Sudan (Northern States) > Activities by Sectors
Health Services
Patient consultation
Across Sudan’s northern states, there is a need for the provision of good quality, accessible health care. In addition to primary health care needs, the population faces disease outbreaks, sexually transmitted infections, and inadequate support for reproductive health.
In Khartoum State, there are not enough health care facilities to meet the needs of the population. More than 50 percent of Medair’s PHCC (Primary Health Care Centre) patients come from outside its catchment area in the camp. Clinics outside the camps and squatter areas are often too far away for many IDPs to reach, and are also prohibitively expensive. In addition, many of the IDP population in Khartoum have limited knowledge about basic hygiene procedures, the benefits of preventive measures, and the importance of seeking clinical treatment at the onset of any disease.
South Kordofan has been assessed by the Federal Ministry of Health (MoH) as one of the four most underserved states in northern Sudan. Malaria is a particular problem, especially in the rainy season, and there are a lack of routine immunisation services, especially in the former rebel areas. Reproductive health is also a key concern, with a maternal mortality rate of 552 per 10,000 live births.[1] Data from Medair’s ongoing work in South Kordofan shows a high level of sexually transmitted infections (especially in the Western Jebels), linked with a low level of knowledge about HIV/AIDS. These problems are compounded by a lack of basic health knowledge within communities, and a lack of capacity among health staff to adequately diagnose and treat cases.
In West Darfur, the health situation remains extremely fragile, with numerous outbreaks of disease, including meningitis and measles. The referral system for secondary health care is under extreme pressure, as insecurity has limited the use of ambulances and puts a high risk on using commercial trucks. Consequently, there is an urgent need to maintain a high level of primary health care in rural areas throughout the state. Reproductive health remains of particular concern. It was noted as a key need prior to the current conflict, and there continue to be reports of Sexual and Gender Based Violence (SGBV). A recent survey indicated that knowledge of HIV/AIDS was worryingly low.
Emergency Relief
In Khartoum State and South Kordofan, Medair maintains an emergency response capacity that can provide an initial response to likely disease outbreaks or other health emergencies in all regions of operation. This response capacity includes ongoing training of staff, keeping basic supplies in stock, and maintaining protocols for responses to disease outbreaks.
In West Darfur, all of Medair’s health services activities are considered emergency relief, given that most of the population we serve are conflict-affected and about half have been displaced. We have the capacity to respond to outbreaks and to provide up to six emergency clinics per year in the event of displacement or returns.
Medair also supports around 20 primary health care facilities in West Darfur (of which four are in IDP camps and one is in a refugee camp), providing supervision, staff training, a reliable drug supply, and a framework for a Health Information System (HIS). Reproductive health is a major focus, including ongoing training and supervision of health staff and midwives; HIV/AIDS awareness; provision of Safe Delivery Kits; provision of contraception and post-rape treatment; and construction of two more Safe Delivery Areas. Public health promotion is facilitated through the training and support of over one thousand Community Health Promoters (CHPs).
Rehabilitation
Medair provides access to primary health care for hundreds of thousands of vulnerable people in Sudan’s northern states. This includes outpatient consultations, immunisations, training of staff, and provision of essential drugs. Reproductive health care is also a top priority. Furthermore, community health promotion is integral to our work, with training projects occurring in clinics and in households.
In Khartoum State, Medair’s PHCC in the OES camp has the capacity to see 2,500 outpatients a month. In addition to those services already mentioned, we provide growth monitoring for under 5s, dental treatment, laboratory services, and short-stay rehydration treatment. Trained CHPs visit each home within Medair’s target area in OES at least once every three months to give health and hygiene education, and to ensure early referral of any cases of illness. Besides the house visits, a health and hygiene education project is targeted at pregnant and lactating mothers, and a separate project is targeted at children.
Medair also operates a basic mobile clinic which provides outreach health care at least three times per month in Khartoum State. The mobile clinic serves a population identified as lacking in access to basic health care services, usually a camp or squatter area.
In South Kordofan, Medair supports a total of 17 PHC facilities by providing training, supervision, supply of essential drugs, and management of an HIS. We support access to immunisations, and the implementation of the Roll Back Malaria initiative. Medair is increasing its focus on reproductive health care through staff training; awareness-raising and education; supply of specific medicines and Safe Delivery Kits for expectant mothers; and implementation of a Safe Delivery Area at a supported health facility.
Medair also supports health and hygiene promotion activities, which are provided with clinic services and through other appropriate methods such as village volunteers, drama groups, Village Health Committees (VHCs), and village elders. Health education messages focus on achieving appropriate behaviour change with a key focus on HIV/AIDS, nutrition (feeding habits of children under two years), and family planning.
Water & Sanitation (WatSan)
In South Kordofan, only 55 percent of the population in government areas and only 20 percent in former rebel areas have access to safe drinking water.[2] Up to 25 percent of the hand-pumps in the state are estimated to be non-functioning (sometimes due to mechanical breakdown, but often due to inadequate groundwater supplies or similar problems), and people report walking up to four hours to collect water during the dry season.
Although people may access surface water during the rainy season, it is frequently dirty and polluted. Access to sanitary facilities is even scarcer than access to safe water, which clearly increases the risks of diarrhoea and related diseases. For example, only 18 percent of households surveyed in Allirri Hills have a latrine, with some villages having no latrines at all.
While the water situation in West Darfur has always been precarious, problems have been exacerbated during the current conflict, and are compounded by the lack of humanitarian access due to insecurity. There is an urgent need to find solutions that will provide sufficient access to clean water, especially for large population concentrations, without affecting long-term sustainability of water sources.
Problems with the groundwater supply means that many people rely on unclean surface water sources, which can be linked to the high occurrence of waterborne diseases. Open water sources such as hand-dug wells need improvement, and some existing hand-pumps and water systems are now in need of repair or rehabilitation. There is also a need to construct sufficient latrines, and to promote their correct usage among the population.
Emergency
In South Kordofan, Medair has procured an emergency water treatment system that can be used to treat surface water or groundwater supplies, in order to provide access to safe drinking water for at least 2,500 people.
In West Darfur, Medair has the capacity to deploy up to six emergency water systems per year in the event of crises (consisting of two tanks connecting a jetted water point with 30 taps), serving up to 25,000 affected people. We can also construct up to 1,000 emergency latrines in the event of sudden crises.
Medair maintains water systems supplying 130,000 conflict-affected people in West Darfur. Medair will rehabilitate existing and build new hand-dug wells, fitted with hand pumps, and train more mechanics. The team is constructing over a thousand household latrines and providing hygiene training.
Rehabilitation
Medair employs a multi-faceted WatSan strategy in eight targeted villages in South Kordofan. We directly improve access to safe water by constructing new boreholes, and by supporting community maintenance of non-functioning boreholes through the provision of hand-pump spare parts. Medair also supports the construction of latrines, and promotes hygienic and sustainable latrine usage.
Medair provides additional sources of water by constructing rainwater harvesting systems, such as roof gutters and storage tanks, and by making “bio-sand” water filters available to some communities that have unsafe water supplies.
The WatSan team is also actively interested in watershed management that will improve the recharge of groundwater aquifers. Medair will support community construction of two terraces and will also survey potential sites for the construction of check dams. These structures should improve surface irrigation for agriculture and also demonstrate the benefits of techniques that were once widely practiced but have since been forgotten.
[1]“Nutrition And Food Security Survey In South Kordofan”, WFP / SC-US, February 2006
[2] “Nutrition And Food Security Survey In South Kordofan”, WFP / SC-US, February 2006