Politics, War, and Health in South Sudan

To call South Sudan a political hotbed is an understatement.  The country is the newest in the world.  The ruling government is still making the transition to a legitimate political party after twenty plus years as a rebel army.  If I am ever on the brink of forgetting the political importance of this location and moment, I am reminded daily by the four journalist who live with me at CCC (and the others who frequently rotate in and out between helicopter trips and UN charted flights to the country’s less stable regions).

Politically, when South Sudan succeeded from Sudan, they succeeded with 75% of the oil shared by the two nations.  Since succession, Sudan and South Sudan have been in a political chess match over oil revenues.  Sudan moved their pawns across the boarder to occupy the disputed oil rich region of Abyei, then tried to control the center of the board by knighting South Sudan with absurd oil transport fees (the oil pipeline runs through Sudan).  South Sudan retaliated by shutting down all oil production, a move that captured one of Sudan’s power pieces at the sacrifice of one of their own.  Now, both parties are now fighting tit-for-tat along the border, each claiming land and resources to be their own, scrambling to be the first to announce, “check” and “check mate”.

The impact of South Sudan’s politics and war on the health sector are significant.  The government of South Sudan’s budget is almost entirely dependent on oil revenues.  Thus, when the oil production was stopped, the primary means for the government to finance its work stopped.  At first, the government spoke of cutting salaries, but that didn’t sit well with the government employees.  Now they’ve eliminated a number of programs and ordered all ministries to cut funding by a minimum of 30% (although I doubt the military budget will be reduced).  For the health sector, these cuts mean South Sudan cannot afford to sufficiently purchase drugs nor send teams to rural areas to deliver the drugs.

The UN’s Multi-Donor Trust Fund (MDTF) has supplied South Sudan with the bulk of their medicines since the comprehensive peace agreement was signed 5 ½ years ago.  In June, the MDTF runs out.  At that time, South Sudan is supposed to begin purchasing drugs and fully manage their own medical logistics.  As of last month, the government didn’t have a budget or a plan to purchase or distribute replacement drugs.  Before the political situation heightened, meager management and apathy were to blame, now it is the lack of resources.

The drugs supplied through the MDTF are projected to run out in August.  Many South Sudanese are banking on the UN or other NGO’s to step in with additional millions in assistance.  However, no such funds have been allocated and the UN has repeatedly said they will not add funding for the purchase of basic medicines, something South Sudan should and could have planned for months ago.  The UN has been attempting to push more and more responsibilities onto the government, at times opting to leave work undone rather than intervene with management or resources.

Those living in the village, who rely on free medications or medications at drastically reduced prices, will be the first to suffer.  Months ago I was trying to convince a group of villagers to purchase mosquito nets. A woman responded that nets are 15 SSP but malaria medicine is 1 SSP.  She said, “Why should I buy a net?”  After discussing the benefits of prevention and risks of disease, I added, “How long do you think you’ll be able to receive medicine at that price…A lot of people around the world are working hard to help you and your children stay alive, soon you’ll have to do your part”.  When I spoke I didn’t realize that the time would possibly come so soon, but I fear it is.

Aside from the availability and distribution of medicines, another result that politics and war is having on health is that the environment is becoming increasingly hazardous.  The halted oil revenues have prevented the government from procuring the requisite diesel fuel to run city generators.  The consequence is not only that my room is much hotter than I would like, but also that the city run water purification plant has shut down.  Instead of having purified water delivered throughout the city for drinking and bathing, people are receiving unpurified water directly from the Nile.  To drink that water unpurified is literally to drink poison.  To bathe with unpurified Nile water is to invite all manner of fungi and skin infections, which contribute to an overall compromised immune system.  Just two months ago the mayor of Juba made it illegal for water trucks to collect water from the Nile, citing the plethora of diseases associated with the usage of that water as the primary basis for the decree.  Of course now, out of necessity, that decree is ignored.

Those who are savvy will collect and utilize rainwater, but that practice hasn’t reached the “tipping point” yet in South Sudan.  If you couple the water problems and the coming decline of public medicines available with the ever-increasing cost of living in Juba (since the start of the Heglig conflict, market prices have risen at least 15%), the health prospects for the poor appear bleak.  Those with money will always find charcoal to boil their drinking and bathing water, they’ll purchase medicine from private clinics, and they’ll purchase oil for their personal generators.  But those without financial resources will have a difficult time.  Thus, in the politics and wars of South Sudan, like most other conflicts, the poor are sure to suffer first and longest.  In the end, it is they who will concede to being “check mated” in Sudan and South Sudan’s continuous game.

Nile River at Juba, South Sudan