Crisis in western Sudan is delaying help for south of countryBMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7454.1456-c (Published 17 June 2004) Cite this as: BMJ 2004;328:1456
Last month's outbreak of Ebola haemorrhagic fever renewed concern that decades of war and neglect have made southern Sudan a reservoir for exotic diseases, yet plans to rebuild the country's shattered health service in the wake of peace talks are being undermined by the crisis in Darfur, western Sudan.
The outbreak occurred just as an agreement was being concluded to end 21 years of conflict, leading to renewed urgency in plans for postwar reconstruction. UN secretary general Kofi Annan told the Security Council: “Generations of Sudanese people have known nothing but the terrible consequences that perennial war has wrought on the country, including large scale death and destruction, mass internal displacement, refugee crises, and famine.”
Most of the destruction has been wrought on the south, where millions of people have been displaced and millions more rely on airdropped relief food.
There are only 1500 hospital beds for some eight million people in rebel controlled areas. Healthcare is almost entirely provided by outsiders—45 different international agencies—but provision is unequal, says Unicef. Equatoria has 26% of the population and 48% of the facilities, whereas Bahr el Ghazal has 49% of the population and only 21% of the facilities. Most of the Upper Nile, site of the most chronic malnutrition, is currently off limits to humanitarian operations.
“Children in southern Sudan are routinely sick, and one in four die before reaching their fifth birthday,” said Ben Parker, a spokesperson for Unicef. “Only about half the population is in easy reach of even a basic health post. Malnutrition is rife—the worst wasting rates in the world—immunisation ratios are low, and women have a one in nine chance of dying in pregnancy or childbirth,” he added.
Malaria is most common illness, followed by diarrhoeal infections, respiratory ailments, intestinal parasites, eye and skin diseases, and sexually transmitted diseases. Others include trachoma, onchocerciasis, elephantiasis, sleeping sickness, Kala azar, tuberculosis, and leprosy.
As well as incubating Ebola and a still unidentified “nodding disease” that has killed or paralysed scores of children, the war has thwarted attempts at global eradication of Guinea worm: Sudan currently has 80% of the world's caseload.
Last month the US Agency for International Development announced a new five year $34 million health transformation programme for southern Sudan. Yet release of development funding is currently on hold pending resolution of the conflict that has engulfed western Sudan.
UN deputy humanitarian coordinator Bernt Aasen warns: “Over the past month, the situation in Darfur has taken all the attention of the international community and rightly so, but this may actually have a negative impact on the resources flowing into southern Sudan. We may find ourselves in a very difficult humanitarian situation if we are not able to scale up our activities.”
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