SOUTH SUDAN

Information last updated: 11 August, 2020

  • Population: 11.2 M
  • Population +65 yo: 3.4%
  • GDP Per Capita: 1,119 USD
  • Informal employment: 87% (2018)
  • First registered case: 5 April
  • Hospital beds: N/A

Status

  • Community spread since: May 23
  • # of confirmed cases: 2,470 (as of August 10)
  • # of deaths: 47
  • # of recovered: 1,175
  • Level of confinement and until when: all educational activities suspended for 6 weeks (Since March 20), nighttime curfew from 8 pm-6 am installed, domestic air and land transportation suspended (April 14)

Response set up and capacity

On paper, the government of South Sudan has been in charge of responding to the COVID-19 crisis, however from a health standpoint, due to years of neglect and underinvestment, there is currently a fragile health system that lacks government ownership and is deeply dependent on international donor funding. An estimated 90% of all health services are provided by NGOs.

Although the death toll in the country is significantly lower than the deaths from the ongoing intercommunal violence and morbidity of existing disease, there is great risk of a collapse in the health system if appropriate measures are not implemented to prevent the spread. Currently, South Sudan has one of Africa’s most fragile health systems with limited health coverage and some of the world’s worst performing health indicators. For example,  close to 71% of the population lives more than 5km away from the nearest health facility, 13% of primary care facilities were found to be non-functional and there is a severe shortage of qualified medical practitioners. 

Today, approximately 3.6 million people, including 521,000 Internally Displaced People (IDPs) and 300,000 refugees are in need of basic health care services. This means that if there is failure to maintain essential medical services during the COVID19 epidemic, these populations could be at great risk of dying from vaccine-preventable and treatable conditions. Furthermore due to decades of conflict there are physical and deep mental traumas in millions of South Sudanese making them very vulnerable in the current situation. This is true especially for people who already have pre-existing mental illnesses, are living in conditions of poverty or are health workers. Therefore, the current COVID crisis could aggravate the mental health situation by limiting their ability to cope with stressors.

Nonetheless there have been a number of measures taken to prevent the community spread of the virus such as information and awareness campaigns, movement restrictions, social distancing, and public health measures. These measures were facilitated by the adaptation of the equipment and standard operating procedures that had been prepared for a potential outbreak of the Ebola virus. However the enforcement of these measures have faced problems such as the non-respect for lockdowns, misinformation and lack of community consultation and involvement in implementing or coming up with prevention measures.   

Given this context of a country with poor health indicators and an already very limited health access, it is essential to maintain access to and delivery of life-saving health services and vaccinations especially reproductive health services.    



Stakeholder Mapping

Entities / Organizations

• Transitional Government of National Unity (TGoNU)
•National COVID-19 Task Force
• Ministry of Finance and Planning
• First Vice-presidente
• National Committee on COVID-19
• University of Juba

Additional actors

• African Development Bank
• UNDP
• Japan
• USAID
• EU
• World Bank
• IMF
• UNICEF

Mitigating factors - What is being done?

For more information, see the timeline below: 

  • March 20- Schools and universities suspend classes, public events and gatherings are suspended for 6 weeks.
  • March 24- Closure of the Juba International Airport to international passenger flights. Closing of border crossings except for cargo.
  • March 25– Nighttime curfew from 8 pm to 6 am is established.
  • March 27- Norther Upper Nile region is placed in lockdown for 14 days following an escape from quarantine of 500 people in Sudan. 
  • March 29- Transportation is restricted as boda-bodas (motorbikes) are banned from circulating, and buses are allowed to operate in half-capacity. Businesses are ordered to cease operation with the exception made for essential commodities, such as food, medicine and fuel.
  • April 5- First case of coronavirus was detected in a UN worker who travelled from the Netherlands in February. 
  • April 14: domestic air and land transportation suspended.
  • May-  60 ventilators were ordered in addition to the existing 4.
  • May 8-12– restrictions start being lifted despite rising number of cases with air transport resuming on May 12.
  • May 13- two confirmed cases are detected in the UN PoC site in Juba. 
  • May 14- first COVID-19 reported death.  
  • May 18-19: High level officials including 3 out of 5 Vice Presidents test positive for the virus. All members of the High-Level Task Force test positive. The HLTF was dissolved on May 16 over criticism of its handling of the COVID-19 pandemic and a new 13-member HLTF was reconstituted.
  • May 22: Peace talk parties reach an accord on revenue-sharing in southern Sudan. Doctors announce a strike in all hospitals in Sudan for a period of 72 hours, after four medics were attacked in Omdurman.
  • June 2: Sudanese peace talks resume with high hopes. Khartoum extends the coronavirus lockdown for another two weeks.
  • June 3: Ministerial Order signed by the Health Minister issued the immediate suspension ofCOVID-19 negativity certificates until further notice.
  • June 14: The Health Ministry reports more than 7,000 Covid-19 cases in the country.
  • June 15: The Ministry of Finance will provide direct cash support to vulnerable families.
  • June 18: The lockdown in Khartoum is extended until June 29.
  • June 19: The MoH sets up a mobile laboratory in Nimule which is considered a hotspot for infections. Nimule recorded its rst case on 28 June 2020.
  • June 22: The Deep Knowledge Report Group analyzed 20 measures of countries’ ability to respond to COVID-19. Findings indicated that South Sudan has only 14 ventilators, 24 ICU beds, & est. 1.5 doctors per 10,000 people
  • June 29: The Covid-19 lockdown in Khartoum is extended to July 7. After, restrictions will gradually be eased.
  • July 8: the Government started gradual lifting of the lockdown in some areas such as Khartoum with movement allowed between 05:00hrs and 18:00 hours
  • July 12: Sudan Civil Aviation Authority (SCAA) allowed the resumption of in-country flights
  • July 31: the Ministry of Health has confirmed 2,322 COVID-19 cases in South Sudan, with a case fatality rate of 1.98 percent.

In regard to medical equipment and health care capacity:

  • The Dr. John Garang Infectious Diseases Unit in Juba expanded from 24 to 82-beds. 
  • One functional PCR machine according to citizen accounts. Testing capacity is 500 tests per week with a current backlog of close to 6,000 tests. 
  • Current prevention, testing and treatment capacity are centralized in urban centers.

Risks, vulnerabilities, obstacles

  • One of the main challenges for an effective nation-wide response is the severely limited fiscal space the country has to respond to the health and socio-economic shocks derived from COVID-19. Since more than 80% of the country’s budget depends on the revenues from oil, the current decline in global oil prices and demands is a major threat to the government’s revenues. This means that the country may have to rely on external financing to fund measures to tackle the health and socioeconomic impact of the pandemic. However, due to its high-debt risk position,  South Sudan may face difficulties in its ability to take on credit and could potentially  face even greater constraints on the capacities of the government to widen its fiscal space. 

  • On another hand, from a human development and peacebuilding standpoint it is extremely worrying that despite recent efforts of the government in implementing a social protection system, inadequate implementation and coverage still remain an operational challenge. Since only .06% of the 2018-2019 budget has been allocated to the national social protection policy framework, vulnerable households have had to rely on informal community social protection and ad-hoc donor-based humanitarian aid which currently make up 99.7% of the current social safety-net system.  Furthermore, being ranked 179/180 in the Corruption Perception Index, South Sudan faces a high fiduciary risk of state capture. 

  • When analysing the poverty and multidimensional deprivation indicators the scenario is even more worrying. It is estimated that poverty will increase as much as 13.9% in South Sudan. Furthermore, from a multidimensional point of view of deprivation, the country is ranked 186th out of 188th countries in the Human Development Index, estimating that over  91% of its population suffers from multidimensional poverty. Among the implications of these figures is that only 14% of urban households and 1% of rural households have electricity. This presents a barrier to information reception with regards to COVID-19 given that most communication is made through electronic devices. This situacion also complicates the ability for children to receive education since the modality of distance learning programs is inaccessible to the most marginalized and vulnerable. Another implication is that only 11% of households have access to adequate water and sanitation facilities which may be a major challenge in the country’s process to contain the virus. 

  • With regard to food security and livelihoods, the picture is not any more promising. Given South Sudan’s status as a country in a compounding crisis facing a second swarm of locusts, there is a serious threat to food security. This threat compromises the subsistence of a large part of the population (85%) that depends on farming and commercial agriculture for their livelihoods. Inflation caused by the limited amount of imports received due to border restrictions, has further strained the situation. This has translated into higher food prices such as the increase in the price of sorghum of 54-295% and transportation wise, the prices have more than doubled since the onset of the COVID pandemic.

  • Regarding gender inequality, women face a higher risk of infection due to the burden of being primary caregivers, responsible for managing disease at household level and also constituting the majority of health workers in the frontline. There is also the concern that the pandemic can have a negative impact in regard to gender-based violence (GBV) since the restriction on movement of aid workers would significantly reduce the resources available to SGBV survivors

  • Another weak point that South Sudan has faced during the pandemic is the ongoing peace process in the country, that so far has led to a rise in violence. This complication is part of a larger state building process which is currently very fragile. The COVID pandemic is leading to an increase in crime, human rights abuse, civiles claims linked to inheritance/family rights, and land and labor disputes.

  • Regarding the public discourse around COVID-19, there have been some underlying assumptions due to contact tracing and isolation techniques that have created stigma for individuals who have tested positive. Moreover the population of around 1.5 million of internally displaced people, 300,00 refugees and 2.3 million South Sudances refugees in neighboring countries face a very harsh environment. Many live in crowded camps that lack safe and improved WASH facilities and are unable to practice measures such as social distancing and hygiene practices to prevent community spread. Additionally, as retuness transit through urban areas or settle in IDP camps the risk of virus transmission increases. Considering this complicated panorama, many measures such as curfews, restriction of mobility and strict lockdown need to be re-evaluated in face of the potential negative consequences that could detach from them.

Potential actions and demands

  • Regardless of the swift and united response from the TGNoU, some sectors believe that the COVID narrative was used for negative reasons. Therefore, regardless of the regular communication by the National Committee on COVID-19, stakeholders find a lack of transparency when it comes to the availability, allocation and spending of resources. The international coordination has been making a few recommendations in regard to the COVID-19 response. Specifically the proposals have been to utilize channels of donor funding to create a functioning health system, invest in education, consider the ongoing peace process, and balance between the short-term humanitarian need and long-term sustainable development. 

Key resources

Contributor(s): Sara Ortiz.

The C-19 Global South Observatory is a collaboration between