South Sudan is one of the ‘most challenging countries in the world for a child'

(UNICEFSouthSudan/Ryeng)

Co-written with Mohammed Alzumair

One of the most challenging countries in the world for a child

UNICEF has labelled South Sudan one of the ‘most challenging countries in the world for a child1’, largely because of preventable diseases such as pneumonia, malaria and diarrhoea.

Our Save the Children Medical teams work tirelessly to provide safe medicines to children to combat these diseases.

However, when devastating flooding and conflict forces children and their families to flee their homes in search of safety, access to medicines and healthcare becomes problematic. Save the Children has been providing medical services in South Sudan since before it gained independence in 2011.

This is a story of the challenges faced by one of our medical teams in South Sudan and how they worked to overcome them.

Haroon sits quietly in the corner of the small dispensary, studying each pack of medicine one after the other.

He confirms that the medicines have not expired and checks for discrepancies with the labelling and the appearance of the medicines, such as changes to the colour or texture. These discrepancies may indicate that the medicines are substandard or falsified.

Substandard medicines may not contain sufficient quantities of pharmaceutical ingredient either due to poor manufacturing or inadequate storage, while falsified medicines have been intentionally produced without any pharmaceutical ingredient. Instead these often contain toxic compounds. This seemingly simple process assures the quality of the medicines, ensuring they are safe for the children who will be receiving them.

Getting medicines to the children who need them

After this, Haroon places the medicines into a sturdy box and tests the weight by putting it onto his head. This is how the medicines will be transported to the mobile health clinics, shielded from sunlight, as Haroon wades through hip high flood-water to reach displaced communities, along with other members of the Save the Children Medical Team in Tonj East, South Sudan. The recent flooding has brought with it fresh waves of disease and displaced an estimated 760, 000 people in 40% of states2.

The box is heavy but removing medicines is not an option.

Medicines for malaria, pneumonia and diarrhoea, three of the biggest killers of children in these parts of the world are included along with other medicines to treat pain and fever. They are all essential and have been specifically selected by the medical team based on their expert knowledge of diseases usually prevalent during rainy or flood season.

Climate crisis

Unfortunately, the flooding has become an annual occurrence.

Haroon and his team have learnt from previous experiences and have developed a process to ensure they can deliver these medicines to the affected children. This process requires coordination across wider team in-country and international supply chain teams to procure and import additional medicines from the Netherlands to the capital city, Juba.

The supply chain team in Juba have an agreement with airport staff to ensure that the medicines are not left on the scorching hot runway (temperatures soar up to 38 degrees Celsius in the dry season) while awaiting collection. Exposing medicines to these temperatures can lead to degradation, impacting their effectiveness and increasing the risk of side effects.

The limited road networks between the capital and other parts of the country means transport has to be facilitated by small planes, only able to carry minimal quantities of medicines per trip. During the flood season, this option is not available either, as runways are often non-concrete and non-functional, so staff have to ensure medicines are transported before the flooding starts.

Impact of floods

The impact of the floods are widespread. The availability of normal food and water supplies had become impossible, resulting in three quarters of the population facing food insecurity3. This leads to increased numbers of malnourished children, who are at a higher risk of becoming unwell and are less likely to survive4.

All too often, malaria cases rise with the flood water because the water provides a breeding ground for the Anopheles mosquitos, which carry the malaria parasite. Malaria is not always deadly; survival is possible if medicines are available, but with 56% of the population living more than 5 km away from a heath centre5 (which has been further exacerbated by flooding,) the sad reality is that this medication is out of reach for almost half the children that will fall ill with malaria.

Pneumonia claims the life of one child every hour in South Sudan

Pneumonia claims the life of one child every hour in South Sudan6. Like malaria, lack of access to treatment is cited as one of the main reasons for its high mortality rates. Children suffering from malnutrition and living in areas with high levels of unsafe water are at increased risk6. In fact, access to medicines for all these preventable diseases can have a huge impact on a child’s survival.

Haroon is also worried about the snakes, who proliferate in this region, following humans, also desperate to escape the flood water. In October 2021 alone, Save the Children doctors treated 31 snake bites in just one state. Haroon is worried about the local conflict as well.

Working through conflict

As if the floods were not enough of a challenge, violence has recently erupted between two tribes in Tonj East.

Because of the safety risks to healthcare staff working in the Mapara and Mangan Primary health care units, the difficult decision was made to close these centres, cutting off vital healthcare to the affected children and their families for several months.

The team is concerned about leaving these children without medicines at this time. They collaborate with local partners and hold discussions with community chiefs to highlight the importance of healthcare provision to these children and their families. Finally, permission is granted and Haroon and the team are allowed to resume service provision.

Setting up the mobile clinic

After the treacherous journey, Haroon and his team arrive and begin to set up the mobile clinic.

Haroon makes sure that the medicines are stored in a dry, well-ventilated area to ensure that their quality is maintained before being given to patients. After patients have seen the doctor, Haroon dispenses the medicines prescribed and explains to patients and their families how the medicines should be taken to ensure they will be effective.

Reaching just under 1000 patients 

In this way, Haroon and his team managed to reach just under 1000 patients, children and their families in just one month.

This is an astonishing example of the work our medical services teams carry out, overcoming unthinkable challenges and enabling access to safe and quality medicines for those who otherwise would have had to go without.

Learn more

Read more about the climate crisis and how it's affecting children ^[1]

Help protect children in South Sudan and others in crisis^[2]

Find out more about our work in South Sudan, the world's youngest nation^[3]

References

1. Health | UNICEF South Sudan 2. South Sudan Flooding Snapshot No.3 2021 (reliefweb.int) 3. South Sudan emergency | World Food Programme (wfp.org) 4. Support essential health care for all | UNICEF South Sudan 5. Malaria season | UNICEF South Sudan 6. Pneumonia is killing one child every hour in South Sudan (unicef.org)^{[4][5][6][7][8][9]}

References

1. ^{^} Read more about the climate crisis and how it's affecting children  (www.savethechildren.org.uk)
2. ^{^} Help protect children in South Sudan and others in crisis (www.savethechildren.org.uk)
3. ^{^} Find out more about our work in South Sudan, the world's youngest nation (www.savethechildren.org.uk)
4. ^{^} Health | UNICEF South Sudan (www.unicef.org)
5. ^{^} South Sudan Flooding Snapshot No.3 2021 (reliefweb.int) (reliefweb.int)
6. ^{^} South Sudan emergency | World Food Programme (wfp.org) (www.wfp.org)
7. ^{^} Support essential health care for all | UNICEF South Sudan (www.unicef.org)
8. ^{^} Malaria season | UNICEF South Sudan (www.unicef.org)
9. ^{^} Pneumonia is killing one child every hour in South Sudan (unicef.org) (www.unicef.org)