South Sudan


children vaccinated


births assisted by skilled birth attendants

MAF Pilot Reinier Kwantes helps unload cargo–medicine and medical supplies–after landing in Kodok. The cargo was distributed to all the IMA medical clinics in the region.
Photo by MAF/LuAnne Cadd

Work continues in an ever-changing environment

IMA World Health has been a key partner in addressing South Sudan’s health needs since 2008, working closely with the nascent government’s Ministry
of Health, civil society, donors and other critical partners primarily on health systems strengthening, malaria and HIV/AIDS interventions.
On July 9, 2011, the Republic of South Sudan became an independent nation after nearly three decades of conflict and the displacement of hundreds of thousands of South Sudanese. After more than a generation of conflict, there was peace and celebration.

Jonglei and Upper Nile, where IMA projects focused, were the two most challenging states. Forming a natural corridor from Sudan, the states’ populations constantly shifted as citizens made their way home from exile; severe flooding from seasonal rains made access to communities nearly impossible for much of the year and communication systems were very limited. Despite these unique challenges, progress was swift and encouraging. Our projects exceeded targets, and for a time, health indicators in Jonglei and Upper Nile improved faster than the rest of the country.

But in mid-December 2013, violent conflict arose again, and Jonglei and Upper Nile were two of the three hardest-hit states. Many civilians were killed or injured, and more than 2 million have been displaced, facing hunger and other horrors of war. IMA and partners rallied in response, switching gears from long-term interventions to emergency support where most needed. Finding inspiration in the resilience of the people, IMA re-opened ransacked health centers and established mobile clinics in conflict zones, recruiting displaced health workers to staff them and serve their own dislocated communities.

Despite ongoing and ever-changing challenges, IMA’s projects have continued to help hundreds of thousands of people in South Sudan, to the credit of IMA staff, our partners and South Sudan’s resilient people.

Rapid Results Health Project

$57 million | Ministry of Health, Republic of South Sudan/World Bank | 2013–2016

In January 2013, IMA and its 12 international and local partners began implementing a flagship health systems strengthening initiative, the Rapid Results Health Project. RRHP strengthens the capacity of health systems throughout Jonglei and Upper Nile states to provide preventive and curative health services. This catchment area, which started with 24 counties in two states but expanded to 29 counties upon the creation of the Greater Pibor Administrative Area, comprises 3.1 million people — more than 25 percent of South Sudan’s population.

Key activities include preventive and curative services, reproductive health services, delivery of essential medicines and training of health care workers. The conflict that erupted in December 2013 displaced hundreds of thousands in IMA’s catchment area and greatly affected project efforts. Despite extreme challenges, IMA and partners have continued to support health services throughout the conflict period and have continued to support basic health care in the face of ongoing instability.


outpatient visits


pregnant women received at least one antenatal care visit


people treated for severe acute malnutrition


people admitted for
moderate acute malnutrition


medical consultations

IMA has a major role in the development of the health care system in South Sudan. Since 2008, IMA has been working with South Sudan’s government, international and national partners, and other health organizations to strengthen the health system’s capacity.
Photo by MAF/LuAnne Cadd

IMA has a major role in the development of the health care system in South Sudan. Since 2008, IMA has been working with South Sudan’s government, international and national partners, and other health organizations to strengthen the health system’s capacity.
Photo by MAF/LuAnne Cadd


people treated for severe acute malnutrition


people admitted for
moderate acute malnutrition


medical consultations

OFDA IDP Emergency Health and Nutrition Response in South Sudan

$1.7 million | OFDA | 2015 – 2016

IMA World Health launched emergency health services in South Sudan in 2014 in response to conflict. Conflict-related emergencies contribute to disproportionately high levels of morbidity and mortality, and 90 percent of countries with the highest rates of maternal mortality recently experienced conflict—including South Sudan.

With support from the U.S. Agency for International Development’s Office of Foreign Disaster Assistance, IMA provides vital primary health care and emergency health services through seven mobile clinics and outreach sites in Upper Nile and Jonglei states. The project’s emergency health services include disability and trauma referral, screening for gender-based violence and psychosocial needs, and immediate primary health care. Working with partners, IMA also expanded its activities to include nutrition service provision in areas of Jonglei with high rates of malnutrition. Nutrition services focus on children under 5 years of age, pregnant or lactating women and other vulnerable persons through prevention, screening and treatment of acute malnutrition to reduce morbidity and mortality.

Scaling Up for Universal Coverage and Impact

$2.35 million | Population Services International/Global Fund | January–December 2016

A key component of the Ministry of Health’s malaria prevention strategy is to distribute long-lasting insecticide-treated nets, or LLINs, across the entire population every three years. With resources from the Global Fund through Population Services International, IMA World Health works with the Ministry, as well as implementing partners that work directly with beneficiaries, to mass distribute LLINs in every community across Jonglei and Upper Nile states.

The political crisis that began in 2013 hit Jonglei and Upper Nile hardest. Ongoing conflict, poor roads and rainy season flooding have challenged net distribution, but IMA and partners have continued to overcome obstacles to train volunteers on distribution procedures and key malaria messaging for recipients and to mobilize the distributions at the community level.


bed nets distributed

KalaCORE South Sudan Emergency Response

$3 million | UK’s Department for International Development | 2015–2017

Visceral leishmaniasis, also known as kala-azar, is a parasitic disease that afflicts many people in South Sudan. It is almost always fatal if not treated. Fever, weight loss, an enlarged spleen and liver and anemia are common signs of this disease, which is transmitted by the sandfly. With support from KalaCORE, a partnership dedicated to the control and elimination of kala-azar, IMA partners with Mott MacDonald to implement a kala-azar control program in South Sudan with the primary goal of scaling up access to lifesaving treatment and catalyzing the collaboration necessary to reduce the disease burden in East Africa.

The focus of the program includes improved diagnosis and effective treatment, building surveillance capacity and improving the ability to respond to outbreaks. IMA trains health workers, establishes emergency response teams, provides pharmaceuticals and supplies, re-activates previous kala-azar treatment centers destroyed during conflict and supports the Ministry of Health’s neglected tropical disease departments.


people received emergency  health education


health workers trained in diagnosis and management of kala-azar

MAF Pilot Reinier Kwantes smiles as IMA’s Serunkuma Luigi Adwok handles paperwork related to the cargo.
Photo by MAF/LuAnne Cadd

With support from the U.S. Centers for Disease Control and Prevention, IMA works with CASA in India to help those living with LF with hygiene education, supplies and wound care.
Photo by Sarah Craciunoiu

Displaced, but not forgotten in South Sudan

The town of Kodok sits on the western side of the Nile River in the far north of South Sudan. The “western side” is important. The eastern side, from the town of Malakal to the northern border has experienced many explosions of violence since December 2013, causing a massive movement of people away from the area. Once South Sudan’s second largest city and a mix of various ethnicities, Malakal is now a shattered, burned and mostly abandoned shell of a town. Its residents have scattered to safety among their own ethnic groups, and this western side of the river offers a small measure of security for upward of a hundred thousand displaced people.

One of the greatest issues that arises when a massive movement of people occurs is access to health facilities; any services still available are now stretched far beyond their limits. With emergency funding from the Office of U.S. Foreign Disaster Assistance, IMA World Health stepped into the aftermath of the crisis early in 2014 to set up and manage multiple mobile clinics for both the displaced and the host communities.

300 meters

On a hot Friday morning in October 2015, the MAF Cessna Caravan, loaded to the max with medicine and medical supplies, takes a little over two hours to reach Kodok from Juba. The plane is filled with fuel for a round-trip as there are no locations anywhere in the north to re-fuel. Pilot Reinier Kwantes plans the final bit of his route to bypass Malakal airspace as he descends. He can’t take the risk of getting shot.

Once he crosses the Nile River, he eases down to take a closer look at the 950-meter airstrip, making a low pass. IMA staff warned earlier that it had rained two days before, and this strip can’t handle much rain. Reinier estimates that a strip of mud begins 400-meters in. The airstrip is wide, though, and there’s room to spare on the right of the mud patch if he needs more.  He lands in 300 meters, braking hard. It was a good call. The IMA clinics need this cargo.

Donkeys, quads, tractors and canoes

It’s clear that getting around this area is difficult, especially in the rainy season. Four donkey carts arrive to pick up the cargo. IMA Medical Supervisor Dr. Oleny Amum and Field Operations Coordinator Serunkuma Luigi Adwok arrive on an all-terrain vehicle. The cargo, supported by numerous donors, includes malaria rapid tests and anti-malaria injectables, external and topical drugs, oral and injectable medicine, IVs, and syringes. Oleny and Luigi are responsible for making sure the cargo makes it to all the IMA medical clinics in the region.

This is the difficult part

Just getting to the Kodok mobile clinic on the outskirts of town is tricky. Luigi drives while Oleny sits on the back. Once off the dirt road, it’s wet, slippery mud the rest of the way. Oleny points to possible less-muddy routes as they make their way to the small enclave of white tents and huts that make up the mobile clinic.

Our level best

The number of displaced people is staggering. In this region alone, an estimated 150,000 people fled their homes and few have settled permanently. Through the mobile clinics, IMA provides emergency and primary health care services to approximately 128,000 Internally Displaced Persons from Upper Nile State, and emergency nutritional needs to approximately 202,500 IDPs and host community members. Between February and September 2015, the clinics in Upper Nile State saw a total of 52,534 patients and distributed approximately two to three tons of medical supplies each quarter; the level of need and service has remained constant since.

“After the crisis there was a shortage of many things for us to survive here, but we are struggling to do our level best to ensure that the health services reach the internally displaced and host community as well,” Luigi says.

Serving to the end

In Kodok alone, there are an estimated 35,000 IDPs. Luigi and Oleny say they receive an average of 110 patients per day at the Kodok mobile clinic. The staff is part of the community of displaced people, having fled their homes and jobs in Malakal. By hiring and training staff who are themselves IDPs, IMA gives health workers a chance to serve their own communities.

The number of displaced people in South Sudan is staggering. One of the greatest issues that arises when a massive movement of people occurs is access to health facilities.
Photo by MAF/LuAnne Cadd

The number of displaced people in South Sudan is staggering. One of the greatest issues that arises when a massive movement of people occurs is access to health facilities.
Photo by MAF/LuAnne Cadd

Emergency Reproductive Health Services of IDPs and Host Community

$1.2 million | UNFPA | January 2014–Present

The UNFPA-funded project provides new services through a mobile clinic and outreach as well as through strengthening local capacity to implement the Minimum Initial Service Package for reproductive health, including interventions to address gender-based violence, sexually transmitted infections and HIV services. It also supports sexual and reproductive health outreach activities in partnership with community-based organizations or support groups. Internally displaced people, who would have otherwise had no access to reproductive health services, are seeking services at an average of 200 patients per month at the temporary clinic in Mingkaman, where thousands of IDPs from Jonglei are still encamped. The program includes procurement of supplies, which is no small feat; the remoteness of the area makes it difficult to obtain quotes, especially given the rapid inflation of the South Sudan pound, and materials usually must be transported by small boats that can carry only a few cartons at a time as they cross the Nile from the city of Bor.

One highlight of the program is an hour-long radio show that clinical staff host every Monday evening. They provide information on reproductive health topics and answer questions during the “call-in” segment. Topics include nutrition during pregnancy, making birth plans, birth preparedness, the importance of delivering at a health facility, danger signs during pregnancy, STIs, HIV/AIDS awareness, and good feeding practices for infants and children. The radio talk show was officially launched in January 2016, building on the success of ad hoc talk shows in 2015.

Our partner:

Sudan Medical Care remains amidst adversity

Providing primary health care services to millions of people displaced by ongoing conflict in South Sudan is challenging. The greatest hurdle continues to be a lack of security, which has caused many health workers to flee, fearing for their safety. But that hasn’t been the case with Sudan Medical Care, a non-governmental organization formed by a group of Sudanese doctors in 2009. Dr. Mounir Christo Lado Lugga, IMA’s Country Director for South Sudan, said SMC remains flexible and resilient in the face of great adversity. When South Sudan was experiencing more stable times, SMC was managing 24 health facilities. Though most were destroyed or looted in the fighting, in less than one year, SMC had opened or reopened 21 facilities. “You cannot imagine that resilience,” he said. “It’s not easy to go from zero and then open all those facilities.” Despite ongoing violence, SMC has kept its health workers in the field, which has enabled IMA to continue to help the men, women and children caught in the middle of the crisis that began in mid-December 2013. “We work together,” Lado said.

Photo by MAF/LuAnne Cadd