As South Sudan is on its roadmap to recovery from many years of conflict, the IRC is particularly concerned for the country’s health care system. According to UNICEF, South Sudan has one of the highest infant mortality rates in the world, with 62 deaths for every 1,000 live births in 2019. Malaria is the leading cause of morbidity and mortality, and a cholera outbreak was reported in March 2022, with more than 300 confirmed cases as of early September.

Adding to these challenges is the violence against healthcare workers, patients and infrastructure which contributes to the widespread failure of the health care system to meet even the basic health needs of the population. At least 18 health staff were reportedly killed since the start of 2021, making South Sudan one of the most dangerous countries in the world for health workers.  In comparison, 19 health workers were killed in Syria during the same period. These attacks continue to take place despite the special protection offered to health care under International Law. Under the United Nations Security Council Resolution 2268, these types of attacks are a clear demonstration of the Age of Impunity in which we operate - where atrocities are carried out without accountability and with impunity. They compound an already-challenging situation and further complicate efforts to deliver more effective impactful health care support to the people of South Sudan. 

IRC and partners launched a survey to identify the characteristics of incidents of violence against the health care system in South Sudan, better understand the impact of such violence and work with stakeholders to advocate for a safe and secure environment while delivering health care services.

 Cosmas Ayella, Deputy Director of Programs South Sudan, said, 

‘’The findings show that continued insecurity in South Sudan is a worry for health service delivery: on a daily basis, midwives, clinical officers, nurses, and other health staff risk their lives and wellbeing to provide basic health care services. The IRC South Sudan team will continue to work with the Ministry of Health at national and state levels to ensure health staff can safely provide care to everyone in need.’’

The most commonly reported incidents are attacks on health staff, including killing and arrest, and direct attacks and looting of facilities.  The impact of such violence on the health system affects the availability of health services at the community level and has a severe impact on the mental and psychological wellbeing of the health workers. At least 18 health staff were reportedly killed since the start of 2021 and the findings indicate that health workers who have witnessed or experienced such violent incidents are experiencing signs of heightened distress.  As many as 18 health staff were killed anda combined 1,212 working days, or 3.5 years, were missed by health staff following the violent incidents reported as part of this survey. After 73% of reported incidents, communities faced additional difficulties in accessing the required health services. The reluctance of the population to visit health services, out of fear, is among the most important reasons.

The recommendations show that this growing concern requires concerted efforts by all who care about the safety of staff, and right to health in the country. The stakeholders implementing health service provision to ensure that there are sufficient resources in place to adopt basic security measures for all facilities, ensure adequate and standardize monitoring and reporting of attacks on healthcare to strengthen accountability efforts, for the donors to support health activities within the forthcoming Humanitarian Response Plan, ensuring that sufficient funding is available to meet identified health needs and for the government to prioritize health care spending, with specific considerations to reduce violence against health care, ensure perpetrators of violence are held accountablefor their actions and accountability mechanism implemented as part of the transitional justice process.  

For over 30 years, IRC has been one of the largest aid providers in South Sudan, delivering emergency assistance and supporting vulnerable populations in hard-to-reach areas. Our health response includes capacity building in state clinics, training of local health workers, nutrition programs and sanitation services. We also provide support to survivors of sexual violence and child protection services. Community leaders and government officials are trained on the importance of upholding human rights. The IRC helps empower people through cash assistance, job and livelihoods training. Learn more about the IRC’s South Sudan response.