Virus could have ‘devastating’ impact on South Sudan refugees

A Cavan woman leading a humanitarian relief effort in South Sudan says Covid-19 is a “worrying development” in one of the world’s least prepared country’s able of dealing with a critical outbreak.

“What makes it so challenging is we just don’t know how its going to go,” states Noelle Fitzpatrick of a country which presently sits atop the Africa Centres for Disease Control and Prevention ‘Risk Matrix’ for those to be worst effected by high infection rate.

“Up until now the numbers haven’t been high, but really, we know it could be devastating,” admits the Kingscourt native.

Noelle is Country Director for Jesuit Refugee Service (JRS) in what is the world’s newest established nation. Their primary focus is education, where the vast majority to teachers have no formal training and in many cases never completed secondary school themselves.

She was first appointed to the role a little over a year ago, having previously worked as Programme Director with Trocaire on the organisation’s Syria response at the height of the middle-eastern conflict.

There are, according to JRS, over 4.3 million refugees, internally displaced people (IDPs) and asylum seekers living in South Sudan, with the highest numbers from Sudan’s Kordofan and Blue Nile regions.

Noelle oversees the running of operations in three locations, including a base in the country’s Capital city, Juba, where purchasing and logistical supports are coordinated.

Another operation is in the western portion of the country, but the faith-based organisation’s biggest programme of work is in Maban County, on the border with Ethiopia.

It is, Noelle describes, a “complex environment” where four distinct communities from different parts of Sudan now reside. “It’s very barren. At certain times of the year you’ll get it hard to find a blade of grass. Other times we’ve experienced extreme flooding. It’s a wonderful place in many ways, but very austere and quite volatile.”

Access to Maban is limited. There is only one main road. Otherwise movement in or out is by light aircraft.

South Sudan is both politically and economically fragile also, and has been ever since gaining its independence almost a decade ago. Subsequent years of civil conflict have taken a toll, creating fissures in a society with more than 60 diverse ethnic groups and hundreds of different dialects.

The latest Transitional Unity Government has only been in power since March and, already, there are tensions over the lack of a clear implementable strategy on protecting the country against the outbreak of Coronavirus.

South Sudan was one of the last countries in Africa to confirm a case (April 5). At that stage, there were only a handful of infections. Latest figures show there is now approximately 200, and that number is rising.

For a country sharing a border with six neighbours, South Sudan did act quickly, prohibiting movement across borders, restricting cargo to just essential food and fuel, and international flights were rapidly suspended.

The painful reality is when COVID-19 did arrive, it most likely unwittingly did through someone at the upper end of the socio-economic spectrum or the humanitarian community.

“The vast majority of [South Sudanese] can barely put food on the table, never mind afford cross international borders, unless perhaps you’re a truck driver,” explains Noelle.

While the current case number sounds low, like everything in South Sudan, context is crucial.

The country’s health system relies heavily on aid organisations for support.

There is only one COVID-19 testing machine for the whole country, and it’s located in Juba. As a result there’s little testing capacity outside the capital, and the backlog now numbers in the thousands.

“The city is only now beginning to be electrified. In March 2020 with the onset of the COVID-19 threat, the Government decided to prioritise linking hospitals in the city to the national grid. Before that everyone was running off generators and solar panels, most of us still are!” Noelle points out.

The shutdown of schools and industry has, meanwhile, created its own challenges. Many travelled back to their home villages, where usually the general population is much older. The question posed by that migration is has the virus travelled and to where?

“The sands have really shifted a lot in South Sudan’s fight against COVID-19 in the last couple of weeks,” observes Noelle.

Interestingly, the majority of positive Covid cases to date have occurred in people presenting as asymptomatic. That revelation has the internationally scientific and medical communities scratching their heads collectively.

Among the queries raised is whether more people infected will remain asymptomatic, while others are hypothesising why Africa has not yet been badly struck - with considerations stretching from higher temperatures to a younger age profile, or combination of both.

Only three per cent of the population in Africa is over the age of 65 years, compared to over 19% in Europe, 15% in America, and 11% in Eastern and South-Eastern Asia.

A country where Malaria is common too has given rise to rationale about something in those medicines, which may assist resistance.

“There’s also the question then whether people here are just naturally more resilient because they’ve had to deal with much more viruses and illnesses from an early age,” surmises Noelle. “All of these things are still only theories.”

Cross-contamination in communities, like densely populated refugee camps, is and remains a high risk. In those environments, Noelle acknowledges, that social-distancing and self-isolation is almost an impossibility.

As of mid-April there were more than 190,000 people sheltering in several UN-run civilian protection camps across South Sudan, where there can be four and five families to a single area.

An outbreak of COVID-19 was reported last week in one UN-run camp, home to more than 40,000 people near Juba. The potential for rapid spread and the on-set of panic Noelle regards as “immense”.

“Many people do not have access to radio and TV the way we do in Ireland, so may not have a full grasp of the facts of the disease. What they do know, however, is there is very limited capacity within the health system to deal with a severe outbreak.

“That knowledge alone can create panic and all sorts of related issues.”

The threat of infection still feels “remote” for many in a situation still steadily evolving. “It is very difficult for people, they can’t stay away from the market places, stall owners and street traders can’t afford to shut shop. There is no social welfare, no protective net provided by the Government. If people don’t earn something day to day, they and their families will suffer by hunger. COVID-19 is only one risk to their survival.”

A “silver lining”, Noelle resolves, is that people are now starting to accept the virus is spreading and are beginning to take matters more seriously.

“What we’re trying to do in South Sudan is make sure the people we work with, the community leaders and others, they understand the facts of COVID-19. The problem is, when people don’t have access to clear information, there is so much misinformation out there, so much rumour.”

In many ways COVID-19 is only the latest twist in a difficult life journey the people of South Sudan have had to endure. Their resilience, against generally insurmountable odds, Noelle comments, is something that still amazes her.

“People’s capacity to live simply, live day to day despite awful situations, be generous and kind is really humbling. I’m not romanticising it, there is nothing romantic about poverty, diminished life expectancy, and limited access to basic health and education, but, the resilience and gracefulness of people amidst all the challenges is the reality I experience. Really, there is an awful lot I have learned from people here. There is something we could all learn about the resilience the communities in South Sudan have, and I’m humbled every day by it.”

For more on the work of JRS and the Jesuits globally see www.jrs.net and contact the Irish Jesuit Mission Office at www.jesuitmissions.ie