HI’s race to protect frail people against COVID-19 in a country with only 24 ICU beds

About 11 million people live in South Sudan, and statistical modeling suggests that the coronavirus is likely reach more than half of the population. For a country with just 24 intensive care unit beds and very limited medical equipment, slowing the spread of the virus is paramount, and HI teams have been fighting to do just that since March.

The presence of the coronavirus was detected late in this East-Central African country. The first Covid-19 case appeared in early April. Trend analysis from 45 African countries that reported cases as of March 24, suggests almost all countries will reach 1,000 cases by the end of May, and 10,000 cases a few weeks after that. We are on standby for a rapid increase in the number of new cases in South Sudan within 3-6 weeks from end of April. 

HI has been accompanying vulnerable people with disabilities and internally displaced people in South Sudan since 2006. Fearing the worst, HI’s 95-person team had anticipated the risks, and had already adapted their activities to prevent the spread of the virus. 

Disastrous hygiene conditions

“Our teams are making every effort to improve the country's emergency response to COVID-19 and to protect the most vulnerable,” explains Armogast Mwasi, South Sudan Program Director for HI. “From door-to-door outreach to the most vulnerable, to the coordination of working groups with the country's health authorities, HI is working at all levels. But the situation is complicated."

Health and Hygiene conditions are disastrous. 56 per cent of the South Sudan population are without access to primary health care services, out of approximately 2,300 health facilities, more than 1,300 (57%) of facilities are non-functional and health facility surveillance gap is at 40 per cent, as well over 50% of the population lacks access to safe water and a mere 15 per cent of the population have access to latrines, WASH infection prevention and control is at 7 per cent. Currently 1.67 million displaced people and 279,880 spontaneous returnees are living in the country.

"Even without the coronavirus, 6 million people are likely to experience crisis or emergency food security outcomes. Communities with high numbers of returnees and IDPs are particularly vulnerable, given that food sources and market supplies are already scarce. Closure of border crossings related to COVID-19 response have put pressure on already high food prices, exchange rate fluctuations, closure of businesses considered non-essential with key concerns on reduced income earning opportunities, further increasing their vulnerability. The result takes the form of negative coping strategies and disease outbreaks.

"So, as you can imagine, the conditions here are definitively not in place to effectively combat the spread of the pandemic, but our teams are doing their best to protect our beneficiaries, the persons with disabilities and older people, among the most vulnerable to this virus. The virus exacerbates the ongoing humanitarian crisis around health infrastructure, economy, livelihoods and water, sanitation and poor hygiene."

The challenge for HI is to maintain access in the midst of movement restrictions, xenophobic and violent attacks to meet the basic needs of vulnerable people so they do not become even more vulnerable. We must ensure their access to food, hygiene products and health services, as much as possible.”

Door-to-door

HI’s activities continue in the settlements of displaced people, but in addition HI now also contributes to prevention activities. Awareness raising and learning how to stop the spread of the virus is done with each beneficiary or target group, and the ways we do this are also adapted to protect each person from the virus. We have already conducted 389 house-to-house sessions, reaching 3,110 individuals.

For that purpose, HI led active and systematic identification, evaluation and referral of Persons with Specific Needs or Extremely Vulnerable Individuals. By late March, the project had identified more than 5,200 people in two UN protection of civilian sites in Juba. All of these individuals will learn to protect themselves and their friends and families from COVID-19. On April 1, HI launched house-to-house community engagement awareness campaigns on COVID-19 preparedness, prevention and response in the protection of civilian sites.

“Leave No-One Behind!” is the message

"Leave No-One Behind! Persons with disabilities are at high risk of getting sick during the COVID-19 pandemic because they may not receive information on how to protect themselves. They may be unaware of where and how to access the services and support they need. Share all information you receive with persons with disabilities and their caregivers, so they can also be informed!" This message is one of HI’s key words.

HI has trained and identified 27 staff, as well as 69 community focal contacts, including older people, members of organizations of persons with disabilities, women and youth representatives, and religious leaders in two protection of civilian sites run by the UN Mission in South Sudan (UNMISS).

So far, teams have conducted 12 awareness-raising sessions, each with only eight participants, according to social distancing measures. Participants learn to protect themselves and provide the people they assist with prevention information. They were taught about the COVID-19 outbreak, the ways the virus spreads, signs and symptoms, and precautionary measures such as the use of face masks, avoiding handshakes, social distancing, and frequent hand washing. They also learned how to spread positive messages, regarding the protection of the people with disabilities, and how persons with disabilities and their caregivers should be provided equal access to healthcare and supportive services.

Reaching as many people as possible

In order to effectively raise awareness of COVID-19, and to reach the greatest number of people with stay-healthy messages, the team has involved media, and has sponsored one radio talk show reaching approximately 280,000.

With the support and input from organizations of persons with disabilities, we have adapted the national task force’s COVID-19 awareness materials. Two posters and a radio script will be used for wide circulation throughout South Sudan.

Simultaneously, HI has been coordinating with national authorities and humanitarian actors in three of the five established COVID-19 working groups. These groups are risk communication and community engagement, infection prevention and control, and case management. HI staff are participating in bilateral meetings and the national coordination platform, clusters, and technical working groups. In the health cluster, HI has been appointed the lead agency for coordination of the sub-group on COVID-19 mental health and psychosocial support national hotline and disability working group.