South Sudan is home to an estimated 56 ethnic groups and almost 600 sub-groups. After the excitement of South Sudan's independence in 2011, the year 2012 was characterized by continuing conflict with its northern neighbour as well as internal ethnic divisions that regularly erupted into conflict. Health status and the ability to access care were often directly related to the political and inter-ethnic crises still ongoing in the country. Moreover, access to health services for minorities and indigenous peoples in South Sudan is hampered by lack of infrastructure to facilitate travel to a clinic or hospital, poverty and the resulting inability to pay for health services, as well as discrimination.
Conflicts between South Sudan and Sudan over oil revenues continued throughout 2012. In January 2012, South Sudan shut off oil production entirely, citing the high price Sudan was demanding to use its pipeline. The government of South Sudan obtains 98 per cent of its revenue from oil production. As a result, the reduction in government funds had a direct impact on the provision of health services. South Sudan has the highest maternal mortality (2,050 deaths per 100,000 live births) and under-five mortality rates in the world. Of the 17 neglected tropical diseases recognized by the WHO, all are present, and endemic, in South Sudan. More than half of South Sudan's 10.5 million people live more than a three-mile walk from any basic primary health facility. There are only 37 hospitals in the country. Plans for enhancing South Sudan's health sector and transferring more responsibility away from donors and to the government stalled when oil production was shut down for nine months of 2012.
Inter-ethnic conflict also has a severe impact on health status and access to services, particularly for minority groups. In Jonglei State, in the south-eastern part of the country, conflict between Lou Nuer and Murle communities continued in 2012. The year began with a massacre in Pibor town. Revenge attacks and counter-raids continued. Despite the presence of UN troops in the state, government disarmament campaigns, as well as numerous attempts at conflict resolution through engagement with community leaders and local politicians, the cycle of violence has continued.
For those caught up in the Jonglei fighting, the nearest medical facility equipped to address the resulting serious injuries was a five-hour boat ride away. Even in the absence of conflict, minorities in Jonglei report that they are often afraid to seek health services because of discrimination – they fear that medical service providers from the dominant community will not provide effective treatment or might even harm them if they seek care. Whether justified or not, these fears have a direct impact on the health of minority groups.
South Sudan is also hosting hundreds of thousands of refugees and internally displaced people as a result of continuing conflict with Sudan and within South Sudan. Refugee flows throughout 2012 have led to dire conditions in the remote camps on the border between South Sudan and Sudan, with rampant disease and malnutrition leading to thousands of preventable deaths. Minority communities and indigenous peoples, who often make up a substantial proportion of refugee flows and who are often found in the most remote areas, are particularly negatively affected by the dire state of health services.
4 Downie, T., The State of Public Health in South Sudan, Washington, DC, CSIS, 2012, p. 2.
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