Continued attacks on health facilities and blocked access to aid organizations are worsening the humanitarian situation in South Sudan, according to the international human rights coalition Watchlist on Children and Armed Conflict.
At least 20 percent of South Sudan’s 1,900 hospitals had closed as of December 2017, and about 50 percent were functioning at a very limited capacity, according to Watchlist’s report “Everyone and Everything Is a Target,” released Monday. The report looks at the conflict’s impact on health care and aid from Jan. 2016 to Dec. 2017 through interviews with refugees, humanitarian personnel, and aid actors.
The new findings come as 10 South Sudanese aid workers — including three United Nations staff — were declared missing this week by the U.N.
Seventy percent of South Sudanese lack access to adequate health care. And more than 7 million people in South Sudan — nearly two-thirds of the population — are in need of humanitarian aid, and risk becoming food insecure in the coming months without sustained humanitarian assistance, according to the U.N. Office for the Coordination of Humanitarian Affairs.
Some health facilities have been attacked during the 5-year-old civil conflict between government and opposition forces, while others have been directly targeted. Meanwhile, relief efforts by international and local nonprofit organizations are severely complicated by the restrictions and access issues aid workers face.
“We were not surprised on the number of attacks [in South Sudan]. There have been fairly routine stories coming out on targeting NGO-run facilities. But we were surprised by the number of denials [of access]and different forms denials have taken,” said Christine Monaghan, a research officer at Watchlist and the report’s author.
These denials of access go beyond aid convoys being turned back at a checkpoint.
“It’s conceivable you have an NGO in Juba trying to fly to a smaller town. On the way to the airport they might be pulled over because the government yesterday put in new requirements for NGO vehicles. They don’t have a license plate, and they have to pay a fine,” Monaghan said. “At the airport, the authorization they were told was required might have changed. They might have to pay a fee or denied access to board the flight entirely. They have to pay a fee to land the plane. The list goes on and on.”
Last year, aid agencies reported 1,159 humanitarian access incidents in South Sudan — the highest number of incidents reported during the conflict, and an increase from the 908 estimated in 2016, according to OCHA.
During Watchlist’s reporting period there were at least 50 attacks on medical facilities and personnel in the form of arson, looting, and kidnapping and 750 denials of humanitarian access — although numbers are likely an underestimate, according to the coalition, which includes Human Rights Watch and World Vision.
Insecurity and access issues are blocking millions of South Sudanese from receiving health care. In some cases, medical facilities are operational even when civilians have fled from the region.
In this case, “It is an NGO-funded project, keeping a facility open, providing them medical equipment — but the only people there to treat are party to the conflict,” Monaghan said.
The healthcare shortages are contributing to preventable illnesses — such as malnutrition, respiratory infections, and diarrhea — becoming epidemics.
The number of people suffering from malnutrition is expected to rise from 5 million to 5.5 million people this year. Famine was declared in two districts in north-central Sudan last year, impacting approximately 100,000 people. The country again faces the risk of famine, aid officials warned this week.
The South Sudan report is Watchlist’s latest analysis of conflict, following similar reports on Yemen and Afghanistan last year. While the conflicts are all quite different, some of their effects on civilians are comparable, Monaghan says.
“The impact on children winds up being similar. Children are the most impacted and the most vulnerable. Women, particularly pregnant and lactating women, are at high risk as well,” she said.