Red Cross volunteers on the front lines of potential health crises in Central African Republic and South Sudan

تم النشر: 3 فبراير 2014 6:25 CET

Katherine Mueller, IFRC

In developing countries, health care, on a normal day, can be challenging at best. But when crises emerge, as is currently occurring in South Sudan and the Central African Republic (CAR), it doesn’t take long for the poor infrastructure that did exist to come crumbing down.

In CAR, half of the health infrastructures are not functioning anymore.

With an increase in the number of people seeking emergency care, medical supplies can quickly be depleted. Health care staff, themselves sometimes the victims of conflict, are unable to report for duty. Firefights can leave hospital facilities pockmarked with bullet holes, unsafe to access and often completely empty after being looted. Understaffed and under resourced, it can be a perfect breeding ground for disease to take hold and spread. An upsurge of measles cases in both countries, and rising malaria and diarrhoea cases, are threatening the lives of thousands of children under the age of five.

In both CAR and South Sudan right now, there are worries about malaria. In CAR, the situation is potentially more dire, with the rainy season just weeks away. As it stands, malaria is the number one killer in the country, with 60 per cent of health facility visits due to the potentially fatal mosquito-borne disease (source MSF). The International Federation of Red Cross and Red Crescent Societies (IFRC), with a grant from the Global Fund, had intended on launching a bed-net distribution programme in April. However, given the current situation, that timeline has now been bumped up.

“We need to do what we can to ease people’s suffering as much as possible,” says Jean Pierre Taschereau, IFRC head of emergency operations, from his office in Bangui. “They are living in very difficult circumstances and the last thing they need is to get sick from malaria, on top of the insecurity and inability to lead normal lives. Though we have already started an emergency distribution of 12,000 anti-malarial treatments through local partners, we need to do much more to prevent people from getting sick in the first place. To help in that effort, we will soon begin distributing over 2.3 million mosquito nets, to reach approximately 4.8 million people across this country.”

Efforts to get the nets to those who so urgently need them are hampered by the insecurity prevailing in the country. The road connecting Bangui to Cameroon, where most of the supplies coming into the country transit from, is regularly closed because of attacks. Hundreds of trucks are waiting at the border for safe passage to be re-established.

In South Sudan, senior management at the local Red Cross are also worried about what will happen if the conflict is not contained by the time the rains come in a couple of months. “The worst could happen as the threat of malaria and waterborne diseases is high during the rainy season,” says John Lobor, Deputy Secretary General, South Sudan Red Cross. “The current support from IFRC that includes hygiene promotion, and water and sanitation activities, will be helpful in preparing people to ward off a health crisis. Still, a lot needs to be done in terms of outreach and allocation of resources, to reach the population across the country.”

The crisis is impacting on an already dire health situation with South Sudan showing some of the worst health indicators in the world. The maternal mortality rate is the highest, globally, with 2,053 mothers dying per 100,000 live births. Access to water and sanitation is also one of the lowest in the world, with only 9.9 per cent of the population having access to treated water.

In South Sudan, there is also concern about polio. There were outbreaks in neighbouring countries in 2013, with over 200 cases reported in three countries (190 in Somalia, 14 in Kenya and 9 in Ethiopia). With a population that is constantly on the move, the chances of an outbreak in South Sudan grow. “Polio spreads most rapidly in the poorest, most inaccessible and insecure areas where immunization coverage is low and sanitation and hygiene are inadequate,” says Dr John Haskew, IFRC regional health delegate.

Late last year, in a preventative measure, IFRC and the South Sudan Red Cross supported a government polio vaccination programme, reaching more than half a million children in West, Central and East Equatoria States. “The recent polio campaign that was held towards the end of 2013 was timely and will help to contain the spread of the disease that is already affecting neighbouring countries,” says Lobor.

“I had heard about polio but not about how it affects children,” says Rose Mande, a 30 year old mother of two. “I made sure to encourage other mothers to keep their children at home during the polio vaccination campaign so that they too could be immunized.”

Red Cross Societies in both countries are doing what they can to limit any outbreak. But high insecurity makes it challenging and unsafe for volunteers and staff to venture too far. To date, there has not been any deadly outbreak of disease in either the Central African Republic or South Sudan due to the conflicts. However, if the situations don’t change quickly, so too could the health situation, and not for the better.