South Sudan ranks third (after Yemen and Somalia) in the hierarchy of the 178 countries by Fragile States Index, and has remained so since its independence in 2011.

South Sudan Context Analysis

Protracted years of civil war in South Sudan have led to widespread human rights violations, large-scale internal displacement and refugee outflow to Sudan, Uganda, Kenya, Ethiopia and other neighboring countries. The uncontained COVID-19 outbreak exacerbates an already dire humanitarian situation in South Sudan suffering from a deteriorating food insecurity situation, rising violence, fragile health systems, locust invasion, and looming floods.  Despite the signing of the Revitalized Agreement on the Resolution of the Conflict in South Sudan (R-ARCSS) in September 2018 and later the formation of the Transitional Government of National Unity (TGoNU), pockets of clashes and widespread Intercommunal conflicts are still prevalent. The conflict and displacement have led to disruptions of food production, livelihoods, and humanitarian assistance, as well as a severe economic downturn. Nearly 4 million people are estimated to be displaced, including 1.5 million IDPs and 2.2 million South Sudanese refugees[1]. In addition, South Sudan hosts nearly 300,000 refugees from Sudan, DRC, Ethiopia and CAR. Although data exists on the drivers of the complex crisis in South Sudan, the impact of the COVID-19 pandemic is not limited to the already fragile health system but also has a ripple effect on the socio-economic, humanitarian and political state of the nation. Women and children bear the biggest brunt facing severe challenges to their survival, development, learning and protection, compounded by early and forced marriages, teenage pregnancies, conscription and the risk of getting involved in other harmful activities. Save the Children is committed to preserving the children’s right to survive, learn and be protected employing a multifaceted approach response and mitigation measures.

South Sudan Drivers to the Complex Crisis

Coronavirus Disease (COVID-19) Pandemic & South Sudan Fragile Health System

The index case of COVID-19 was declared in South Sudan on 5 April 2020. As of 15 August, there were 2,488 confirmed cases and 47 deaths due to the pandemic. As of 15 August 2020, there had been 16,396 tests. 79% of the cases are Asymptomatic, while 75% of the cases have been amongst men. Central Equatoria State (including Juba) has the highest number of cases while Upper Nile, Western Equatoria and Warrap States have the least number of confirmed cases. Imported cases from neighboring countries account for 1.6% of all cases. However, these official figures of confirmed cases of COVID-19 likely obscure the true magnitude of the pandemic due to associated social stigma and limited testing capacity. The data modelling for COVID-19 for South Sudan shows that in “an unmitigated epidemic”, after a year of the onset with total number of symptomatic cases to be between 2.8m – 3.4 m, and total deaths between 23k and 31k^[2]. Between 100,000 and 200,000 people may become unwell, requiring hospitalization; between 15,000 and 35,000 may reach a critical condition, requiring specialized support.

COVID-19 is potentially the greatest threat to South Sudan's already fragile health system. The South Sudanese population is highly vulnerable to epidemic diseases, due to low immunization coverage, a weak health system, and lack of access to hygiene and sanitation infrastructure.  COVID-19 therefore strains the already frail essential basic services. 56 per cent of the nearly 12 million population do not have access to primary health care services where 80 per cent of health services are provided by NGOs – South Sudan is short of 40,000 health workers and drugs and equipment supplies cover 50% of needs. Out of approximately 2,300 health facilities, more than 1,300 are non-functional.[3]  Moreover, South Sudan has one of the highest under five mortality rates (90.7 deaths per 1,000 live births) and maternal mortality rate (789 deaths per 100,000 live births) worldwide. Around 75 per cent of all child deaths in South Sudan are due to preventable diseases. Malaria and Cholera are endemic and 7,460 children dies from pneumonia every year. Across the country, only 34 per cent of households reportedly have access to a safe and improved water source, less than 30 minutes distance from their home. Access to soap or chlorinated water at the community level is extremely low. Across 27 counties in the country, less than 10 per cent of people have access to soap[4].

Response efforts remain inadequate at the moment with insufficient funding for implementation of the national response plan. Testing remains a huge challenge with a lab based in the capital that is able to perform the tests and is experiencing a huge backlog of untested samples. Additionally, transportation of samples to Juba has been a challenges due to cancellation and inconsistency of flights services since the onset of the pandemic. Despite the limited testing capacity, under-reporting, and asymptomatic cases, community transmission is on the rise in South Sudan, with experts predicting that the pandemic will peak in July or August. Guided by the World Health Organization (WHO) and supported by the United Nations Mission in South Sudan (UNMISS) and the United Nations Children's Fund (UNICEF), the Transitional Government of National Unity is trying to raise awareness nationwide, however the general public’s adherence to prevention measures such as use of masks and social distancing guidelines remains a challenge as the population is forced to flout isolation protocol in search of means of livelihood. Risk awareness campaigns have been helpful in increasing the public’s awareness levels on COVID-19 as well as contributing to the efforts to reduce the spread of the virus, however, the biggest gap is the implementation of the knowledge, attitude, practices and behaviours being promoted. Case management capacity is still limited at subnational level and adherence to isolation measures especially in-home care is sub-optimal. Contract tracing efforts is challenged by inadequate listing of all contacts and Supplies constraints due to overall limited global stocks of COVID-19 supplies constraining activities such as increasing testing.

COVID-19 has magnified pre-existing access constraints and aggravated their impact on humanitarian operations, including the COVID-19 response. Prior to the confirmation of COVID-19 in South Sudan, the High-Level Task Force (HLTF) implemented a series of policies to prevent the importation of COVID-19 into the country. With effect from 25 March to 12 May, restrictions on movement were put in place that led to the closure of the Juba International Airport to inbound passengers, severely limiting the movement of key staff in and out of the country. Access constraints including bureaucratic impediments, violence against humanitarian personnel, restriction on movement, and insecurity as a result of intercommunal violence and roadside ambushes. Increasing conflict-related access restrictions in Central and Eastern Equatoria, Upper Nile and Jonglei, continue to impact operational capacity. UNMISS troops significantly reduced PoC patrolling in the past months due to COVID-19 related restrictions (including a reduction of UNPOL capacity in PoC sites).

In light of COVID-19 and its impacts on operations, an estimated, 787,000 children are missing out on measles vaccine, as the second phase of the nationwide vaccination campaign is postponed due to COVID-19. Some $44 million worth of projects were cancelled from the original 2020 HRP. Closure of schools has meant a scale-down of school feeding programmes in learning centres and cancellation of distribution of education supplies and training sessions. Longer-term WASH activities have been replaced with quick impact activities integrated with broader protection-centered emergency response such as restoring access to safe water.

The COVID-19 pandemic is an unexpected setback to the already fragile education system. Over 2 million school-aged children currently enrolled in formal and non-formal schools are not able to attend regular schooling. This is in addition to approximately 2.4 million children estimated to be out of school in 2020. Juba's infectious diseases hospital has been expanded, UNMISS has renovated and equipped hospitals in 10 states, and Non-Governmental Organizations (NGOs) are providing extra staff and response services, however equipment and expertise are insufficient. Further, to address the anecdotal reports of increasing mysterious community deaths, the Ministry of Health in collaboration with WHO and partners set up a COVID-19 mortality surveillance team that will support the collation of information on COVID-19 death alerts from several key sources.

Food Insecurity

Many households are estimated to be extremely vulnerable to food insecurity during the main rainfall season, and the impact of COVID-19. As per the FEWSNET forecast, the flood prone areas are already in Emergency (IPC Phase 4), in the event of severe flooding some of the households in these areas could deteriorate to Catastrophe (IPC Phase 5). It also states that, Catastrophe (Phase 5) is also likely for ‘pockets of vulnerable households’ amongst the IDPs or others relying on daily labour, and in case of a conflict or other restrictions impeding humanitarian access for longer duration Famine (IPC Phase 5) is likely[5],[6].

According to the Humanitarian Needs Overview, as of January 2020, 7.5 million people were in need of humanitarian assistance, yet, attacks and ambushes on humanitarian convoys continue to severely hamper the delivery of assistance and access to populations in need. The latest Integrated Food Security Phase Classification report documents an estimated 6 million people, (around 51% of the total population) expected to experience Crisis (IPC Phase 3) or Emergency (IPC Phase 4) between March and July 2020.[7] IPC further estimates 58 counties with a GAM of 10 percent and above, 43 counties classified as Critical (GAM of 15.0–29.9 percent, IPC Phase 4) and 14 counties as Serious (GAM of 10.0–14.9 percent, IPC Phase 3). Most counties in Unity, Upper Nile, Jonglei and Warrap and parts of Eastern Equatoria and Lakes had Critical levels (IPC Phase 4) (IPC, September 2019). INFORM measures South Sudan's risk of humanitarian crisis and disaster for 2019 to be very high, at 8.9/10, down from 9/10 in 2018. South Sudan's vulnerability is measured at 9.2/10.[8]

Movement restrictions related to COVID-19 response have resulted in the closure of ports and border crossings, severely affecting trade activity between South Sudan, Uganda and Sudan. In South Sudan, reports are emerging of reduced food imports, price increases, and shortages from panic buying as people fear that goods will stop flowing into the country. Importation of staple products, including maize imports from Uganda declined nearly 30% in March and prices in the public markets have increased: maize prices increased by 50% and sorghum 15%. South Sudan relies heavily on food commodity imports. Trade is expected to continue decreasing as COVID-19 restrictions are in place, putting pressure on already high food prices and reducing the purchasing power of South Sudanese households. People in South Sudan are experiencing acute food insecurity, with approximately 20,000 at risk of IPC 5 (Catastrophe) levels, prior to the COVID-19 restrictions. Travel restrictions put in place causes additional gaps in supply chain, however, in order to revive the economy, the government has lifted restrictions like curfew and interstate movement with little attention paid to prevention measures.

WFP attributes the malnutrition levels to inadequate childcare and feeding practices, food insecurity, Illness, poor water quality and sanitation.  The population in need of humanitarian food assistance will exceed the previous projections of 6.48 million, with 1.3 million under 5 acutely malnourished children and 352,000 PLWs. With the increase in prices due to COVID-19 related restrictions, flooding and the resulting impact on agricultural and livelihood activities and the pandemic itself, it is expected that the rural poor will become even more vulnerable. The newly emerging challenges will make new caseload requirements for daily needs extremely difficult.  The affected population is heavily reliant on the food markets and primarily receive their income from the sources that are affected by COVID-19 and its impact.

South Sudan faced serious flooding in 2019 and the Government declared a state of emergency seeing the extent of damage in the country. The 2019 floods disrupted  the food pipelines, damaged infrastructure (roads, buildings and water sources); led to disease outbreaks, displacements and also contributed to violence due to struggle over meager resources. The extensive damage to the roads and the flood water levels made it impossible to reach these communities through roads. The estimated population affected by the flood at end of the year was 908,000 with 420,000 displaced (OCHA, November 2019). In addition, current year’s flooding has already devastated the affected population leading to large scale displacements in the flood affected areas. Moreover, the desert locusts infested some of the areas in the country since the beginning of the current year. In FAO, analysis of the locust’s situation shows presence of locusts in Magwi, Torit, Lopa/Lafon, Budi and Ikotos counties of Eastern Equatoria with recent spread to Kapoeta North county of Eastern Equatoria and Renk County of Upper Nile. Without the quantitative assessments, the damage is presumed to range from moderate to severe.

Falling global crude oil prices and the COVID-19 pandemic mitigation measures have had a negative impact on the economy. The International Monetary Fund revised the GDP growth rate for 2020 from 8.2 per cent to 4.9 per cent. The loss in revenue is expected to create new challenges regarding funds available for the implementation of the Revitalised Agreement on the Resolution of the Conflict in South Sudan (R-ARCSS). South Sudan ranks second most at risk country on the COVID-19 Economic Exposure Index.

Political Instability, Insecurity and Humanitarian Access

South Sudan’s Transitional Government of National Unity (TGoNU) continues to faces severe, inter-locking political, economic, and security challenges towards achieving lasting peace and stability for Africa’s youngest nations. Although the TGoNU is showing progress, the gains are overpowered by the factors relating to macroeconomic crisis, impact of conflict and debilitating climatic conditions.  The struggle however continues for lasting peace in the country, which is currently masked by the unresolved issues such as failing to include 25% women representation in the executive office, and the ongoing intercommunal violence. IGAD notes that the peace-building process has slowed down, as the spread of COVID has restricted the mobility of the mediators. The delays in the unification and deployment of forces, confinement of these forces in cantonments and training sites and the COVID-19 related restrictions are likely to cause security threats in the areas.

The security situation in South Sudan remains highly volatile, impacting humanitarian service delivery and exposing the lives of aid workers at a greater risk. Violence prevents access for relief workers and civilians alike. Harassment and looting of relief material and cash are common. Civilian authorities and security forces continue to interfere with and impose bureaucratic restrictions on NGOs. NGOs have reported incidents of intimidation and harassment perpetrated by different armed groups, who have demanded NGOs seek permission before undertaking work especially in opposition held areas. Humanitarian imports have been disrupted since last December, following a presidential decree on custom exemptions.

The intercommunal violence incidents in South Sudan saw a downward trend since 2018, have become rampant in the recent past compounded by the power vacuum in the absence of the appointment of state governors. Jonglei, for example, may be on the edge of a third major eruption of violence with progressively advancing mobilization of armed youth. The recent incidence of violence led to killings including those of humanitarian workers. Humanitarian partners have been relocated from Pibor Town this week, however, the Government is planning to rollout a community peace initiative in Jonglei in the coming weeks to quell the rising tensions. The displacement due to the clashes with the opposition army and National Salvation Front is coming to 17,000 people in Central Equatoria. With another 23,000 affected by the intercommunal violence in Jonglei, Uror County and 43,500 affected in other counties due to clashes and cattle raiding. The reports also expect approximately 289,000 refugees to return to South Sudan from its neighbouring countries. The current incidents of intercommunal violence characterized with killings, child abductions and cattle raiding among the communities in Greater Pibor has led to huge influx of IDPs in Bor, Akobo and Twic East.

Cattle raiding is particularly a common trigger of tension as cattle are the main source of wealth and pride for many communities. Increase in Cattle raids and intercommunal violence in South Sudan is perennial and cyclic, and is fuelled by the onset of the dry season requiring pastoralists to move their cattle to contested water and pasture sources.  The violence is characterized by attacks, counter attacks and revenge killings. However, the nature of communal violence has changed drastically indicating more military type arms and ammunition used increasing the causalities to many fold compared to the previous years. Thousands of people were reported killed and injured in the past months and had to flee their homestead impacting the stability in the areas and access to humanitarian aid impossible.

Gender Violence during COVID-19

Women are often disproportionately affected by crisis and are at higher risk of Gender Based Violence (GBV). Women who live in the rural areas are the most vulnerable and the first to lose their incomes and livelihoods when disaster strikes. South Sudanese women and girls already face extreme levels of GBV, much of which goes underreported. Compared to the reports for the first quarter of 2019, there is an eight per cent increase in reported GBV incidents in the same period of 2020. Similarly, the reported incidents of physical assault have been increasing in the first three months of 2020. In such context, where intimate partner violence is pervasive even before COVID-19, there is an anticipated increase in the general trend of intimate partner violence with self-isolation, social distancing, and other stay at-home measures in place.

[1] https://reliefweb.int/report/south-sudan/south-sudan-humanitarian-needs-overview-2020-november-2019

[2]   London School of Hygiene. Data modelling for South Sudan.

[3]https://www.humanitarianresponse.info/sites/www.humanitarianresponse.info/files/documents/files/ss_20191120_south_sudan_humanitarian_needs_overview_2020.pdf

[4]https://apps.who.int/iris/bitstream/handle/10665/136881/ccsb;jsessionid=63F5CFA31CDE41C57A5B6AC0C9D0E6B4?sequence=1

[5] FEWSNET, Food Security Outlook 2020

[6] https://fews.net/east-africa/south-sudan/food-security-outlook/february-2020

https://fews.net/east-africa/south-sudan/key-message-update/may-2020

https://data.unicef.org/resources/jme-report-2020/

[7] http://www.ipcinfo.org/ipc-country-analysis/details-map/en/c/1152422/ - South Sudan: Acute Food Insecurity and Acute Malnutrition Situation January 2020 and Projections for February - April 2020 and May - July 2020

[8] https://reliefweb.int/sites/reliefweb.int/files/resources/Inform%202019%20WEB%20spreads.pdf