Editorial. Conflict devastates health service delivery in South Sudan

Author(s): Dr. Edward Eremugo Luka

South Sudan emerged in 2005 with some of the poorest health indicators - the maternal mortality ratio of 2,054/100,000 live births was the worst in the world. Under-five and infant mortality were in the red, in addition to a low immunization coverage [1].

            Independence in July 2011 saw a huge improvement in healthcare delivery throughout the country. The opening of roads improved access to health facilities, which are staffed with clinical officers and nurses, as well as drugs for treatments of malaria, pneumonia and diarrhea – the three main killers of children in South Sudan.

            The return to conflict in December 2013 has set the country back and reversed the many gains achieved. The flare up of fighting on the eve of the 5th anniversary of independence has worsened the situation. The two conflicts have displaced thousands of people and has the potential to create an environment for the worst humanitarian and health crisis in the country [2].

            The effects on healthcare cannot be understated. Many health facilities have been destroyed, medical supplies looted and several health workers have lost their lives trying to save their patients. Pregnant women have no access to care, children die of malnutrition and preventable diseases due to shortages of food and drugs. The trauma of war can also have devastating consequences on the mental health of the people [3]. The economic impact of the war has seen Juba Teaching Hospital, the only referral hospital in the country, going days without electricity, curtailing its life-saving operations. Young trainee doctors have gone on strike for lack of salary payment.

            Not only that, the crisis has seen the resurgence of epidemics, such as cholera. In April 2014, the outbreak in Juba, which subsequently spread throughout the country, lead to hundreds of deaths and suspected cases [4]. In July 2016, cholera returned (5).

            Many agencies, including the World Health Organization, USAID, UNOCHA and DFID, have responded to these challenges as humanitarian emergencies. These responses will be only temporary remedies. Good healthcare delivery requires security, as well as sound economic and political stability.

            Only peace can ensure that the health of the people of South Sudan is restored.


Dr. Edward Eremugo Luka

Editor-in-Chief SSMJ



  1. National Bureau of Statistics, Ministry of Health. The Sudan Household Health Survey 2006. http://www.southsudanmedicaljournal.com/assets/files/misc/SHHS.pdf  Published 2006
  2. UNOCHA, 2016 South Sudan Humanitarian Needs Overview, http://reliefweb.int/report/south-sudan/2016-south-sudan-humanitarian-needs-overview
  3. The Lancet Editorial, No peace of mind in South Sudan. The Lancet, 2016; 388 (10041:212
  4. Luka E. Responding to the cholera outbreak in South Sudan, Editorial. South Sudan Medical Journal 2014; 7 (2): 27 http://www.southsudanmedicaljournal.com/archive/may-2014/editorial.-responding-to-the-cholera-outbreak-in-south-sudan.html
  5. Unicef South Sudan, Press Release, Children at risk from cholera outbreak in South Sudan http://www.unicef.org/southsudan/media_16676.htm