South Sudan is facing a critical shortage of drugs and life-saving medicines, according to Médecins Sans Frontières and a government official.
It comes at a time when humanitarian organisations have been placed in a near-impossible situation — increasingly relied upon to provide most of the funding in the medical and educational sectors but subject to new legislation that could burden their operations.
“The conflict in South Sudan has now continued for over two years, heavily impacting its population and putting as always the most vulnerable at risk,” Doctor Joanne Liu, MSF international president, wrote in an open letter obtained early by IRIN. “On top of this already dire humanitarian situation, an additional and preventable medical emergency is unfolding.”
The end of a medical procurement programme, funded by foreign governments, “has now led to unacceptable and devastating outages of drugs throughout the country,” Liu wrote.
An official from South Sudan’s ministry of health, who requested anonymity due to the sensitivity of the disclosure, backed up Liu’s information and said that because the reporting system was so ad hoc it was hard to know what drugs were needed where, which made rectifying the situation even more challenging.
Shortages at the Juba Teaching Hospital in South Sudan’s capital began in November.
“We are supposed to give the medication for free; this is the system of the government – but we can’t do that,” Eric Mawen, a doctor at the hospital, told IRIN.
Due to the funding shortfall, patients there are now required to purchase their own drugs before treatment. If they can’t pay, they don’t receive treatment.
Mawen said the doctors are sometimes beaten and threatened by those who want treatment but can’t pay.
“One night, soldiers came and said ‘Give me anti-malaria’. I said I didn’t have any anti-malaria (medication) and they didn’t believe me. I said, ‘Let’s go to the pharmacy’. There was nothing there, and I was saying ‘Don’t shoot [me]’.”
The drug shortage is in part due to the failure of the South Sudanese government to follow through on purchasing drugs, according to interviews with health officials from foreign governments and humanitarian organisations in the country.
“Because of the financial situation in South Sudan, a lot of people can't afford to buy essential drugs anymore,” explained Gloria Puertas, a specialist working for the European Commission’s Humanitarian Aid and Civil Protection department (ECHO).
The drug procurement programme has been “handed back to the government, [but] there was little doubt that they would not be able to fill this gap amidst the continued crisis in the country,” Liu wrote in the letter.
The money for the programme was never allocated, according to foreign development officials. A crippling financial crisis, coupled with the cost of fighting a civil war, has drained the country’s budget.
Development experts also told IRIN that the reason that health and education programmes in South Sudan are not fully funded is because the government is gambling that international aid and humanitarian organisations will fill any gaps.
An emergency British-led drug distribution initiative is expected to get under way in the coming weeks, until a long-term programme begins, funded by the American, British, Canadian, and Swedish governments, along with the EU.
Some development officials say that any additional support should stipulate that the South Sudanese government follows through on promises to increase funding for health and education.
Government expenditure on health accounted for only four percent of GDP in 2013, the eighth lowest rate in the world, according to the World Bank. A recent report from CARE International noted that 80 percent of healthcare services are provided by NGOs.
The 2016 national budget allocated more than 10 times the amount in funding to its military than it did the health sector.
At the same time that humanitarian and aid organisations have become the main provider of essential services like healthcare, a new law signed in February could hinder their capacity.
The law is unclear, but NGOs must register and sign individual "country agreements" with the government, which is seeking stricter regulation.
The NGO regulation could be used as a coercive tool, said Lucia Goldsmith, coordinator of the South Sudan NGO Forum. “But the greater concern is… a government who wants a greater degree of control of what’s going on here, but doesn’t have the capacity to implement it.”
US Senator Bob Corker, chairman of the Senate Foreign Relations Committee, said in a statement: “The flow of humanitarian assistance must not be impeded. With the scale of the suffering increasing as the crisis continues, actions by the government that restrict delivery of life-saving aid will only make the situation worse.”