UNICEF SOUTH SUDAN COUNTRY OFFICE
Rapid Response Team Report
Location (State/County/Payam/etc): Pagil, Ayod county, Jonglei
Date of the Mission: 02nd -9th Oct, 2014
1 / Name & Title of UNICEF Team Leader / Philip Otieno – WASH Specialist
2 / Names & Titles (with org/depart/section) of other members of the team / Ruth Kimani- Health Specialist
Anita Khamisa Abdalla – Nutrition Officer
Edisha Micael Atim, Education Coordinator (COSV)
3 / Sites visited / Pagil
Information and Data collected
4 / General Information / Provide the following general information about the mission site
Number of registered people:7,272
Total number of children under five (if available):1.382
Humanitarian situation and needs (IDPs, last time they received support, who is in control of the area etc.):
When the team arrived on the ground it was apparent that this particular location was under the control of SPLM-IO. The centre appeared like a military camp, as there were many armed soldiers patrolling around. On 15 December, 2013 when fighting broke out between factions of the South Sudan’s national army it quickly spread out to other states, including Jonglei. The escalation of violence, which later assumed an ethnic overtone claimed thousands of lives innocent civilians, caused colossal loss of property, deprived the population of their livelihood; and thus, created immense suffering to women and children. Many NGOs find it difficult to work in the area due to the restrictions placed on them by the government. As such the community has been left to fend for itself, and survive on its own resources.
They war resulted in an influx of population into Pagil Payam. Most of the incoming people were IDPs from Bor in Jonglei State, others came from Upper Nile State and Unity State. An assessment which was done sometime in April, placed the total figure of the IDPs and the host community to be at 25,000 people. However, because people had been assured of imminent services which never came, they started moving to other locations where they could access services.
Immediate Response Provided and Follow up Actions
5 / Nutrition
Situation Overview and Humanitarian needs: / Provide a brief situation analysis and list down the critical humanitarian needs related to Nutrition
The people in Pagil are pastoralists dependent mainly on their livestock. The main crops are traditionally maize and sorghum. However, abnormal levels of flooding the area since the beginning of the rainy season this year has had a negative impact on agricultural activities. Hence, the population is dependent on food assistance to cover basic needs. According to the population, access to staple foods such as sorghum and maize require walking long distances through flooded areas.
There are no established nutrition services in Pagil. Nutrition services have been disrupted since the escalation of the conflict in Ayod in April 2014 with most of the population now internally displaced within the county. COSV is currently running nutrition services in Jeich and Gorwai payams.
There is one operational PHCU structure situated in Pagil covering the whole payam. The centre is equipped with three health staff (one medical assistant and two trained community health volunteers). The staff has not been paid since the beginning of the year. However, due to lack of supplies, the services of the PHCU are very limited. COSV, who is the lead agency for health in Ayod county, are currently attempting to bring in essential health supplies to the area.
Malaria and Kala Azar are endemic in the area. Around 20 cases have recently been reported in or around Pagil. COSV have been running Kala Azar/TB program in Ayod county but these have been hampered by the fighting and insecurity in the area.
No recent nutrition survey data is available for the area.
Immediate Response/Results: / Summary of key interventions and results including challenges and how they were overcome
Key nutrition interventions for the rapid response included MUAC screening of children 6-59 months with provision of treatment for cases with acute malnutrition as well as micronutrient supplementation and deworming for children under 5 years. Pregnant and lactating women were assessed for their nutritional status using MUAC as well as provided with key messages on optimal infant and young child feeding.
Age 6-59 months was determined by using height criteria 65-110 cm using screening sticks with clearly marked cut-offs. The same methodology for determining age was use by both WFP team and UNICEF using. Through MUAC screening 7 children were found with severe acute malnutrition. All identified SAM cases were immediately admitted for treatment with RUTF. 271 children were found moderately acute malnourished. These children were registered with WFP and further received RUSF treatment through the general food distribution.
Please note: MUAC screening results are not included in this report as these cannot be validated.
A total of 1,843 children aged 6-59 months received Vitamin A supplement and 1,554 children aged 12-29 months received deworming tablets.
A total of 409 pregnant and lactating women were assessed for their nutritional status by MUAC 41 (10%) were found at risk with a MUAC <-21.0cm and 65 (15.8%) were found with MUAC 21-<-23.cm. Our screening results raises serious concerns for the nutritional status of pregnant and lactating women in the area and a risk factor for further deterioration of the nutritional status of children in Ayod.
A total of 1,317 pregnant and lactating women received IYCF key messages during the screening. The messages were convey with the local language to the population focusing for pregnant and lactating women and their children under 5.
COSV currently has 2 nutrition staff (1 nutrition supervisor and 1 medical assistant) and 2 community outreach volunteers on the ground in Pagil. 13 additional community outreach workers were recruited during the RRM. As part of the capacity building for the establishment of OTP services, trainings were provided by UNICEF/COSV on admission criteria and procedures, community referrals, systematic treatment of SAM as well as health and nutrition key messaging. There are currently no options for treatment / referral of SAM cases with complications. COSV has an agreement with WFP to set up TSFP in the near future.
Challenges:
  • No space in current PHCU structure for OTP activities. Temporary OTP activities took place at the screening site. COVS planning to set up tents in identified space close to PHCY to house OTP activities.
  • Supplies are currently being stored in PHCU which has limited storage space. COSV plans to provide tent for storage purpose.
  • No Stabilization Centre available in the area.

Provide data against the following indicators and mention the source of information in the end
N/A / # of children 6-59 months screened for acute malnutrition via the RRM
7 / # of SAM cases detected
271 / # of MAM cases detected
7 / # of children 6-59 months admitted to a SAM management programme
271 / # of MAM cases 6-59 months referred for treatment
1,317 / # of PLW access IYCF messaging
1,843 / # of children reached 6-59 months reached with Vitamin A
1,554 / # of children 12-59 months reached with deworming medication
Source of information: Tally sheet
Follow up Actions required: / What key actions are required and by whom?
  • COSV to establish OTP structure (tent) in conjunction to the existing PHCU.
  • COSV to ensure storage space for nutrition supplies (tent) and ensure this is secured and meets the requirements for storage of nutrition supplies
  • COSV to recruit additional staff for OTP in Pagil.
  • COSV to provide a further assessment of the nutritional situation among children 6-59 months through ensuring careful monitoring of the nutritional situation in Pagil by implementation of regular MUAC screening activities in the community as well as monitoring of admission patterns.
  • UNICEF/COSV to ensure options of Stabilization Centre referrals.
  • UNICEF to liaise with COSV by end October to follow up and support on any arising matters to ensure quality set-up of OTP services (capacity building tools, (technical advice etc).
  • UNICEF to ensure timely response to supply request to avoid stock-outs for OTP activities.

6 / Health
Situation Overview and Humanitarian needs: / Provide a brief situation analysis and list down the critical humanitarian needs related to Health
Pagil community has only one PHCU which is supported and run by COSV. Currently, the area is densely populated, with majority being people displaced by the conflict. Due to the heavy rains and floods malaria was noted to lead on the morbidity burden.
During the mission more than 100 patients tested positive for malaria. However, there was also an endemic spread of Kala-azar. 15 people had tested positive for kala-azar and were admitted at the small PHCU on meds. Amongst the 15, were 6 children below 5 and 2 pregnant women.
  • The current Health situation is generally extremely poor.The PHCU is run by a Community Health Worker (CHW), and there were no medical supplies. The last drug and medical supply from COSV was done in November 2013 as did the last immunization coverage.
  • In collaboration with the County Health Department(CHD) and the CHW in charge of the PHCU comprehensive curative consultations were provided and the beneficiaries benefited from the drug kit delivered by UNICEF. With the high morbidity rate the drug consumption was very high. 242 patients were attended to:123 female women;86 children; and 33 male adults. Malaria, Acute watery diarrhoea and pneumonia were the leading morbidities.
  • The CHD in charge of the facility reported there had been an outbreak of measles with three deathsreported resulting from the same 3weeks before the mission.
  • There were 15 new cases of Kalazar who were already admitted after testing positive. Apparently, it is a very big challenge to treat the disease, especially for pregnant mothers since the only drug available was contraindicated to pregnancy. This was noted to be a very huge disease burden.
  • Obstetric health (safe motherhood): It was noted that most deliveries were unattended to by a skilled health care provider because. Most mothers preferred / resulted to home deliveries.
  • Due to floods and community walking barefooted in the waters, there was an endemic of Bilharzia

Immediate Response/Results: / Summary of key interventions and results including challenges and how they were overcome
  • PHCU kit and mosquito nets were handed over to the CHD and the facility incharge
  • EPI:
  • Total 3,217 children (1,637 males, 1,579 females)were vaccinated against Polio
  • Total 3,795 children (1,851 males, 1,944 females)were vaccinated against measles
  • To facilitate the EPI services 10 vaccinators and clerks were given a refresher training
  • Curative measures were provided and a total of 242 patients were treated
  • Preventive medicine was done by distributing the treated mosquito nets to the most vulnerable group
  • Management of Kala-azar in pregnant mothers and children below 5 years, liaised with COSV Juba who promised to tackle the health problem.

Provide data against the following indicators and mention the source of information in the end
3,795 / # of children 6m-15 years vaccinated against measles
3,217 / # of children under 15 vaccinated against polio
367 / # of households reached with at least 1 ITN
86 / # of consultations for children under 5
*source of information: RRM pagil mission 2nd- 9th Oct 2014
Follow up Actions required: / What key actions are required and by whom?
  • Kala-azar integratedassessment, awareness and management follow up by COSV
  • Need for a cold chain system to ensure all children are immunized at all times to facilitate sustainability of routine immunizations
  • COSV to ensure consistent supply of drugs and medical supplies and follow ups
  • Need for Traditional Birth attendants training- COSV/UNICEF
  • Need for communication means eg Thuraya to facilitate submission of weekly surveillance morbidity and mortality rate reports to ensure quick emergency responses take place in case of any outbreaks- COSV

7 / WASH
Situation Overview and Humanitarian needs: / Provide a brief situation analysis and list down the critical humanitarian needs related to WAHS
It was clear the government infrastructure had been disrupted by the war. Most key personnel were not on the ground. For example, the Payam administrator was not there as well WASH personnel who could provide useful information on the WASH situation on the ground. This made it difficult to come up with authoritative figures or a clear description on the WASH situation in Pagil. The movement of the team was also restricted to the camp where base was set up and the airstrip where the team would go receive supplies from time to time. The information that is provided here is therefore based on observation and general information gathered from informants.
The population at Pagil center have no access to one functional borehole. There was another borehole about half a kilometre away, which had broken down. It was not possible to establish the exact number of functioning and non-functioning boreholes within Pagil payam as the relevant personnel who could provide this information was not on the ground. However, there is a team that had been trained on borehole repairs, but the main challenge they faced was accessing spare parts whenever there was hand pump break down. The communities relied on functioning boreholes to draw their water. However, community members were also observed drawing water from a seasonal river and in ponds.
Since the war broke out, no supplies had reached the area including basic household supplies like soap. This has undermined safe hygiene practices at household level such as washing hands with soap at critical moments. Most people practice open defecation. They said that this was due to mobile nature of the community, where they kept on moving from one place to another, and this made them not appreciate the necessity of constructing latrines. This combined with the apparent poor hygiene practices could easily trigger an outbreak of water and sanitation diseases.
Pagil is a swampy area. As we moved around we observed snail shells in stagnant water, and this could lead to Bilharzia incidents. This is a point of concern that would require further action in future RRM missions.
Immediate Response/Results: / Summary of key interventions and results including challenges and how they were overcome
Key interventions included:-
  • Training the community and supporting them to treat their water. This was especially essential as they were drawing water from unsafe sources. They were supported with water floc
  • The community has no access to market where they can get basic supplies such as soap. They were therefore supported with soap to enhance safe hygiene practices at the household level. Such practices include hand washing at critical times.
  • Provision of 20 sets of spare parts to rehabilitate boreholes that had broken down
  • Promotion of basic hygiene messages to be applied at household and community level.

Provide data against the following indicators and mention the source of information in the end
7,000 / # of people reached with hygiene promotion messages to be shared with their community
N/A / # of people provided with sustained access to safe water supply (at least agreed emergency standards of 7.5L)
1,500 HH / # of people provided with WASH supplies
source of information: UNICEF RRM
Follow up
Actions required / What key actions are required and by whom?
  • Need to identify potential WASH partner ready to work in the location-action by section and cluster.
  • Rehabilitation of non-functional boreholes- action to be taken by payam and county administration.
  • Follow up RRM missions to the location.

8 / Child Protection
Situation Overview and Humanitarian needs: / Provide a brief situation analysis and list down the critical humanitarian needs related to CP
Pagil is one payam of Ayod County in Jonglei State. CADA is the only child protection partner in Ayod with little access to Pagil due to insecurity.
During the RRM it was noted that there were no ongoing child protection activities in the area. There are many IDPs in the area and many children are in need of psychosocial support and family tracing and reunification (FTR).
The community is ready to cooperate with NGOs coming to help, there is no local community protection department in the area.
i)CADA needs to work with community to bring transformation in the children life.
ii)Community involvement is vital to the work with NGOs to reunite the separated children with their parents.
Immediate Response/Results: / Summary of key interventions and results including challenges and how they were overcome
  • FTR activities
  • Awareness and prevention messaging
  • 5 vulnerable children referred for follow up

Provide data against the following indicators and mention the source of information in the end
60 / # of people reached with lifesaving information/awareness sessions
34 / # of registered UASC receiving FTR services and family-based care/appropriate alternative care services
5 / # of children referred for critical child protection services
source of information
Follow up Actions required: / What key actions are required and by whom?
  • Scale up the child protection activities in the area,
  • FTR cases registered need to be follow-up,
  • Unaccompanied children need to be traced
  • Community need to be given awareness about the important of the activities in the area

9
: / Education
Situation Overview and Humanitarian needs: / Provide a brief situation analysis and list down the critical humanitarian needs related to Education
Most of the schools in Pagil are still closed as the focus has changed to basic needs. Majority of the people in Pagil are IDPs from Ayod County. This area before the crisis had a limited number of schools, Pagil itself as a Boma had two schools but by the time of the RRM, both schools were closed due to lack of school materials and very limited teachers. Meanwhile, there are other 8 schools in the Payam but only 2 were functional, Weichdeng and Chuilbong where some of the children have to walk for 3-4 hours to reach the school. According to the teachers and the Payam Education team, most of the school materials were destroyed, and no teaching or scholastic materials are in place for teaching the pupils. Some of the teachers and pupils have deserted education and have moved to different locations to look for other means of survival. This is evident with the fact that during this RRM, a very limited number of the age group between 14-18 were identified in the area. There are no Early Childhood Development activities in Pagil; there are also very limited female teachers in the area. Out of 30 teachers identified, only 3 were female.
The following are the critical education and other humanitarian needs:
Basic needs (food, water, health, shelter and education)
However, in education, the following support in critically needed:
  1. Scholastic materials and textbooks
  2. In kind support for teachers or incentives
  3. Establishment of learning spaces

Immediate Response/Results: / Summary of key interventions and results including challenges and how they were overcome
  • A total of 587 pupils were registered from Primary one to seven (389boys, 198 girls) and a total of 221 children (95 boys, 126 girls) were registered for ECD activities.
  • Meeting with parents, community leaders and chiefs to discuss the education situation in Pagil and to plan for the opening of the closed schools in Pagil. Local authorities were very positive and supported the plan to open the schools despite all the challenges
  • No TLS was set up in Pagil. However this needs urgent follow-up in next 1-2 weeks.
  • Identification of 15PTA members (11male, 4 females) and 10 SMCs (all male) to support the sustainability of the TLS when it will be set up. All were trained on psychosocial support
  • School materials were received but handed over to local authorities by UNICEF (10 school in box and 10 ECD )
  • 30 teachers were identified and trained on psychosocial support; (27 males, 3 female)

Provide data against the following indicators and mention the source of information in the end
221(95 boys, 126 girls) / # of pre-school children (aged 3-6) with access to play and early learning, including supplies
587 (389 boys, 198 girls) / # of school-aged children including adolescents (aged 7-18) with access to Education in Emergencies, including supplies
30 (27 male and 3 female) / # of teachers trained to provide Education in Emergencies
25 (21 male and 4 female) / # of other education personnel and Parent-Teacher Association members trained to support Education in Emergencies
N/A / # of classrooms established/rehabilitated
source of information:
Follow up Actions required / What key actions are required and by whom?
  • Training of PTAs and SMCs to support the TLS/education in emergencies, COSV
  • Awareness campaign to support girls to go to school, by COSV
  • COSV, in collaboration with UNICEF on TLS, to establish latrines in the TLS sites(when the TLS will be set-up
  • Integration of Nutrition and health into school services – COSV

Additional Information collected from the mission
10 / Limitations of the mission / Health
  • Low turn up of children under five for immunization, this was attributed to the increasingly flooded swamps following heavy rains. Mothers reported to have left the children at home since they could only carry one to the mission.

11 / Recommendations (specific) /
  • Need to ensure sufficient drug and medical supplies to Pagil with prompt follow ups.

12 / Suggested follow-up mission: date / January 2015.

Supplies distributed: