Four Ventilators: What COVID-19 in South Sudan Reveals About Healthcare in the Developing World

South Sudan only has four ventilators and 24 ICU beds in the entire country.

Developing countries such as South Sudan have struggled during the pandemic to increase healthcare treatments and continue to improve their healthcare systems. The United Nations (UN) expressed concern for South Sudan and other Least Developed Countries (LDCs), such as Trinidad and Tobago, Afghanistan due to a lack of healthcare resources, fragile healthcare systems, and a lack of national financial resources. South Sudan is one of several developing countries who lack resources as they face the pandemic; South Sudan is one example of resource drought.

The country of South Sudan is just ten years old and has an extremely fragile healthcare system. The instability of the government and socioeconomic tensions harmed the healthcare system and amount of resources as public health investment was neglected, meaning that COVID-19 preparation was stalled. While South Sudan has had a lower number of COVID-19 cases compared to countries like the U.S., the country’s healthcare system has been harmed by the international reaction of countries towards aid for stabilization. 

Determining the Impact of COVID-19 on the Population

There are many factors that go into determining the impact of COVID-19 on the population. Some of these factors are the current healthcare resources available, and the amount of at-risk people in the country. 

South Sudan has had a total of 3206 COVID-19 cases and 62 deaths as of Dec. 13, 2020. However, according to the United Nations, there has been “limited testing and social stigma obscure the true magnitude of the pandemic.” It is also known that COVID-19 can have lifelong health effects; 1 in 3 South Sudanese people face food insecurity, which heavily weakens the immune system and further harms a person’s health. 

There are also around 4 million South Sudanese (about two-fifths of the population) who are displaced due to conflict, making them more vulnerable to COVID-19. The South Sudanese who are displaced are living close together (easy transmission) already need medical care and aid and South Sudanese prisons also already have unstable healthcare. This crisis is further exacerbated by the fact that there are extremely limited critical care resources in the country, not enough to support a country of about 11 million people.

What the International Community Thought the Pandemic Would Look Like in South Sudan

The international community initially believed that the critical care resources in South Sudan were not enough for the entirety of the population (around 11 million people). The country has been described as one of the most under-prepared countries for COVID-19. The country has a limited amount of critical care resources, and the United Nations stated that although there are lower numbers of cases, a lack of testing in Juba, the capital of South Sudan, and surrounding areas are the cause of this. 

As the country continues to face challenges of food insecurity and escalating violence, because South Sudan is still a developing country, citizens are at a high risk of COVID-19. There are over two million internal refugees in South Sudan, and over four million people have also been displaced overall. Displacement means that citizens have to live in closer, non-socially distanced areas, creating an environment in which COVID-19 could easily spread. The international community and human rights organizations such as Human Rights Watch were concerned at the beginning of the pandemic about the health impacts for at-risk populations in South Sudan.

What the Pandemic Actually Looked Like in South Sudan

Dr. Mark Thaller, Ph.D. in Conflict Analysis and Resolution, an advisor to the South Sudan Minister of Federal Affairs, discussed the impact that the pandemic had on South Sudan as a whole. Thaller spent several months in Juba over the summer and noted that testing was required for entry into the country. 

South Sudan was one of the last countries to record a case of COVID-19, which could be due to lower amounts of testing in the country. In Juba, testing was fairly common; however due to the costs of high amounts of testing and transportation issues, getting tested for COVID-19 is more difficult in smaller cities and rural areas.

The Centers for Disease Control and Prevention (CDC) instituted a level four COVID-19 notice for South Sudan earlier in the year. This travel advisory notes that the infection level in South Sudan for COVID-19 is higher than other countries in the world. Dr. Thaller said that this travel advisory was put in place mainly because of the lack of critical care resources in the country, a potential problem if a traveler or citizen would be infected. 

Issues that the Healthcare System Faces

The healthcare system in South Sudan continues to face several main issues: political conflict and social unrest, a weak economy (due to low revenues from oil companies during the pandemic), a lack of international donor coordination, and severe underfunding. The pandemic added more stress to the instability of the healthcare system in South Sudan. 

Coverage for essential health services, such as treatment for pneumonia, are below 50 percent. Less than seven percent of the governmental budget for the past several years has gone to healthcare funding. This can be compared to the United States’ healthcare budget of 17.7 percent in 2019. This severe underfunding limits the amount of testing for COVID-19, creates a lack of critical care resources (such as ICU beds and ventilators), and affects the costs of treatments and medicines.

Dr. Thaller explained that while doctor and hospital visits in South Sudan are free for the public, the costs of medicines and treatments is what ultimately harms the people. For instance, he explained that if the average income per month is $10 USD, and medicine insulin costs $2.00 USD, that is already 20 percent of a person’s monthly income, not including food, water, and other necessities. Dr. Thaller also explained that this does not take into account the hours spent in line waiting to see a healthcare worker, or even the low pay-rates for healthcare professionals themselves. 

The United Nations and Mitigating COVID-19

The United Nations has been working to mitigate the impact of COVID-19 on malnourished and displaced children, due to violence, since the spring. Their work focuses on the 1.14 million displaced children in South Sudan and other children throughout 37 different countries. In the past year, The United Nations Educational, Scientific and Cultural Organization (UNESCO) also launched a Global Education Coalition to support children’s education in response to COVID-19 as well. The United Nations Children’s Fund (UNICEF) also responded to COVID-19 by appealing to international donors to provide $651.6 million for COVID-19 information about handwashing, personal protective equipment, and psychological counselling for children. 

Other organizations such as the Food and Agriculture Organization and the World Food Programme (WFP) have also worked towards mitigating the spread of COVID-19 in South Sudan and other high-risk countries. The Food and Agriculture Organization has been working to prevent COVID-19 from further damaging populations who face hunger crises. WFP has worked with governments to make sure that children/their families are able to identify alternatives to how they receive food and nutritional support.

It is also important to note that the number of international and UN volunteers declined in South Sudan due to COVID-19. However, the UN and other organizations have worked hard to make sure that children are the focus of their efforts, especially with the high amounts of displacement due to violence.

The World Bank’s Partnership with South Sudan

The World Bank also partnered with South Sudan to ensure vulnerable populations are reached and to rebuild the healthcare system and provide economic aid. The World Bank provided $7.6 million for COVID-19 emergency response in early April.  This was in response to the government’s request to pandemic and build up the national systems in regards to public health. The $7.6 million was implemented under the Provision of Essential Health Services Project. The World Bank has been a consistent partner to South Sudan as the country has worked towards strengthening the healthcare system that was deeply harmed due to conflict (civil war) and low access to important health services (such as access to affordable insulin).

“The COVID-19 outbreak is anticipated to overburden South Sudan’s weak public health preparedness and response systems and may have a socio-economic impact on South Sudan in terms of increasing food insecurity and deepening poverty and vulnerabilities,”

Husam Abugga, World Bank Country Manager for South Sudan

Dr. Thaller noted that this was one of the most helpful ways that an organization has helped South Sudan. The people and government need funding to solve healthcare issues, not short-term band-aid solutions that overlook the problem itself. While cities like Juba have done fairly well economically despite the pandemic, according to Dr. Thaller, this does not mean that the lack of funding for necessary institutions is solved throughout the nation.

Vulnerable populations and healthcare systems/departments are the main receivers of the aid from the World Bank. This will help the healthcare system and population of South Sudan in the long-run, offering more solutions to the prevention of further issues, rather than the UN’s short-term response.

WHO and Other International Organizations Coordinating With South Sudan

The World Health Organization and other non-profit organizations, such as WFP, have also been coordinating with South Sudan and other countries to mitigate impact and ensure better medical care. WHO has also been working with WFP, the International Medical Corps (IMC), and South Sudan’s Ministry of Health to further access to testing and treatment in South Sudan.

South Sudan has had a relatively low infection rate/positive case rate in comparison to what many international organizations originally projected.  However, as previously mentioned, this could also be a result of low testing/access to testing in more rural and displaced areas. Testing and accessible treatment is especially important in a country with a large at-risk population. Since South Sudan only had 24 ICU beds and four ventilators over the summer, WHO’s coordination for medical care with the government is an extremely important step to long-term healthcare treatments.

Ways That Individuals Can Help

Individuals can help by spreading awareness about the situation in South Sudan and similar countries, volunteering with the UN (which may not be the best option for some), donate to organizations like Save the Children and the IRC to help mitigate ways that people are at risk for COVID-19, and donate masks to South Africa in general.

As previously mentioned, Dr. Thaller emphasized the idea that donating money is one of the most effective ways for an individual to help South Sudan. Donating to larger organizations, such as the WHO, can help South Sudan in the long-run and eventually provide more stability for the healthcare system.

Kyle’s Campaign for Change (KCC) is an organization run by Kyle Thaller, Dr. Thaller’s son, who helps provide diabetes testing and insulin for South Sudanese people, primarily focused in Juba. Lack of insulin accessibility and diabetes testing in South Sudan is another example of a lack of coverage for essential healthcare services, and KCC helps to provide the necessary tools for people in the healthcare system. While this has less to do with the pandemic, KCC helps provide a solution for the instability of the healthcare system in South Sudan.

Where to Donate and Make a Positive Impact

Below is a list of all of the organizations that you can donate to and have a positive impact on South Sudan’s healthcare system and several million people. Donating and spreading awareness about South Sudan’s healthcare situation is a way that will create a long-lasting impact for South Sudanese people. 

• Donate to WHO’s COVID-19 Solidarity Response Fund
• Donate to Kyle’s Campaign for Change to help provide diabetes tests or financial support
• Donate Spread Your Wings to support girls’ education in South Sudan 
• Donate Save the Children to help children in poverty in South Sudan
• Donate to the International Rescue Committee to help save children’s lives
• Donate Shout 4 Masks to provide face masks in South Africa
• Donate to the UNHCR to help children in South Sudan and other countries
• Donate to CARE to support education, hunger, and women in South Sudan and other countries
• Donate face masks to the UNHCR for refugee areas
• Donate to World Vision to aid children who are affected by food insecurity and conflict in South Sudan

Vaccine Distribution for Developing Countries and LDCs

South Sudan is one of many developing countries that was not prepared for the pandemic. There is a lack of testing, funding, and resources that many other LDCs have faced for the past several months. This is important to remember as vaccines are beginning to be distributed and as people await to be vaccinated in these countries. 

While vaccine developers have noted that one-third of the world population will be vaccinated by the end of 2021, this does not necessarily include developing countries or lower-income countries. Developing countries such as South Sudan and Afghanistan will have to wait until 2023 or 2024 for vaccines. This means that continuous support for developing countries and LDCs is incredibly important for the next several years.