SUDAN - HIV Humanitarian Overview:

Statistics

Humanitarian and HIV situation

The dynamics of peace, recovery and conflict continue to shape Sudan. Progress towards peace and development in the South is hampered by ongoing conflict and displacement in Darfur, as well as continuing attacks against aid workers.

In January 2005, 48 years of north-south war ended with the Comprehensive Peace Agreement (CPA), though it has already shown serious signs of strain after two years of relativ peace. The conflict in the South has left about 2 million people dead, 4 million displaced and more than 600,000 living as refugees outside the country. The United Nations  (UN) estimates that over the years, conflict and drought have left 6.7 million Sudanese displaced, including some 550,000 refugees in neighboring countries. ¹

Darfur represents one of the largest humanitarian crises in the world, with almost 2.4 million internally displaced persons (IDPs) and a total affected population of approximately 4.2 million. ² A combination of underdevelopment, chronic poverty and decades of conflict have made the Sudanese the largest population in need of humanitarian assistance in the world. The Darfur Peace Agreement (DPA), signed in May 2006, was never respected by the parties of the conflict and fighting is still heavy in Darfur.

Conflict:

Despite the CPA, the Equatoria states in Southern Sudan have remained subject to violent attacks from the Lord’s Resistance Army (LRA), especially the Western, Central and Eastern Equatoria, including Magwy, Ibba, Ezo, Maridi and Yambio counties.  With the withdrawal of the LRA from another round of peace talks under the mediation of the Government of Southern Sudan in January 2007, the attacks have increased and the living conditions worsened

Displacement:

The return of the largest displaced population in the world poses significant challenges. 600,000 people are expected to return, half of them in organised return programmes. ³ Over 160,000 people were newly displaced as a result of continued wide-spread violence and conflict in Darfur during the first half of 2007. In August 2007, SLA-Unity claimed that there were 22,000 IDPs congregating 2-3 km to the North-East of Um Sauna, Southern Sudan. Fighting also reported in the Al Lait sector of North Darfur (OCHA).

Humanitarian access:

An unpredictable and violent security environment restricts relief assistance to nearly one million people. Lawlessness has forced relief organizations to suspend programming. Attacks against the relief community have increased 150% in the past year. 

Humanitarian space:

The signing of a second ‘Joint Communiqué’ between the Government and the UN has alleviated pressures facing the humanitarian community, in particular with regard to visas, entry/exit permits, staff recruitment, and customs. However, NGOs implementing projects related to the protection of civilians or sexual gender-based violence (SGBV) continue to face government pressure.

Food/nutrition status:

Sudan is a low-income, food-deficit country. About 17% of children under the age of five are underweight. Food production was hampered by fighting and displacement, as well as by recurrent droughts. Large areas in east Sudan are chronically food insecure. Malnutrition rates in the Eastern states of the Red Sea and Kassala are consistently above emergency levels (WFP).

Health status:

Sudan has a weak health infrastructure in terms of human resources, health service coverage and funds. There are major disparities in the distribution of services and resources between and within states, between rural and urban areas and in states affected by conflict. There are also increasing cases of hepatitis in South Darfur and potential cholera in North Darfur. ⁴

Natural hazards:

Floods: In August 2007, 365,000 people were hit by flooding in the North of Sudan, with rising river levels and the expectation of more heavy rain. The west and north of Sudan have been hit by flooding in July 2007. Torrential rains have devastated several parts of the Sudan since 4 July 2007. Well over 30,000 homes were destroyed or seriously damaged, leaving at least 150,000 people without shelter. ⁵

Drought:

Sudan has repeatedly suffered from severe drought, in 1989, 1990, 1997, and 2000.

HIV epidemic

Low, generalized epidemic transmitted mainly through heterosexual sex. The highest prevalence is among sex workers. Drivers of the epidemic are unsafe sex related to long civil conflicts, displacement, high mobility, and poverty.

Most at risk:

• Sex workers and their clients
• Internally displaced people, refugees
• Tea sellers
• Street children
• Truck drivers
• Prison inmates
• Police
• Armed forces personnel

Most vulnerable:

• Women and girls (women are increasingly vulnerable, especially in Darfur and IDP camps, as a result of their poor economic status, high rates of illiteracy and the prevalence of SGBV

National Strategic Framework: 2004-2009, goals include:

• Distribution of anti-retroviral drugs (ARVs) to 16,000 people (provided for free under Global Fund grant as of March 2004
• Maintain 2 percent prevalence
• Foster traditional believes and practices encouraging youth to marry
• Increase percentage of population that can identify modes of HIV transmission and prevention from 10% to 70%
• Provide Prevention of Mother-to-Child Transmission of HIV (PMTCT) to 1500 mothers and their infants
• Provide Voluntary counseling and testing (VCT) at 270 testing sites in public health facilities that will have tested/counselled 2.5 million people

Prevention priorities

• Increase the level of knowledge about HIV transmission and prevention through increased communication efforts.
• Provision of PMTCT
• Provide post-exposure prophylaxis (PEP
• Ensure blood safety and blood-banking facilities and regulations for blood testing do not exist in the south

The south is also experiencing a lack of access to key HIV services, including access to information, distribution of condoms, VCT, PMTCT and providing care for people living with HIV (PLHIV), including antiretroviral therapy (ART). ⁶

Care/treatment coverage

• The availability and accessibility of treatment and care are poor. Major bottlenecks for scaling up treatment and care include a lack of entry points and services for voluntary testing and counselling, weak health care services and infrastructure, and lack of human capacity in the public system and civil society.
• Delays in procuring HIV drugs and related supplies due to inadequate and parallel procurement and supply management systems
• Stigma and discrimination remain present, even among health workers ⁷

Response to HIV among populations of humanitarian concern

The 2008 Work Plan contains a specific section on cross cutting issues, including HIV. Activities focus on the provision of basic health care and essential HIV services to displaced populations, prevention education on risks of HIV and the promotion of sustainable livelihoods for PLHIV. The Work Plan emphasises the distribution of condoms; the provision of safe blood supplies and PEP; training on HIV for agency and government staff; the promotion of safe sexual and reproductive health practices; and the mobilization of community-based responses.

Specifically, programmes will include:

• Expansion of VCT and PMTCT-related services
• Provision of ART
• Raising awareness and political commitment of HIV issues
• Development of legislation to protect the human rights of PLHIV
• Integration of HIV in to school curricula/ informal education programmes
• Reduction/ prevention of HIV among demobilized armed forces, including child soldiers
• Promotion of behaviour change at community level and within workplace
• Enhanced coordination, monitoring and evaluation.

Common Services and Coordination sector: programmes will support and facilitate links between the humanitarian community and government/local actors on HIV, also focusing on policy processes to integrate HIV into the development of state recovery plans.

Education sector: emphasis on HIV prevention and awareness, and its inclusion in primary and secondary curricula.

Governance/ Rule of Law sector: increase the capacity of parliament members to address HIV, and build the capacity of the National HIV programme.

Health and Nutrition sector: expand basic health services, including the provision of HIV and reproductive health services. Nutritional support will be provided to the most vulnerable, including those with HIV, and information, education and communication (IEC) materials for HIV will be designed and disseminated.

Protection/ Human Rights sector: strengthen community capacity to care and support PLHIV and their families, as well as raising awareness of HIV among host communities and local authorities

Funding for HIV in humanitarian situations

Global Fund: Grants in rounds 3, 4, and 5 with UNDP as Principal recipient. A total of USD 25,262,790 has been dispersed as of December 2006.

The World Bank and Intergovernmental Authority on Development (IGAD) signed a USD 15 million grant to support the IGAD Regional HIV Partnership Program (IRHAPP) in June 2007. The program seeks to mitigate the impact of HIV among cross-border and mobile populations in IGAD’s member states: Djibouti, Eritrea, Ethiopia, Kenya, Somalia, Sudan and Uganda. The four-year project, which aims to reduce the vulnerability of these mobile populations, was initiated with the support of the World Bank and will be the first to be financed by the Africa Catalytic Growth Fund (ACGF). ⁸

PEPFAR: USD 6,885,000 for 2007 and USD 2,536,000 approved for 2008.

Total funding requirement for the 2007 Work Plan for Sudan as of July 2007 was USD 1.250 billion, 54.9% funded. The 2008 Work Plan for Sudan, valued at USD 2.29 billion, addresses humanitarian, recovery and development interventions, and is divided into national and regional programmes. The two components are:

1.         Humanitarian assistance for vulnerable conflict-affected populations

2.         Programmes to enable transition towards national recovery and development.

The Darfur programme within the 2008 Work Plan represents almost two-thirds of the total humanitarian requirement for Sudan.

In terms of humanitarian assistance, the Work Plan aims to respond to the humanitarian and protection needs of the most vulnerable; strengthen community coping mechanisms; provide reintegration assistance for returnees; enhance humanitarian access to vulnerable populations; and expand the provision of basic primary health services.

With regard to recovery and development activities, the Work Plan aims to build national and state level capacity, enhance good governance, assist with awareness campaigns and dissemination of IEC materials; improve equitable social services; and support voluntary return and sustainable reintegration.

Common Humanitarian Fund (CHF):

The CHF works as a common fund mechanism to collect contributions to the 2008 Work Plan, established by donors and UN agencies. The CHF aims to give the Humanitarian Coordinator (HC) greater ability to target funds at the most critical needs, encourage early donor contributions and allow rapid response to unforeseen needs. The HC manages the fund with the support of OCHA and UNDP. The CHF also has an Emergency Response Fund (ERF) to serve as a rapid onset mechanism for unforeseen needs. In 2007, CHF channelled USD 133 million with the largest allocations going to humanitarian needs in Southern Sudan and Darfur. The largest proportion of funding was to the health, nutrition, food security and livelihoods sectors. ⁹

A Disarmament Demobilization Reintegration (DDR) program does exist for Sudan.

Central Emergency Response Fund (CERF): USD 19.25 million allocated as of 17 August 2007. USD 8.7 million allocated in August 2007 for flood response in the most affected areas - states of Gedaref, Kassala, Khartoum, Northern Kordofan, Unity, and Upper Nile. The funding has been allocated to 11 different projects to be managed by five United Nations agencies: FAO, UNICEF, UNFPA, WFP, and WHO.

Two Multi Donor Trust Funds were launched to support government capacity building, judiciary reform, health, education, water and sanitation, infrastructure development, livestock, the census, state planning, agriculture, rule of law, HIV, and private sector development in 2007.

UN Theme Group on HIV/AIDS and UNFPA Representative: Hassan Mohtashami
Chair, a.i.
Telephone: +249 11 83 57 54 92
Fax: +249 11 83 57 54 94
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UNAIDS Country Coordinator: Musa Bungudu
Telephone:+ 249 183 47 64 85
Fax: + 249 183 74 52 85
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Peacekeeping: UNAMID, the newly established hybrid UN-African Union peacekeeping force in Darfur, has an initial mandate of 12 months and incorporates the existing AU Mission in Sudan (AMIS), which has been deployed across Darfur since 2004. Authority was officially transferred from AMIS to UNAMID on 31 Dec 2007. It has become the world's largest peacekeeping force, with almost 26,000 troops and police officers at full deployment, as well as nearly 5,000 civilian staff (ReliefWeb August 8, 2007).

Humanitarian Coordinator: OluseyiBajulaiye,  a.i.Tel: +249.91217.4104       
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OCHA, Khartoum: Mr. Michael McDonagh, Officer-in-Charge,
Tel: + 249 187 086 000                      
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OCHA presence

With approximately 53 international and 180 national staff working in fifteen locations across Sudan, this is the largest OCHA presence outside the tsunami. OCHA-Sudan has central offices in Khartoum and Juba and a liaison office in Nairobi.

Key organizations present in Sudan

UN agencies: OCHA, UNDP, UNICEF, UNHCR, WFP, WHO.

Other agencies: ICRC, IFRC.

Key organizations working in HIV in humanitarian situations

Adventist Development and Relief Agency (ADRA) - South Sudan

121 Riverside Drive PO Box 14756
Nairobi, Kenya
Telephone: +254 20 443 936
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Society for Women and AIDS in Africa – Sudan
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For more contacts:

http://www.plusnews.org/profiletreatment.aspx?Country=SD&Region=HOA

Training on the IASC guidelines

One training in January 2007 hosted by WHO and SNAP (Sudan National AIDS Control Program)

Additional resource

UN in Sudan
Updated maps on Relief Web
Sudan Humanitarian profile map May 2007

For further information, see Contacts Database.