Severe Acute Malnutrition - South Sudan

We're treating desperately ill children in South Sudan camp

Working around the clock to tackle one of the world’s worst nutrition crises.

By Leah Oatway

Jul 25 2014

As the conflict that erupted in South Sudan in December 2013 continues, the humanitarian crisis worsens. An estimated 1.3 million people have been internally displaced by the violence and more than 440,000 are sheltering in neighbouring countries. 

It is now rainy season, and sites where the displaced have sought refuge, including in Bentiu, are suffering terrible flooding, increasing the risk of water-borne diseases.

Jogie Agbogan, our nutrition coordinator for South Sudan, has been working with communities in need since 2008 and is an invaluable member of our 5,000-strong Action Against Hunger staff. 

Right now, she is trying to alleviate the suffering of young children in South Sudan as part of an emergency response team that is working around the clock to tackle one of the world’s worst nutrition crises. 

Our nutrition emergency team in South Sudan recently set up an outpatient therapeutic programme in Bentiu camp, in Unity state, where more than 46,000 internally displaced people are staying. 

We spoke to Jogie to learn more about that process and her experiences in South Sudan.

Why did the nutrition emergency team set up the outpatient programme in Bentiu?

As the security situation continued to deteriorate in the conflict areas, there were increasing reports that the health and nutrition situation in Bentiu was worsening.  A recent Unicef report indicated that up to 24 children under five were dying weekly in the Protection of Civilians camp.

Action Against Hunger and the cluster of nutrition-focused organisations consulted with partners on the ground to assess any potential additional support [that could be provided] to meet the increasing needs.  It became clear that the non-governmental organisations already implementing nutrition interventions were overwhelmed with the influx of displaced people. We quickly responded, setting up the outpatient therapeutic programme  to alleviate [pressure] on other organisations in the area.

What goes on at the programme?

Within the programme we measure all children under five that are brought in by caregivers, referred by community mobilisers, or referred from health facilities. We also: screen all malnourished children to check for any other health complications; screen for and, where necessary treat, malaria; provide antibiotics and rations of ready-to-use therapeutic food; offer Vitamin A supplements and deworming; deliver health education that covers nutrition, infant and young child feeding, as well as good hygiene; and offer individual counseling for mothers on feeding infants and young children. 

We also build the capacity of local staff to carry out these things, to help ensure the work we do is sustainable. 

How does the outpatient therapeutic programme support the people in the camps?

The intervention aims to reduce the number of children under five dying due to acute malnutrition. We focus on two areas in the camp where there are no other nutrition interventions. Health facilities in these locations refer all suspected malnourished children to our outpatient programme, which offers them treatment and their mothers/caregivers advice on preventing their children and other family members from becoming malnourished.

How many beneficiaries will be helped through this outpatient therapeutic programme?

Three weeks into the programme, we had admitted 220 children for treatment.

What role do community mobilisers play in diagnosing acute malnutrition, and referring beneficiaries to you?

Our community mobilisers play a major role in our work in the Bentiu protection of civilians camp. They conduct community screenings, where they measure children’s middle upper arm circumference. All severely malnourished children are referred to the outpatient programme and the moderately malnourished children to supplementary feeding programmes run by a partner organisation.

The mobilisers also organise community health, nutrition, infant and young child feeding education and awareness programmes and conduct individual counselling on breastfeeding to mothers of children under six months old, and mothers of children currently in the outpatient programme.

They also visit former patients’ homes to check on their progress. Finally, they come to the programme once a week to assist the team and learn about other nutrition activities in order to build capacity in Bentiu.

How does the outpatient therapeutic programme fit into the larger strategy of our work in the Bentiu camp?

It is integral to the humanitarian response there. We are filling a large gap with high quality and much-needed services. The programme builds the capacity of other partners to implement nutrition programmes, and provides technical support to the nutrition cluster to ensure that all interventions, analysis and planning are conducted to national and global standards.

How does the programme fit into the larger context of the humanitarian work going on at the camp?

The nutrition emergency team was set up with the primary goal of saving lives during emergency situations when there is a gap in capacity or partner presence, thanks to funding from the Office of US Foreign Disaster Assistance and the European Commission for Humanitarian Aid and Civil Protection.

We also carry out assessments on training needs and design training modules based on partners’ needs and the community situation. Our staff coordinate and collaborate with other implementing nutrition partners to train their staff to enact harmonized interventions based on national guidelines.

Our survey manager will provide technical support to partners in carrying out a nutrition survey, due to take place soon, that will estimate the prevalence of acute malnutrition in the camp.

We will ensure that the programme will eventually be handed over to an organisation that has the proven capacity to continue it with the highest standard when the nutrition emergency team leaves Bentiu.

What about your experience at the outpatient programme so far stands out in your mind?

When I arrived, I was amazed to hear that beneficiaries from around the camp were travelling to our programme because they knew that we provide excellent services. 

Many people remember Action Against Hunger in Bentiu from years back. That memory and the well-known quality of our work gave mothers the impetus to travel further to reach our programme.

The first heavy rain occurred the night before I arrived in Bentiu. The entire camp was flooded- many health and nutrition facilities, as well as families, were once again displaced. 

Access to services worsened, latrines overflowed, and sewage was prominent throughout the camp, posing many health dangers to the people, especially the children.

Of all the organisations present in Bentiu, our recruitment tools (written exam and interview) were reported as the most challenging. This ensure that our staff are the most experienced and could be trained easily.

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Photo credits:  © Agnès Varraine Leca