SKBN CU Humanitarian Update August 2017
[All emphases in bold have been added--ER]
• Critical level of immediate and chronic malnutrition, well exceeding WHO emergency thresholds, were captured in a recent SMART survey in South Kordofan. SAM levels in the Western Jebels were up to 9.3%. It is clear that children are facing the harshest consequences of the protracted war.
• Severe food insecurity reached 39% for households in Blue Nile in July, with 11% classified at highest possible level in the Household Hunger Scale.
• Intra SPLA-N fighting continued in Blue Nile into August, displacing thousands. Several reports have confirmed death of civilians, including one aid worker, and loss of property.
Flooding in both regions damaged crops and created additional displacements. Rains were particularly heavy in Blue Nile, where thousands were without shelter.
Food Security and Agriculture
The harvest season began in late August in many parts of South Kordofan, bringing some relief to the worst lean season since the beginning of the war. By the end of the month most households were harvesting green maize and certain vegetables, but the upcoming sorghum harvest will provide much greater food security throughout South Kordofan.
Overall, rainfall increased compared to 2016, which should lead to better yields. The coming harvest will likely improve over the last year’s, though will likely not match the ten-year average. Rainfall was sporadic during the growing season, with periods of abnormally low rainfall and episodes of flooding which damaged some crops.
However, the effects of the 2017 lean season are not yet fully known. FSMU July monitoring data is now available and presents gradually worsening food security in the more populous Central Region since the previous assessment in April. In the Central Region 14% of households were severely food insecure , which represents a significant increase both from the previous quarter and from the same quarter last year. This has likely contributed to very high rates of stunting in the under-five child population, per a June 2017 SMART Survey. Stunting is an indicator of chronic malnutrition due to long term food deprivation, micronutrient deficiencies, and recurrent illness which interrupt normal growth and has a long-term impact on the affected child. Overall stunting rates were a staggering 38.3% for the population and severe stunting was 14.7%. Boys were more likely to be affected, and younger children showed higher rates, suggesting that recent years have been worse for the population.
 FSMU July/August 2017 Food Security Brief
 SKBN CU SMART Survey Report on file with SKBN CU and available upon request
The Western Jebels faced a comparable situation, with qualitative sources suggesting a steady decrease in food security and the population facing a challenging situation. Stunting in children was similarly concerning with an overall prevalence of 33% and severe stunting at 12.9%. However, quantitative data on food security from the latest report is still being investigated by FSMU, per the last report.
Coping strategies throughout the region were alarming in this lean season. There were reports throughout the season of hunger related displacements (into South Sudan, Government of Sudan regions, or within the two areas), sales of household items and productive livestock, and reliance on foraging and wild foods. In the central region, 75% of children who were identified as sick also were malnourished, suggesting poor access to nutrition was also contributing to illness and increasing risk of death.
The highly invasive pest Fall Armyworm continues to spread north through South Sudan, reaching as far as Aweil recently. There are no reports of this spreading into South Kordofan, but the CU continues to monitor this threat as its impact on sorghum and maize crops could be devastating.
Food security in Blue Nile was substantially worse than South Kordofan. In the same FSMU July assessment southern Kurmuk had a total of 39% of households severely food insecure, compared to 14% in South Kordofan.  This is a dramatic increase from before the recent conflict, with a 144% increase in the number of households since April. This increase is substantially higher than would be expected from seasonal norms.
Prolonged gaps in seasonal rainfall in the early growing season appear to have negatively affected maize crops, as previously projected. The same early harvest has not yet been reported in Blue Nile, extending the usual lean season. As food security worsens, the conflict also inhibits coping mechanism such as relocation to refugee camps. Access for humanitarians is also decreasing, as fighting in unpredictable and occurs in civilian areas, which will further exacerbate the ongoing food insecurity levels. This is a major concern, as 11% of the population in the region were classified in the most severe category of food insecurity. Prospects for this population are grim.
The coming harvest is likely not as productive as in South Kordofan. Flooding was reportedly more severe throughout Blue Nile and gaps in rainfall longer. Overall levels of rainfall improved from 2016 and this year’s harvest could exceed last year’s, but will likely be below the ten-year average. The impact of the conflict on agricultural land is not well known yet. Thousands were reported as displaced, and it is possible people do not have access to their crops or food stores.
The conflict has also had a significant impact on market. Staple commodities in markets are still in short supply, but some improvements are seen in markets further from the conflict. Prices vary throughout the region, but have generally reached untenable levels for the population. Without access to cash to
 FSMU July/August 2017 Food Security Brief
 6 out of a possible 6. 4 through 6 is classified as severely food insecure 6 SKBN CU August 2017 field monitoring activities
encourage trade within the region it is unlikely external food will enter local markets in sufficient quantities.
Due to insecurity, no SMART survey was conducted in Blue Nile, hence no nutrition information equivalent to South Kordofan is available.
Health and Nutrition
Immediate and chronic malnutrition is a major challenge in South Kordofan and appears to be getting worse. As previously reported, global malnutrition and severe malnutrition based on height for weight were 23.9% and 8.4% in the Central Region and slightly worse in the Western Jebels at 29.2% and 9.3% respectively. In the central region only 22% of the population reported having access to nutrition services to assist malnourished children, and this may require crossing to South Sudan. In the Western Jebels, no household reported having access to nutrition services. The potential long-term impact of chronic malnutrition strongly suggests children are facing the harshest consequences of the ongoing conflict.
Children are also at risk of treatable diseases, with very low immunization rates and poor access to primary health care in both the Central Region and Western Jebels. Acute watery diarrhoea, malaria, skin and eye infections were the main identified health risks to children. With limited access to health facilities or medicines children face a heightened risk of death. Under-five mortality in the region was 0.7 per 10,000 per week. 
Another major finding of the recent SMART survey was that knowledge and practices of infant and young child nutrition was very poor. In addition to the immediate need for more access to nutrition and health facilities, dedicated training is needed to teach best practices for childhood nutrition and development, such as proper nutrition for children of different ages and how to identify risks and problems and when to seek medical attention. Even when health facilities are available, health complications that seem “normal” in the community are often not properly identified and addressed.
Reports of Acute Watery Diarrhoea just north of the SPLA-N and Government of Sudan frontline increase concerns of the illness spreading into the region. This is an immediate concern as access to health care in Blue Nile is highly limited and few clinics have the needed drugs to deal with such an outbreak. ["Acute Watery Diarrhoea" is almost certainly, at least in some cases, cholera, which the Khartoum regime refuses to call by its medically accurate name--ER]
Health facilities in Blue Nile already faced many challenges to serving the population, and this is likely exacerbated by the needs of a newly displaced population as a result of the conflict. The fighting within the SPLA-N continues to inhibit access to humanitarians and threatens the population’s access to medical services external to Blue Nile. People remaining inside will have little ability to move to better equipped clinics in the Maban refugee camps due to conflict, and will have highly limited access to medical care inside Blue Nile. Desperately needed drugs are unlikely to be available in the region while malaria and water-borne disease are expected to increase during the rainy season.
 SKBN CU SMART Survey Report
While no nutrition or health seeking behavior assessment was possible since the outbreak of conflict, the situation is feared to be worse than in South Kordofan. Severe food insecurity, a driver of the observed chronic malnutrition, was substantially worse in Blue Nile creating a strong possibility that children are facing an even worse reality.
The local Secretariat of Animal Health has identified and reported hundreds of cases of the dangerous disease sheeppox. This disease is often fatal and can spread quickly. Without access to vaccines or veterinarian care this could spread and affect thousands of animals.
Little is known about this sector. The local Secretariat of Animal Health has not been functioning since the conflict broke out. The CU has received reports of thousands of livestock killed or stolen in the conflict, but without full access to the region it has been impossible to fully assess the impact of the conflict on this important livelihood.
Damaging floods were reported throughout the region in August, creating temporary displacements and property damage. Floods contribute to the spread of disease as most of the population uses either pit latrines or open defecation as their primary waste facility.
Access to boreholes or filters remains a significant issue. Even while water is now more plentiful in rivers and hand-dug wells, humans and animals commonly share the same stagnant water sources. Should cholera or other water-borne disease enter more communities, there will likely be insufficient improved water sources to prevent spreading throughout communities. More clean water sources and animal specific reservoirs are needed to improve health conditions throughout the region.
Heavy rains and severe flooding caused widespread damage and displacements throughout Blue Nile. The main market in the region was flooded, causing an unknown amount of property damage. Newly displaced people were particularly affected, as they did not have access to proper shelter during the rains nor the means to protect any remaining food stocks.
Improved water sources are desperately needed for the same reasons as stated for South Kordofan. Investment in this area is now more challenging as a new conflict has restricted access for potential humanitarian actors. Both sides to the current conflict must respect the limited infrastructure and not further reduce communities’ access to water.
 Per local secretariat 340 reported to have died so far.
Schools have been out of session and little has changed in the last month. Teacher training opportunities are very rare, meaning the months away from classes could not be used to build capacity in most of the region. Investment in education is badly needed. There are approximately 255,000 school age children  in the region and very little access to trained teachers or well-equipped schools.
Resources for education in Blue Nile are scarce, likely creating a situation worse than South Kordofan for boys and girls. Added to this, the current conflict has the potential to affect boys of potential military stature. Progress made to keep children under 18 out of the military needs to be maintained, and educational opportunities created. There are currently no education opportunities offered to provide these children an important alternative, support to this sector is desperately needed.
Protection and security situation update
As the civil and military authorities face changes in leadership at both regional and local levels it is important to ensure the voices and needs of marginalized populations are not forgotten. Women continue to be under-represented in education and leadership, creating an environment with limited opportunities for development. Gender based violence is seldom reported and even more rarely punished. More focus is needed to address these issues at the local and regional level.
Inter-community conflict and cattle raiding continues to threaten the security of civilians living or cultivating near conflict lines. These events not only have the direct consequences of death, rape, and injury to members of the community, but also create a pervasive sense of fear for those trying to work and trade in these areas. As many communities are dangerously food insecure, women and children will have no option but to work in these dangerous locations, putting vulnerable populations at an elevated risk of violence. More investment is needed to bring these cross-line communities together to break the cycle of violence and revenge.
On 13th of August, as a result of intra SPLA-N clashes, one aid worker and three civilians were killed in Blue Nile, including two children. This has decreased the viability of a much-needed humanitarian intervention for the displaced persons. As neither party has taken responsibility for the attack, the CU is engaging with both sides to guarantee safe and unhindered access for a humanitarian actors to assess the needs of the displaced, with the hope of providing life saving assistance. Nearly four months into the
 Based on an approximately 27% of population, ages 6 to 17
 “No Control, No Choice: Lack of Access to Reproductive Healthcare in Rebel-Held Southern Kordofan,” by Human Rights Watch, accessed at www.hrw.org/node/303836/
 SKBN CU Statement regarding sectarian violence in Blue Nile and the death of an Aid Worker, August 17, 2017
conflict, and facing growing humanitarian needs, an immediate cessation of hostilities between the two SPLA-N factions is urgently needed.
Thousands of people are reportedly displaced. The CU has received several reports of destroyed homes, burnt or looted shops, theft of livestock, and destruction of farmland. Alleged human rights violations have also occurred during the fighting. It is not possible with current resources to fully assess the impact of this violence, but it is clear that nearly everyone is affected.
The CU has visited refugees in Maban from 18 to 22nd of August and spoken with newly arrivals from the conflict areas. Since the beginning of the conflict (end of May), refugees are divided between the camps along ethnic lines. Engagement with the refugees highlighted serious protection concerns as violence against civilians was allegedly exerted by both parties to the conflict. Increasing tribal divisions are affecting the stability of the camps and there is a growing risk of further attacks between the communities living in the camps. Insecurity in Maban in relation to the South Sudanese conflict is posing an additional threat to the security of refugees from Blue Nile and hindering their access to assistance.
Annex I: Security Incidents June 2017
12 Aug 2017DellingKarkoKarkoCattle Raiding9 head of cattle reported stolen
13 Aug 2017KurmukYabusYabus Balah, Yabus Kubri, AbengaroArmed ConflictUnknown number of persons killed or displaced. Property damage not yet assessed.
25 Aug 2017HeibanKumborUmdarfiCattle Raiding1 civilian killed during raid. Theft or property damage not reported.
Date not reportedDellingSilaraGawCattle Raiding9 head of cattle reported stolen
Date not reportedDellingFarshayaFarshayaCattle Raiding9 head of cattle reported stolen
Note: The SKBN CU is not in a position to report further on the ongoing conflict since the fighting, which began on May 22nd, has disrupted normal monitoring activities. As soon as possible, more information will be provided.
(c) 2017 Blue Nile Coordinating Unit Humanitarian Update