UNICEF/2016/South Sudan/Ohanesian. for Target results * results 161, , , ,974 73% 1,117, ,882 19%

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1 South Sudan Humanitarian Situation Report 28 JULY 11 AUGUST 2016: : SOUTH SUDAN SITREP #91 SITUATION IN NUMBERS Highlights As of 9 August, 936 cholera cases have been reported, with 22 deaths. Cholera response is ongoing; 313 cases have been treated in UNICEFsupported Oral Rehydration Points throughout Juba. So far in 2016, 61,181 children in South Sudan have benefited from community-based psychosocial support services. However, services have been scaled back throughout the country as a result of limited funding for the Child Protection sector. 40 Out-Patient Therapeutic sites, 40 Therapeutic Supplementary Feeding Programmes sites, and three stabilization centers are operational in response to catastrophic food insecurity in Northern Bahr el Ghazal. UNICEF s Response with Partners Indicators Cluster for 2016 Target Cumulative results * UNICEF/2016/South Sudan/Ohanesian UNICEF and Implementing Partners for 2016 Target Cumulative results Target achieved (%) Nutrition: # of children 6 to 59 months with severe acute malnutrition admitted for 161, , , ,974 73% treatment Health: # of children aged 6 months to 15 years in conflictaffected areas vaccinated 1,117, ,882 19% against measles WASH: # of people provided with access to safe water as per agreed standards ( ,300,000 1,198, , , % litres per person per day) Child Protection: # of children and adolescents reached with 721, , , ,336 39% critical child protection services Education # of children and adolescents aged 3 to 18 years provided with access to 446, , , ,017 61% education in emergencies * WASH and Education Clusters results have been not updated since the last situation report million People internally displaced since 15 December 2013 (OCHA, Humanitarian Snapshot 5 May 2016) 740,752 Estimated new South Sudanese refugees in neighbouring countries since December 2013 (UNHCR, Regional Refugee Information Portal, dated 1 August 2016) Funding Status $54m 2016 Funding $72m requirement: $154.5m** Funds Received in 2016 US$* Carry-over from 2015 Funding Gap US$ $37m *Funds available include funding received for the current appeal as well as the carryforward from the previous year. **UNICEF s 2016 Humanitarian Action for Children (HAC) appeal for South Sudan is currently being revised to approximately US$ million. 1

2 Situation Overview & Humanitarian Needs The situation of women and children in South Sudan has significantly deteriorated following the outbreak of fighting in Juba on 8 July, with pockets of fighting emerging across the country, displacement continues. Up to 12,500 people remain displaced in Juba as a result of the recent violence; over 70,000 have fled to Uganda since the start of July. Insecurity is undermining humanitarian access, further threatening the lives of the estimated 4.8 million people affected by food insecurity. Lives of affected populations are also at risk as a result of the recent cholera outbreak, in particular in Juba. As of 9 August, the cumulative number of cases has reached 936; the case fatality rate remains above the 1 per cent threshold, at 2.3 per cent with 22 deaths. The figures below illustrate the evolution of the cholera outbreak, with cumulative cases, deaths, and new cases by location Evolution of Cholera Outbreak: Cumulative Cases and Deaths Cumulative cases (963as of 9 August) Deaths (22 as of 9 August) Jul 4-Jul 5-Jul 6-Jul 7-Jul 8-Jul 9-Jul 10-Jul 11-Jul 12-Jul 13-Jul 14-Jul 15-Jul 16-Jul 17-Jul 18-Jul 19-Jul 20-Jul 21-Jul 22-Jul 23-Jul 24-Jul 25-Jul 26-Jul 27-Jul 28-Jul 29-Jul 30-Jul 31-Jul 1-Aug 2-Aug 3-Aug 4-Aug 5-Aug 6-Aug 7-Aug 8-Aug 9-Aug Jul 4-Jul 5-Jul 6-Jul Juba Jonglei Terekeka Total Deaths 7-Jul 8-Jul 9-Jul 10-Jul 11-Jul 12-Jul 13-Jul Evolution of Cholera Outbreak: New Cases by Location 14-Jul 15-Jul 16-Jul 17-Jul 18-Jul 19-Jul 20-Jul 21-Jul 22-Jul 23-Jul 24-Jul 25-Jul 26-Jul 27-Jul 28-Jul 29-Jul 30-Jul 31-Jul 1-Aug 2-Aug 3-Aug 4-Aug 5-Aug 6-Aug 7-Aug 8-Aug 9-Aug Humanitarian Strategy UNICEF is working to respond to the cholera outbreak by providing lifesaving health support, preventative WASH measures, and mass awareness building. A multi-sectoral internal UNICEF cholera task force has been formed to coordinate preparations in targeted areas across five states. This is based on a mapping of potential cholera hotspots by the Health and WASH clusters. In addition, UNICEF is supporting community WASH and Health interventions in Juba through partners and direct 2

3 implementation. UNICEF participates in a daily Operational Cholera Meeting coordinated by the Ministry of Health and other humanitarian coordination forums throughout the country. Summary Analysis of Programme Response CHOLERA RESPONSE: UNICEF has been supporting social mobilisation to facilitate WHO s immunisation campaign, which has already reached over 7,000 people since the outbreak. Through partner Health Link South Sudan, UNICEF is supporting eleven Oral Rehydration Points (ORPs) in Juba. As of 9 August, a total of 313 cases have been treated at ORPs, with 80 cases referred for further treatment. UNICEF is also working alongside MSF in the Cholera Treatment Centre (CTC) at Juba Teaching Hospital. UNICEF has provided supplies including tents, cholera beds, and diarrhoeal disease kits. In addition, UNICEF has been restoring WASH services at the CTC, repairing latrines and supporting that 10,000 litres of water are available daily. Water is also being provided to IDPs in POC sites throughout Juba. Through water trucking and the installation of bladder tanks, UNICEF is faciliatating access to safe water in UN House and people remaining at UNMISS Tomping. Meanwhile, efforts to improve sanitation among affected populations are ongoing; 40 latrines have been constructed at the Tomping site, while 100,000 litres of sewage are being collected daily from UN House where latrines are being regularly cleaned. WASH supplies such as water purification tables, soap, and oral rehydration salts are being distributed at the household level alongside cholera preventive messages. As of 3 August, over 57,000 people have been reached. In addition to hotspots of Central Equatoria and Jonglei states, social mobilisation for advanced preventive measures has been conducted in Lakes, Upper Nile, Unity, Western Bahr El Ghazel, and Eastern Bahr El Ghazel states. Most of the interventions have been done through NGO and media partners, with the cooperation of mobile operators and government actors. Sixteen radio channels are broadcasting five messages on cholera ten times a day; it is estimated that approximately 2 million people are being reached daily. HEALTH: Across the country, 72,123 curative consultations were provided to individuals in need of healthcare through UNICEF s support in the reporting period, including 37 per cent of children under the age of five. An additional 2,777 children under five were reached through the integrated community case management programme. Overall, malaria continues to be the major reason for consultations across the country, accounting for 45 per cent of all under five consultations during this period. Treatment has been integrated into nutrition clinics in response to the increasing numbers. UNICEF is responding to malaria through scaling up social mobilization, distributing long-lasting insecticide treated nets (LLITNs), conducting indoor residual spraying, larviciding, and providing malaria test kits and antimalarial drugs for case management. Thirteen thousand eight hundred LLITNs have been distributed in Bentiu town and Rubkona in Unity State, with door-to-door demonstrations on how to hang up the nets. Efforts to raise awareness are ongoing, with information, education, and communication materials, traditional events, and public addresses. Two radio stations in Jonglei are broadcasting Family receiving LLITNs in Bentiu. messages on malaria. Routine immunization activities continued during the reporting period, as shown in the graph below. In addition, Supplementary Immunization Activities (SIA) were conducted in Bentiu, with 740 children under 15 years vaccinated against polio, and 639 receiving the measles vaccine. 3

4 2,372 2,516 2,883 2,112 Children receiving at least three doses of pentavalent vaccine Children receiving Inactivated Polio Vaccine (IPV) Children receiving measles vaccine Pregnant mothers receiving at least two doses of tetanus vaccine During this period, 6,980 pregnant women were provided antenatal care services, with 22 per cent making the recommended four or more visits. A total of 860 deliveries were assisted by skilled birth attendants; 1,171 mothers and newborns attended postnatal visits. In addition, 1,501 pregnant women accessed HIV counselling and testing services during this reporting period; 37 tested positive, 86 per cent of whom were provided with ARV drugs. NUTRITION: During the reporting period, UNICEF along with partners, supported a total of over 50 Stabilisation Centres to treat children suffering from severe acute malnutrition (SAM) with medical complications, and 500 Out-Patient Treatment Centres (OTP) for children with SAM without medical complications. A total of 57,396 children between 6-59 months were screened using mid-upper arm circumference. Of these, 3.4 per cent were suffering from SAM, and 9.7 per cent from moderate acute malnutrition (MAM), suggesting a global acute malnutrition (GAM) prevalence rate of 13 per cent across children screened. Prevalence of Global Acute Malnutrition Across Children Screened (Weeks 29-30, 2016) Unity Jonglei Upper Nile NBeG Lakes EES WES TOTAL % SAM % MAM % GAM As illustrated in the graph above, there is a wide variation in GAM prevalence across states. The situation is particularly critical in Northern Bahr el Ghazal, with a GAM rate of 28.7 per cent among children screened during the reporting period. Food insecurity and malnutrition are major humanitarian concerns in the state; the latest IPC report suggests that over 800,000 people in Northern Bahr el Ghazal are currently facing Crisis or Emergency level food insecurity, with one in every three children between 6 to 59 months acutely malnourished. In response to this catastrophic 4

5 level of food insecurity, 40 OTP sites are operational, 40 Therapeuric Supplementary Feeding Programmes sites are providing take-home rations, and three stabilisation centers are treating malnourished children with medical complications and who are less than six months of age. A number of nutrition activities were conducted as part of World Breastfeeding Week from 1-7 August. In Unity State, such activities included community sensitization, role-plays, food demonstrations and talk shows, all centred on breastfeeding, maternal and young child feeding. WASH: The UNICEF humanitarian response in Wau, in partnership with implementing partner Oxfam GB and the State Directorate of Water & Sanitation, is now supporting over 41,429 IDPs with WASH services in various locations. WASH services include provision of safe water supply at the Sphere Standard of 15 litres/person/day, use of 1 latrine per 50 people, and bathing shelters. Hygiene promotion messages are ongoing, as well as daily environmental clean-up campaigns that include collection of solid and liquid waste. As part of the Cholera Preparedness and Response Plan, residual chlorine for the water source at the Wau Urban Water Network has been raised. Furthermore, UNICEF has provided support to Wau Municipality in terms of disseminating messages on cholera prevention through local radio stations, and distributing information, education, and communication materials. Provision of safe drinking water to the IDPs in Juba UN House POC through water trucking is ongoing. An average of 900,000 litres of safe water is provided daily exceeding sphere standards of 15 litres/person/day. Regular desludging activities from communal latrines in POC1 and POC3 are also ongoing to ensure the IDPs have access to safe sanitation facilities and thus a sanitary environment, safe from open defecation. Management of solid waste collection within the POC has improved greatly, as the truck drivers are now able to access an alternative, more secure dumpsite which is approximately 15 km from the POC. A daily average of 60 tons of solid waste and 120 tons of liquid waste are collected from the POC for safe disposal. Hygiene promotion activities are being scaled up, including hand washing and foot spraying with chlorine disinfectants at entry/exit points as part of cholera prevention activities within the POC. IDPs in Tomping UNMISS base are also being supported UNICEF has supported populations in Unity State s Rubkona town to now have access to improved, equitable, and sustainable safe water supply for domestic use. Over 14,000 people in Rubkona town are now being served by a surface water treatment system (SWAT) producing 100,000 litres/day, with a production capacity of over 200,000 litres/day if the demand increases. Overall, a total of 14 water points (40 taps) have been installed, now serving 90 per cent of Rubkona Town. EDUCATION: According to the Ministry of General Education and Instruction, all schools are open in Juba town despite the tense security situation; classes have also resumed in schools in the UN House POCs. In Wau, IDPs are still occupying the temporary learning space in the POC due to inadequate shelter provision. Continuous advocacy is ongoing by UNICEF in consultation with partners and community leaders. UNICEF is currently in the process of procuring textbooks for all primary classes and alternative learning programmes; however, the process was halted due to the crisis in Juba and insecurity on the roads. In Bentiu, education service delivery was hampered due to strikes and demonstrations by teachers against perceived low salaries/incentives. Similar concerns are arising in Bor POC, while there is high turnover of teachers in Aweil due to delays in payment of salaries. The Education Cluster and Ministry of Education are currently looking into addressing this situation as a matter of priority. CHILD PROTECTION: Child protection in emergency services have been scaled back throughout the country as a result of limited funding for the child protection sector. Against this backdrop, children in need of both family tracing and reunification and psychosocial support services, however, continue 5

6 to rise, particularly in Wau and Juba, where recent fighting took place in June and July. Thousands of children continue to show signs of psychosocial distress. To date, 61,181 children (47 per cent girls) across the country have been able to access community-based psychosocial support services, with an additional 35,663 (48 per cent girls) participating in child friendly spaces and 9,817 children (44 per cent girls) benefiting from focused psychosocial support and case management services. A total of 20,819 caregivers (63 per cent females) have also been reached through psychosocial support services, including community-led PSS activities, facilitated group sessions and workshops, as well as focused psychosocial support and case management services. Nationally, 13,329 missing, unaccompanied, and separated children cases have been identified, with 8,971 cases remaining active and open with an additional 400 cases identified in Juba and Wau. Out of the total number of cases registered, 4,189 children have reunited with their parents through successful family tracing efforts. As of 6 August 2016, UNICEF and its partners have also reached a total of 159,740 persons with Mine Risk Education (MRE) in Upper Nile and Central Equatoria (around Juba and the PoCs). UNICEF and partners continue to respond to the urgent gender-based violence (GBV) situation in Juba. Because of the intensive capacity building work that UNICEF conducted prior to the recent outbreak of violence joint trainings with police and social workers, trainings of health care providers on clinical management of rape (CMR), development of a referral pathway, and other activities. The systems were already in place to respond immediately. Now, the focus is on working with partners and the GBV sub-cluster to better understand the gaps and see how the existing structures and resources can be adapted to meet the current needs. Since the beginning of the current crisis in Juba, 145 households (965 individuals) have been reached with house-to-house visits, including psychological first aid, information about GBV response services, and referrals for survivors, as needed. Due to recent violence in Leer, Buaw, and Koch, which resulted in looting of three child protection partner offices and injuries to civilian and NGO staff, Child Protection in Emergencies and GBV activities have been temporarily suspended in most locations throughout these counties, affecting thousands of women and children. This includes 425 registered separated and unaccompanied children who do not currently have access to family tracing and interim care case management services. Health clinics in Thonyor payam have also been looted, meaning that there are no CMR drugs available and survivors of sexual violence cannot access life-saving healthcare. UNICEF and partners are working to replenish these stocks as soon as the security situation allows. FUNDING: As part of UNICEF s 2016 Humanitarian Action for Children (HAC) appeal, US$ 154 million is required to respond to the needs of children in South Sudan. Following the recent crises, further funding is needed for the Wau response in excess of US$ 2.9 million, while close to US$ 5.4 million is required for the Juba response. In total, UNICEF s funding requirements for South Sudan have now reached US$ million. The current HAC appeal is being revised to include these provisional requirements and will be reflected in the forthcoming revised HAC appeal. 6

7 Revised Funding Requirement for Emergency Response in South Sudan Appeal Sector Requirements in US$ Funds Funding Gap Original Wau Juba Total Available US$ % Nutrition 30,095, , ,200 31,233,396 24,212,166 7,021,230 22% Health 22,869, ,000 3,143,448 26,673,207 14,169,627 12,503,580 47% WASH 38,500, , ,360 40,285,360 26,214,976 14,070,384 35% Child Protection 36,000, , ,960 37,170,960 10,757,556 26,413,404 71% Education 27,000, , ,600 27,405,600 15,743,012 11,662,588 43% Total 154,464,955 2,931,000 5,372, ,768,523 91,097,337 71,671,186 44% *The requirement for cluster coordination costs has been included in sub-costs for the nutrition, WASH, child protection and education. **Funds available include funding received against current appeal as well as carry-forward from the previous year, (approximately US$ 37 million). Next SitRep: 25 August 2016 UNICEF South Sudan Crisis: UNICEF South Sudan Facebook: UNICEF South Sudan Appeal: Who to contact for further information: Mahimbo Mdoe Shaya Ibrahim Asindua Representative Deputy Representative UNICEF South Sudan UNICEF South Sudan mmdoe@unicef.org sasindua@unicef.org 7

8 Annex A - SUMMARY OF PROGRAMME RESULTS 1 Cluster for 2016 UNICEF and partners for Target (Jan-Dec) Results (Jan-Jul) Target 3 (Jan-Dec) Results (Jan-Jul) Change since last report NUTRITION # of children aged 6 to 59 months with severe acute malnutrition (SAM) admitted for treatment 161, , , ,974 7,974 % of children aged 6 to 59 months with SAM admitted for treatment recovered >75% 87.7% >75% 87.7% - # of children 6 to 59 months having received vitamin A supplementation 2,066,708 1,466,261 2,066,708 1,466,261 - # of children 12 to 59 months de-wormed 1,087, ,892 1,087, ,892 - # of pregnant and lactating women reached with infant and young child feeding (IYCF) messages 567, , , ,778 56,556 HEALTH # of children aged 6 months to 15 years in conflict affected areas vaccinated against measles 1,117, , # of children under 15 years in conflict affected areas vaccinated against polio 1,221,772 1,393, # of children under 5 years, pregnant women and other vulnerable people receiving a long-lasting insecticide treated net (LLITN) 400, ,806 39,011 # of preventive and curative consultations provided to children under 5 years at facilities or through community-based care 520, ,609 26,767 # of pregnant women attending antenatal care (ANC) counselled and tested for HIV 35,351 20,015 1,589 WATER, SANITATION AND HYGIENE # of people provided with access to safe water as per agreed standards (7-15 litres per person per day) 2,300,000 1,198, , ,746 17,741 # of people provided access to appropriate sanitation facilities 1,100, , , ,955 3,124 # of people reached with participatory hygiene promotion messages 800, ,192 29,404 CHILD PROTECTION # of children and adolescents reached with critical child protection services 7 721, , , ,336 98,316 # of unaccompanied and separated children (UASC) and missing children having received family tracing and reunification (FTR) services and familybased or alternative care since the beginning of the conflict # of children formerly associated with armed forces or groups and children at risk of recruitment enrolled in reintegration programmes 15,000 13,329 12,000 10, ,000 3,751 10,000 3,751 - # of people receiving gender-based violence (GBV) prevention and response services 80,000 82,669 1,134 # of children, adolescents and other vulnerable people provided with knowledge and skills to minimize risk of landmines and explosive remnants 300, ,740 95,640 of war (ERW) EDUCATION # of children and adolescents aged 3 to 18 years provided with access to education in emergencies 446, , , ,017 1,351 # of temporary learning space (TLS) classrooms established # of teachers/educators/teaching assistants/parent-teacher association (PTA) members and school management committee (SMC) members 10,800 4,953 10,000 4,953 - trained No change since last report is denoted by - 1 Partner reporting rates remain below 100 per cent. UNICEF with its partners continues to improve monitoring and reporting of results. 2 WASH, Child Protection and Education Clusters compile cluster members results monthly. To provide up-to-date snapshot, UNICEF may report tentative results bi-weekly before compiled by the Clusters. 3 UNICEF annual targets for child protection and education are higher than those fixed in the Humanitarian Response Plan (HRP) as UNICEF requirements are higher than the inter-agency appeal. 4 The Nutrition Cluster target does not include refugee children who are covered under the Multi-Sector Refugee Appeal. 5 UNICEF s nutrition response covers all children, including refugee children residing in the country. 6 The results include the National Immunization Day (NID) campaign carried out in April. The results of NID were achieved in collaboration with MoH and WHO. 7 Critical child protection services include psychosocial support delivered through Child Friendly Space (CFS) or community based mechanisms, case management and prevention messaging targeting children and adolescents at risk of recruitment, family separation or other child protection risks. 8