGS) is intended for primarily young girls who have not yet reached grade 5; and
  • The Pastoralist Education Program (PEP) is designated for both children and adults in pastoral areas of the country.

As gender disparities are significant, specific efforts have been created that focus on providing education for Sudanese girls. In addition to the Community Girls’ School, funding from an organization called Girls’ Education in South Sudan (GESS) will help more women and girls be able to attend school, thus improving the literacy rate among South Sudanese girls and women.

There are also two programs that have been specifically created for adults who cannot read or write: the Basic Adult Literacy Programme (BALP) and the Functional Adult Literacy Program (FALP). Intensive English courses (IECs) are included in these programs, giving participants the opportunity to improve their skills with the English language.

Moving Forward

Addressing low literacy rates in countries such as South Sudan is crucial to reducing global poverty. Without the ability to read or write, communication skills are weakened and employment opportunities are limited. Therefore, giving people the chance to access to an improved education such as literacy skills lowers the chance of one being in poverty and gets them on the path to an overall higher quality of life.

A. O’Shea
Photo: United Nations

How the Media Misrepresents South Sudan
South Sudan has spent the last five years locked in brutal civil war. A quick Google search regarding South Sudanese current affairs indicates how the media misrepresents South Sudan. It’s clear that the global news cycle focuses heavily on the darkest moments of this conflict. Al Jazeera’s South Sudanese frontpage is plastered with the following soundbites: “South Sudan: Aid Agencies Struggle to Reach those in Need,” “‘Sick and Hungry’: The Human Cost of South Sudans Civil War,” and “Maternal Death Rates in South Sudan One of World’s Highest.” Similarly, the New York Times starkly reminds its audience that in South Sudan “A Never-Ending Hunger Season Puts Millions in Danger.”

Clearly, the South Sudanese civil war has caused a great deal of suffering. Generally, though, large news agencies provide less airtime to cover the good and instances of perseverance that exist in the face of this struggle. Without paying close scrutiny to such hope-filled details, it’s not difficult to see how the media misrepresents South Sudan. It’s difficult to realize that amongst the seemingly endless stories of pain there are moments of hope. Here are a few examples.

South Sudanese Youth Soccer

In the winter of 2018, the South Sudan Football Association (SSFA) held a youth tournament in Juba, a major South Sudanese city. The event took place over the course of series of days, one of which was national Unity Day — a South Sudanese holiday dedicated to the promotion of togetherness in the country.

Maria Dudi, the minister of sport in South Sudan, had high hopes for the event, saying “The main objective of National Unity Day is to promote the integration of diverse populations through sports of fair play and sportsmanship.” The event was supported by Japanese International Cooperation Agency, a branch of the Japanese government dedicated to developmental assistance in struggling countries.

On May 18, the Facebook page for the SSFA posted regarding intensified efforts to train a new cadre of young referees so that they are capable of operating on the world stage. These efforts, alongside youth tournaments, indicate a renewed hopefulness that South Sudan’s passion for soccer can be used as a vehicle for cooperation and global recognition.

Natural Resources

South Sudan currently faces tremendous economic challenges that are only compounded by the presence of guerrilla warfare throughout the country. Despite this, South Sudan possesses significant potential for economic development due to its abundance of natural resources.

South Sudan houses large oil reserves and vast resource-rich forests. This abundance of resources further highlights how the media misrepresents South Sudan — it’s uncommon for large-scale news agencies to remind their audiences of the economic potential of a nation supposedly destitute and wartorn.

At present, foreign involvement in South Sudan primarily focuses on humanitarian aid rather than investment, as immediate civilian welfare is the highest priority. With the help of the U.N., and the stability provided by eventual peace conferences, South Sudan has the resources to garner the attention of foreign investment, which in turn could slowly bolster its economy.

Promise of Peace Talks

A variety of major players in the African world have stepped in to contribute to South Sudanese peace efforts. Kenyan politician Raila Odinga has offered to mediate and broker peace talks between South Sudan’s rival constituents, with the aid of the Intergovernmental Authority on Development (IGAD). Odinga has plans to meet separately with each constituent prior to any official peace conference. South Sudanese president Salva Kiir has been openly receptive to the notion of a peace conference with his rebel rival, Dr. Riek Machar.

Additionally, the U.N. has entered the fray and imposed a June 30th deadline for the talks. Another deadline looms ahead on July 1, which is the African Union Summit slated to be held in Mauritania. While the past few years have housed a number of recent failed South Sudanese peace talks, these recent events hold a renewed sense of positive momentum and hope for the future.

– Ian Greenwood
Photo: Flickr

South Sudan
Child soldiers were brought to the attention of the American public in 2012 when the “KONY2012” campaign, aimed at dismantling a Ugandan warlord, soared in publicity. However, children being used in combat is not new to various regions of Africa, including South Sudan.

Children in Combat

In 1983, civil war broke out among the Sudanese people, eventually creating in 2011 the countries known today as Sudan and South Sudan. This war led to the separation of families, murders, poverty, lack of educational resources and most notably, South Sudan child soldiers.

According to the International Rescue Committee, the number of children fleeing South Sudan in 1985 to escape recruitment as soldiers in the civil war was as high as 20,000. This number is shockingly high with a 1985 population of only five million in South Sudan. Children fled to neighboring Ethiopia only to die from hunger, dehydration, crossfires and wild animals along the way.

Draws of South Sudan’s Military

Due to outcomes associated with the war, South Sudan has been unable to properly maintain nutrition among its citizens in recent years. Often, children are only guaranteed meals and housing if they enlist in the South Sudanese military, leaving them with the choice between staying unarmed, educated and hungry, or armed, fed and uneducated. Children may choose to join the military simply as a means of survival.

South Sudan child soldiers are known to be used in every way that an adult soldier would be used. Children are given and taught how to use assault rifles, engage in direct combat (as spies), and serve as cooks for troops among other activities.

The prevalence of South Sudan child soldiers seemed to dissolve throughout the early 2000s; however, over the last several years, the numbers have begun to creep up again. In 2013, South Sudan ended a several-year-long ceasefire when tensions between different ethnic groups rose.

Hope for South Sudan

When the war resumed, the children of South Sudan were again recruited for combat. This sparks a series of issues for the South Sudanese people over the next years, such as infrastructure instability, economic poverty, food shortages, violence and poor education.

Although the situation in South Sudan may seem bleak, there is very real hope. South Sudan is rich in diversity with many different religious practices and ethnic cultures. While the tensions between different ethnic groups have instigated a large amount of violent tension, the different groups each bring something unique to the cultural brand of South Sudan.

A history of aid workers present in the country assists the country’s development and recovery from its civil wars. The next few years will be a pivotal time in shaping the future of the Republic of South Sudan and its children, so time will tell if child treatment improves.

– Alexandra Ferrigno
Photo: Flickr