Rapid Assessment Report. Greater Nyal, Panyijiar County, Unity state South Sudan. 16th 26th July 2014.

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1 Rapid Assessment Report Greater Nyal, Panyijiar County, Unity state South Sudan 16th 26th July The IRC assessment team taking a canoe to Maluak Boma. Photo by Taban Juma

2 BACKGROUND/CONTEXT Located in the south of Unity State, Panyijiar County is administratively divided into two units; Greater Ganyiel and Greater Nyal. Greater Nyal consists of 3 main Payams; Kol (6 Bomas); Nyal (7 bomas) and Mayom (5 bomas). It is estimated that there is a total population of in Panyijiar County. In greater Nyal 38,000 individuals were registered during the last food distribution in June. Greater Nyal has suffered severely as a result of the current conflict and annual flooding that has occurred over the last couple of years. This very hard to access area is very isolated almost to the point of being an island- on the three sides of the border is ongoing conflict while on the other side is the Nile river. This has created significant challenges for the population in terms of access to basic services and goods. The only reliable access into the region is by air and within the county access is only by foot- this often requires hours of walking through swamps and mud. The IRC team through a flooded and inaccessible road. Following reports of massive displacement in February, an inter-agency assessment was undertaken in the area that identified urgent needs in food security, nutrition, health, WASH and protection. Interventions to meet these needs began in March mainly- two food distributions by the World Food Program, resumption of health interventions in Nyal by Sign of Hope, child protection and education interventions by UNICEF and UNIDO, Livelihoods programs by Mercycorp and nutrition interventions by IRC and MSF. Most of these interventions have been in Nyal and few have reached far and less accessible areas in greater Nyal. It is against this background that IRC decided to undertake an assessment to understand the current needs, gaps and possible interventions for these hard to reach places and populations , South Sudan population census with 3% population growth per annum

3 KEY FINDINGS The groups most affected by the recent conflict are children, women- especially lactating and pregnant women, the elderly and physically disabled. More than 70% of the health facilities in the county are closed and are lacking equipment, personnel, drugs and are in dire need of repairs. Populations are walking as far as 7 hours to access the Nyal primary health care center (PHCC). Most of the assessed communities report that patients often died on the way due to the distance. Out of the 6 assessed bomas, ( Kuol, Janglow, Kanyhial, Machar,Yup and Maluak) only one boma- Machar- has had an immunization campaign for children under 5 in All assessed households report that they collect water from unprotected sources mostly from swamp areas. While boreholes exist in some areas, IRC found that most communities are opting to use swamp water due to preference in colour and taste of swamp water as compared to borehole water. There are up to 56 existing bore holes installed with hand pumps in the greater Nyal out which 26 were not functional and of those that were functional, 2 were submerged and 8 had poor aprons/drainage channels. Water storage is a big concern. Many of the assessed households report lacking any water storage containers. The few containers seen in the community were found to be extremely dirty. Many households report lacking the most basic NFI s. The most needed items are reported to be mosquito nets, soap and cooking utensils. Most of the assessed households report they are practicing open defecation. Many women defecate at night for privacy and dignity issues. Very few latrines and bathing facilities were observed in all the areas. As a result of the recent conflict and cattle raiding, most families have lost all their food stocks and nearly all their animals. Food production has been severely affected by heavy flooding and most families are dependent on wild fruits, water lilies and distributions from WFP. Two general food distributions have been done since the conflict. Most assessed households report that the food distribution stocks lasted only 1 week. The most common causes of malnutrition in greater Nyal are malaria, diarrhoeal diseases and respiratory tract infections. The current food insecurity in greater Nyal, if not addressed promptly, is likely to have a negative impact on the nutritional status of the most vulnerable i.e. children and pregnant/lactating women. While there are very few services available in the county, the most vulnerable persons have significant challenges accessing the services. Access to any services requires walking for very long periods of time as most roads are near impassable due to flooding. Most of the assessed elderly person, lactating mothers and physically disabled persons report not receiving any assistance since the conflict began. Except for Nyal, markets in all other assessed locations; Kuol, Janglow, Kanyhial, Yup and Maluak are closed. In Nyal, the few available commodities are extremely expensive and unaffordable for most households.

4 Lack of access to education is an issue requiring immediate attention as schools in all the assessed locations have been closed since the conflict began.

5 INTRODUCTION More than seven months since the conflict in South Sudan began, access to population located in hard to reach areas remains a significant challenge. While many inter-agency assessments have been undertaken in these areas, response to meet the identified needs and gaps has been slow for various reasons including physical access challenges faced by humanitarian agencies. From the 2008 population census, it is estimated that there are currently individuals in Panyijiar County. The true figure of those displaced in the county is unknown as no proper registration has taken place since the conflict started. However registrations for food distribution there have been approximately 91,000 individuals registered- 53,000 in greater Ganyiel and 38,000 in greater Nyal. IRC has been providing health and WASH services in Panyijiar county covering greater Ganyiel for the last 19 years. Following the recent conflict and the resultant displacement into Ganyiel, IRC began additional response interventions in the sectors of health, WASH and Protection. Some of these interventions have responded to needs in greater Nyal covering Kol and Machar Payams. To address the populations needs more comprehensively, IRC has since seen the need to bolster its interventions in Greater Nyal and specifically target hard to reach areas in the entire Panyijiar County by establishing a permanent presence in Nyal. Assessment Objective To assess the needs and gaps in services in six (6) bomas in greater Nyal Payam. To design Health, WASH, Nutrition and Protection interventions that meet the identified needs. Methodology The assessed locations were selected based on the presence of a PHCU receiving no support from an NGO. Catchment areas of the PHCU or PHCC already supported by Sign of Hope were not assessed. The assessment used qualitative data collection tools to gather information on the population needs and existing service provision gaps. Tools used included focus group discussions (FGDs), key informant interviews (KIIs), safety audits and transects walk/observation tools. Focus groups targeted groups of women, girls, boys and men in age groups of and groups aged over yrs. 17 FGD s were conducted covering 163 participants KIIs targeted community leaders and NGO s operating in greater Nyal. 19 KIIs were conducted with a total of 26 interviews conducted. 1 safety audits was conducted per location making a total of 6 audits. The audits focussed on safety and access to schools, health facilities and water points. Limitations Access to many of the locations was a major challenge and this meant the team spent a significant amount of time on the road and only had about 2 hours to complete the assessment in most locations. This meant there as little time to dig deeper and understand root causes of some issues.

6 ASSESSMENT FINDINGS-PER LOCATION Kol Payam - Jeliu Boma Located south of Nyal, the greater Kol payam has an estimated population of 22,000 2 individuals. The payam is approximately 4-5 hours away from Nyal-on foot and can also be accessed by canoe from Nyal in 4 hours 3. There are six bomas in the payam five of which were affected by the recent conflict. The community is composed of the Nuer ethnic group and is administered from Kol Payam reporting to Nyal headquarters. In terms of administration there is a payam administrator, including a chief and his deputy. Following the conflict that started in December 2013, most of the community members were displaced to islands- approximately 3hours from Kol. Most of the community members returned back to their villages. There is an unspecified number of internally displaced persons displaced from Leer and Bentiu who have since integrated in the community. According to the chief, most of the population is back except a few left on the islands who are mainly fishing. The area is reported to be safe and has not experienced any security incident since 7 th February. Most of the interviewee s reported that they are likely to stay in the current location if security remains the same over the next few months. Prior to the conflict, the main income generating activities for the communities were farming, animal husbandry and fishing. This has however changed since the conflict began as most of the cattle were raided and many fishermen lost their fishing equipment. On the other hand, flooding in recent years has severely hampered agricultural activities resulting in a near shut down of economic activities in the area. There is currently no NGO working in the area except for IRC Nutrition and community case management activities administered by the IRC program in Ganyliel. HEALTH Access to healthcare is a serious concern for this community. There is an empty primary healthcare unit (PHCU) building in the area. The PHCU was opened in October 2013 and has been closed since February Since the closure, the patients have been forced to walk to Nyal-5 hours on foot or Ganyiel- 8 hours on foot to access health services with most of the patients reportedly dying enroute to the facilities. The conditions on the road are very difficult as the area is swampy and muddy as witnessed by the assessment team. The facility has 3 rooms; - an outpatient department (OPD) room, extended program of immunization (EPI) room and nutrition room. IRC has been running a nutrition program from Ganyiel that serves Machar and Kol. No health staff are available in the facility. There are no drugs, medical supplies or equipments in the facility. There is no referral mechanism in place and the nearest health facility is 5 hours away on footing. Communication to Nyal can be done via radio or satellite phone. All the 2 Estimates from the boma chief. The 2008 population census reports individuals with an estimated 3% increase in 2013 the population was projected at. Given the recent conflict and the resultant population movements it is difficult to estimate the exact number of people in the area. No proper registration has taken place to date. 3 During the rainy/wet season these are the only two ways the area can be accessed

7 deliveries are done in the community in the presence of a traditional birth attendant depending on availability. A solar fridge is available but no vaccines are available. There is no delivery room, maternal health, waiting space, warehouse, stabilization or emergency room. Windows, doors, roof and floor are in need of repairs. No health data or epidemiological surveillance is in place and no recent immunization activities were reported. KOL Primary Health Care Units (PHCU) before IRC intervention. Photo by Gilbert KAYOKO. July 18 th, NUTRITION Food and livelihoods situation Since the conflict began there have been two general food distributions (GFD) done by the UN-WFP one in April and another in July Lack of food was highlighted as one of the top priorities in this community. From focus group discussions, participants reported that the distributions had significant challanges right from registration to the actual distribution. Registration was reportedly conducted in Nyal. This reportedly left out many individuals who were unable to walk the 4-6 hours needed to access the registration. Distributions were also held in Nyal making it challenging for the most vulnerable to access and carry the food for several hours through swamps and mud. Average daily food consumption is reported to have decreased with most families reporting consumption of one meal a day in order to preserve the little they have as they are unable to predict when the next distributions will be held.

8 Panyijar county is currently cut off from main supplies- cut off by flooding on one end and conflict on the other end. The market has a very limited supply of food items. IRC observed only biscuits, soap, salt and slippers in the market and even these are in very limited quantities. The other market sources are 5 to 8 hours walk on average, additionally women walk for long hours in the forest in search of roots, traditional vegetables, water lilies and even fish which at times are hard to come by when the water level rises secondary to the heavy rains. Considering that the MIYCN component is non-functional in the area under assessment, there are major challenges in feeding children below the age of 24 months. The community was largely dependent of animal produce- specifically milk for children- but since the cattle were raided supply is very limited. Lactating mothers reported that they are facing challenges in breastfeeding children under 6 monthsthey have to spend hours looking for food to support the entire family and breastfeeding one child is not a priority. Children under six months are pre-disposed to both chronic and acute malnutrition. Women participating in focus group discussions Current nutrition interventions: Only one of the five expected components of a nutrition program are present in Kol, the outpatient therapeutic program (OTP) is run by the IRC. The program started in October 2013 and has a current case load of 222 beneficiaries of severely malnourished children between the ages of 6 to 59 months - this is the highest number since the program started. There are four community nutrition workers (CNWs) in Machar and 1 in Jeliu with 2 CNWs in charge of the 2 sites. It s worthwhile to appreciate that caretakers walk for very long hours to seek and benefit from the services.

9 There are routine drugs (Vitamin A, Albendazole and amoxicillin syrup) additionally there was RUTF. All the drugs need to be replenished as they can barely last a fortnight with the current trend though the albendazole and vitamin A can last about 6 months if no campaign for the same is undertaken. No mass MUAC screening has been carried out in 2014 year- the last is dated October an activity that took 3 days and only managed to cover 3 out of the 6 bomas in Kol Payam. Reporting tools are available and there is adherence to as IMAM. An examination of the register reveals that nearly 90% of admitted children have a MUAC of 11.5 cm which is an indicator of a greater need as far as capacity building is concerned. WASH Water situation: The only source of water in this area is a swamp. There are reportedly 13 boreholes in greater Kol of which only two are functional. Most households report walking an average distance of 30 minutes to get water from the swamp. There is an urgent need to repair and treat water from these existing boreholes. 100% of all the focus groups confirm that they have not been using any form of household water treatment for treating water from either the boreholes or that collected from the swamp. In the school it is reported that pupils also drink from the swamps. No water management committees are in place. Community members report that they lack water storage containers. Women reported having 1 (one) jerry can of 20litres per household for an average family size of seven. IRC observed that most of the water storage containers were extremely dirty. Sanitation: No latrines are observed in the area even in the school or the health facility. 100% of the FGD s report practicing open defecation. Women and girls reported having to wait till nightfall to defecate for privacy reasons. There are no existing bathing facilities. Hand washing at critical moments is only done before eating with no soap. Soap is lacking in the market and very pricey when available. Women manage their menstruation periods traditionally and general hygiene of the community is at risk of many water borne diseases. PROTECTION Services in this location are almost non-existent. The health facility has been closed since February To access health services patients walk up to Nyal- 5 hours on foot or Ganyiel- 7 hours on foot. This is especially challenging for complicated medical cases and persons with disabilities. There is a school in the area that operates irregularly- sometimes students attend and teach each other, sometimes a teacher is present. UNICEF has been supporting the school with learning materials. The school schedule is irregular because teachers have not been paid and the hunger situation in the community necessitates everybody to seek food from the swamps and forest for long hours- education has ceased to be a priority. Attendance by children is also irregular. This is reportedly due to hunger, distance and illness.

10 Focus group discussion with men in Kol Water is accessible from the swamp with many families walking an average of 30minutes to access the swamp. The routes are reported to be safe. Access to distribution and registration is a major challenge. All registration was done in Nyal- 4-5 hours away on foot leaving out the most vulnerable who are unable to walk that far. There are 400 registered vulnerable individuals in the community by the local authorities. Most of the vulnerable persons are living with relatives. Specialised services for vulnerable persons are lacking. The community FGDs reported that the most affected groups during the conflict are the blind and old, the physically disabled, children, pregnant and lactated mothers. These is because these groups at risk of being killed especially when the community members have to flee at a moment s notice. Interviewed vulnerable persons reported that they are in need of food, sleeping items, medicines, soap, mosquito nets, blankets, crutches, cooking utensils and wheel chairs Groups that are reportedly coping better are male youth, girls and non-pregnant women because they are able to fish and can go to the forest to look for wild fruits and thus more food secure compared to the rest of the population.

11 JUNGLOW BOMA IN NYAL PAYAM The Boma is located an average of 1.5 hrs to 2 hours walk from the Nyal payam headquarters. The chief of the boma reported that there are an estimated 8,000 individuals in the boma. There are 7 (seven) villages in the boma with the furthest being an 1 hour walk from the boma center. The socio-ethnic group is Nuer under Boma Administrator reporting to Nyal Payam Administrator. The community reports that there have been no safety or security incidents since February The chief reports a small number of IDPs in the boma all of whom have integrated in the community i.e. have been allocated a piece of land to put up shelter and farm. No population movements are expected unless the security situation significantly changes according to him. The main community income activity is agriculture. No organization is operating in the area. There has been no food distribution- note that GFDs are done in Nyal and there have been no previous assessments carried out in the area. The main challenges the community reported to be facing is food insecurity, lack of primary health care services and lack of education.. Communication is only by thuraya. There is no other agency working in the area. HEALTH There are no services available in this boma. The health facility has been closed for years and the nearest facility is Nyal- accessible on foot- 2hrs walk. Persons with disabilities reported that they are unable to access the facility. The road is either flooded or very muddy and unsuitable for walking. There is one trained traditional birth attendant but she reported lacking delivery kits thus limiting safe access to reproductive health services. he biggest challenge the community is facing is lack of access to healthcare facilities. The nearest facility that is functional is in Nyal- accessible by walking 2 hrs. There was a PHCU facility in the area but this has not been functional. The facility has 3 rooms all in dire need of repairs. The rooms are used as; an OPD room, EPI room and maternal and stabilization room. Janglow Primary Health Care Units (PHCU) before IRC intervention. By Gilbert KAYOKO. July 19 th, 2014.

12 There is no delivery, maternal and child health room, waiting space, warehouse, or emergency room. Additionally, there is no waste pit, placenta pit, sharp pit, toilets, shower, and incinerator. Windows, doors, roof, floor need repairs. Fencing and gate of the facility is not available. There are no other structures available in the compound. No water system provision in place. Note that the compound and this facility have not been used for years and are full of grass. No personnel are available in the facility. There are no drugs in the facility and there is no referral mechanism to the nearest health facility. The nearest airstrip and referral point is accessible 2 hours on foot (NYAL). No immunization activities have been undertaken in the boma since last year. NUTRITION Food and livelihoods situation: The supply and consumption of food in all households has significantly reduced since the crisis began. Most households report having less than a week s supply of food which is a major concern for the house hold heads and especially women who are either expectant, lactating, elderly or having young ones in their youthful age. Similar to other sites, food distribution was only carried out in the main Nyal payam thus a must walk for 2 hrs. Most households reported that the last food distribution supplies lasted less than a week i.e. at the family level on average and most households are depending on wild fruits and water lilies to survive. The main source of livelihood is agro pastoralism which has been affected by flooding due to heavy rains in the recent past. The resultant effect is inflated prices for the very basic food commodities. Increased food prices greatly hinders food availability as well as access. Most importantly, unavailability of milk is likely to affect the nutritional status of children under five in the area. The food security situation is worsened by unavailability of a physical functional market, the nearest being a minimum 1.5hrs to 2 hours walk. Nutrition interventions : According to the respondents there is no nutrition program currently being implementation in this particular Boma i.e. no SC, OTP, SFP, MIYCN and the community component. There is however an OTP service available in Nyal and additionally there is a day care SC at the same site (F75, F100, Resomal, plumy nuts and routine drugs are available at the day care) both are run by MSF. MSF reported a closing caseload of 400 children the week prior to the IRC assessment. Severely malnourished children are later discharged to the PHCC run by sign of hope for a sleep over (only F75 and routine drugs are available) and return to the day care from where they are discharged to the OTP till recovery. The absence of any nutrition program in the boma to address infant and young child feeding has contributed to malnourished under 2 years children. Additionally there is no IYCF counsellors thus all

13 mothers and caretakers especially the ones with infants less than 6 months have very limited options or none. The last health and nutrition campaign was conducted in March 2013 which entailed issuance of the tetanus vaccine to all women of reproductive age, vitamin A and measles vaccine to children less than 5 years of age. WASH Water: There are two main sources of water in this community- a borehole (3 in the entire boma) and swamps. More than 90% of the community reported that they drink water from the swamp mostly because they prefer the taste as compared to that from the borehole. The borehole and swamps are located at an average of 15 minutes walk for most households. Water sources are not treated. The swamp water is shared by both wild and domesticated animals. Water is stored in jerry cans which are reported to be very few and observed to be very dirty. There was a water management committee formed in the community but the community reported that the committee did not receive any training and are unaware of what their role should be. Sanitation: No bathing facilities were observed. From the discussions, over 90% of the community practice open defecation very far away from homes (30 minutes walk) during the day and close-by the homes during the night or when it is raining there was no demarcated location for defecation; few reported washing hands thereafter some using the swamp water. Those who do have their own latrines reported sharing the same with up to 14HHs leaving nearby with the latrine owner responsible for latrine cleanliness and maintenance. The respondents cited lack of resources, inadequate local technical skills, collapsing ground formation 4 as challenges impacting on them not building their own latrines. Women interviewed mention that it was man s responsibility to build a latrine for the HH but they lacked resources to do it. Despite these challenges all respondent agreed that using latrines brings in benefits like reducing risks to snake bites, wild animals when defecating in the bush, prevents diarrhea and also comfortable during rainy seasons. The respondents cited using the cut method as embarrassing when done during the day but okay at night since no one is seeing what they are going to do. Over 90% of the women manage children s feaces through burying it nearby the homestead. All respondents reported managing refuse waste through either burning on site or in a pit; and they will wait for it to dry and burn during rainy season. They all reported not sharing any of these refuse disposal mechanisms. On the way to Janglou, one HH latrine was observed constructed of iron sheet superstructure and cemented floor but there was no Hand Washing facilities close to the latrine. At the School in Janglou a 3 stance latrine block not completed was also observed, one stance had plastic slab while the other 2 stances had pre-concrete structural slabs. 4 One responded said it could collapse during digging and kill

14 Women manage their periods traditionally. Overall hygiene of the community is at risk of water borne diseases yet there is no functional health facility nearby. PROTECTION The community of Junglow identified the vulnerable among them to be women (pregnant and lactating), children, elderly, men and the youth in that order and urgently appealed for immediate intervention to salvage the access to service situation. There are a reported 200 elderly persons and 30 disabled persons in need of assistance. The school has been closed since the conflict began due to lack of teachers. Teachers have reportedly not been paid. Even when there is a motivated teacher, attendance is reported to be very low as many children only have access to one meal a day and are too tired to attend school. Access to distribution is no different from other areas. Registration and distribution were only conducted in Nyal. Many of the vulnerable persons reported not being able to access registration or distribution. In this community there are reportedly no groups that are comparatively fairing well as compared to others. Most communities members are struggling to get by. Some report selling the few cattle left to purchase food items. Many are relying on water lilies and wild fruits for food. Information on any issues around services and assistance is normally relayed via chief or boma administrator, county commissioner. Information is passed from one person to the next although megaphones are sometimes used. The most pressing needs for this community are reported to be food, blankets, mosquito nets and medicine.

15 KANYHIAL (BOMA/VILLAGE) - MAYOM PAYAM. The village is located in the northern part of the greater Nyal payam. The boma is administered under Mayom payam. It is accessible on foot- 6hrs from Nyal or alternative a combination of canoe and footing -5 hours on canoe to Maluak and 2hrs on foot from Maluak. The community leaders report that there are an estimated 1,700 households in the boma of whom 225 are registered as vulnerable. The last reported security incident was in February whereby all cattle were raided from the community. Most the community members took refuge in nearby islands for a couple of months. Being located at the furthest end of the payam, the location is vulnerable to attacks. Most of the displaced households began returning to the boma in March and it is reported that as of April nearly all households have returned. According to the community leaders no assessment has been conducted in the boma since the conflict started. In 2013 there were some health related campaigns conducted by some organizations (Vitamin A and measles). Return to normalcy in the boma has been an uphill task as the community was largely dependent on animal products for food and income. The community is at a loss on how to revive these essential components of their lives. IRC could observe old women harvesting water lilies from the swamps - a sign of the severity of the food security situation in the village. On the other hand, weather patterns are totally unfavourable causing destruction of crops and the boma is a near island due to the high volume of water. During the dry season the land is not productive and utilisation of the swamp water is a major challenge as the residents have no means/equipment to pump the water into the farms. The market has been closed since the conflict began. The main source of income used to be agriculture and animal husbandry with occasional fishing. Since the conflict, most households have lost/are missing the fishing equipment making it near impossible to fish. A care taker harvesting water lilies in a swamp Communication is only via satellite phone and there is no UN agencies or NGO s in the area.

16 The community members agreed unanimously that inaccessibility due to flooding, lack of food, lack of education and insecurity are the greatest threats facing Kanyhial. HEALTH There is no healthcare facility in the boma. There was a PHCU sometime back but has been closed since There is a small building that was used as the PHC comprising 2 rooms that can serve as an OPD and stabilization room. The roof and floor need some rehabilitation and the other elements are missing i.e. the following: No waiting space, ware house, Windows, doors, roof, floors are the higher priority for repair. The waste pit, placenta pit, sharp pits, toilets, shower, and incinerator are missing and must be put in place. Fencing and gating of the facility not available and is necessary to be built. There are no other structures available in the compound. There is no water system provision in place. Note that the compound not used. There are no personnel and there is only one TBA. All deliveries are home based. There is no referral mechanism in place and the only place to access healthcare is at the Nyal PHCC 6 hours on foot. The community reported that many patients died on the way to Nyal due to the distance and the state of the road. No immunization activities have been organized in Kanyhial PHCU NUTRITION Food and livelihood situation: Similar to other areas in the greater payam food consumption has reduced as compared to the time prior the crisis. Recently planted crops are yet to mature for harvesting, mainly maize and thus the community is forced to consume water lilies and wild fruits/roots. At the moment very few people have food supplies at the household level and most are living from hand to mouth i.e. by the minimal fish they get in a day and the immature maize but majorly utilizing the water lilies. The main commercial road from Nyal headquarters is impassable (insecurity and majorly flooding) thus no essential goods have reached the residents due to the cut off. This has adversely affected the terms of trade, availability and access to basic commodities. In most cases, the prices of the few available

17 commodities have more than doubled. The distance challenge has also resulted in very few community members registering for the GFD. Even the few that managed to receive the assistance report that supplies only lasted for about a week. There is no functional market in the area thus one has to walk for a minimum 6 hours to access the one in Nyal. As far as the children below 2 years of age are concerned, there are no optimal feeding practises as there are no programs attributed to the same. Another negative contributing factor is the fact that, the mothers/caretakers are away in the field in search of food thus substantially away from the children for very long hours. No exclusive breastfeeding is been practiced nor complimentary feeding in accordance to the infant and young child feeding policies. Lack of soap is also reported to result in increased cases of diarrhoea mostly impacting negatively children aged less than 5 years. In terms of existing capacities and nutrition related capacities, there are no components on ground i.e. for both IMAM and MIYCN, this is wanting considering the food security needs in the area. WASH Water: The community is living in an island surrounded with swamps and this is the main source of water. There is a hand pump but this is near submerged in one of the swamps. In any case the community reported that they prefer to use the swamp water as they prefer the taste of swamp water compared to the water from the handpump. Another reason the community is opting to use the swamp water is the time factor. Most households reported that it was faster to collect water from the swamp compared to waiting at the water point. Water is currently not treated. Water containers seen were very dirty and not enough for an average house hold of size 7- yet another reason many households are resorting to using swamp water. Sanitation: Open defecation is seen around the houses and no latrine is seen in the community. The general look of the sanitation of the community is very poor since there is no sanitation infrastructures seen in the community.. PROTECTION Access to distribution has been most problematic for this community. Like in all the other places, registration and distribution was done in Nyal- 6 hours away. This led to exclusion of the most vulnerable most of whom were unable to walk through the swamps and waist deep water to access the distribution. In any case, most community members reported that the route was unsafe and community members feared to be attacked.

18 IRC team walking to Kanyial for the assessment. Children, women and elderly are reportedly as the most affected by the recent conflict. This is because most of them lacked access to food and had to walk very long distances to access food or other assistance. Some of the groups reported to be comparatively coping better are youth- boys and girls and non pregnant mothers. The most vulnerable are reportedly in need of food, sleeping items, drugs, soap. In general, the community reported to be in need of agricultural tools, fishing tools, mosquito nets, health services and water jerry cans. While the community leaders and structures remain the same, the community reported that they are no longer organized as before the conflict as everyone is now focused on providing for his/her family. The school has been closed since the conflict began mainly due to lack of salaries for teachers, lack of food necessitating spending enormous amounts of time in the swamps or forest to look for wild fruits or water lilies. Information on any issues-security or available assistance is often shared by the chief and sometimes via radio to the radio room in the boma. MALUAK BOMA-MAYOM PAYAM Located south of Nyal, the Boma/village has an estimated population of about 7900 individuals of who 50 are registered by the local authorities as vulnerable under 3 main categories namely; the blind, children and the disabled. The boma is administered by the boma Administrator who reports to Mayom Payam Administrator. The location can be accessed by canoe in 4 hours or on foot in 4hrs from Nyal headquaters. There are no recent reported movements i.e. in and out of the Boma nor are there any reported security concerns. The community leaders report that there are some IDPs displaced from Bentiu all of whom are reported to have integrated in the community. The main income generating activities for the community are fishing and agriculture. The community reports that the most affected by the recent conflict are the women, unaccompanied children and elders due to their inability to walk fast, inability to work and lack of food.

19 Crops destroyed by flooding The Maluak community does not have a functional market, this basically indicates that the community members are obliged to walk for very long distances for basic household commodities which are not guaranteed and when found the prices are highly inflated. With no income generating activities the situation is grim. No organization is working in the area and no assessment has been undertaken in the location since the conflict began. Communication from this area can only be done by satelite phone. There is no radio facility. The community identifies the top most challenges they are facing as lack of health care services, lack of education/school; lack of clean drinking water and flooding. HEALTH The community here like most of the visited sites is lacking a health care facility. The only option for the community is to access the Nyal PHCC accessible 4 hours on foot or canoe. There is one building that used to be the PHCU but this has not been functional since the before the conflict began. The building has 3 rooms that can be used as an OPD room, EPI room and maternal and stabilization room. The building is damaged and its floor and roof are in need of repairs. Other elements necessary for a PHCU are missing i.e.

20 maternal and child health room, waiting space, and ware house. The facility has no personnel or medical supplies. There has been no immunization campaign organized in There is no data on epidemiology or referral mechanism to the nearest health facility - 4 hours footing (NYAL PHCC). Further referral can only be done from Nyal where the nearest airstrip is. All the deliveries are home based. There are eight (8) TBAs in the community. NUTRITION Food and livelihood situation: Average food consumed has reportedly decreased per family level per day. The market supplies and productions have reduced substantially majorly due to inability to access the location due to flooding and conflict. The area lacks a functional market and has experienced low agricultural production due to flooding which has resulted to destruction of crops in the farming fields. Some of the households have food while others do not. This is reported to be a major cause of malnutrition. Most of the households have access to only one meal per day which is not sufficient considering the output in terms of kilo calories per person per day. There have been only 2 GFD with no specific dates when the next would be carried out. The last GFD stocks reportedly lasted for less than a week. The GFD occurred in Nyal. Feeding for children under 2 is a challenge for many households. Mothers spend significant amounts of time away from the young ones in search of food (wild fruits and roots). No infant milk products have been distributed in the past thus none of the infants are dependent on the same. The community members of Maluak reported their main source of livelihood is farming and fishing, which comes with its own package of challenges. Current nutrition interventions: No nutrition or food security assessment has been done in Maluak nor has there been any organisation on ground for the past 5 years highlighting the urgent need for health and nutrition in the area. There has been no IMAM or MIYCN in the community. There has also been no nutrition campaign conducted in the recent past. Two general food distributions have been done since the conflict started- 7 months now- i.e. in April and July. The distributions were done in Nyal- Four hours walk from Maluak. This impacted negatively on access as several members of the community did not benefit from the exercise. This is reported to have mostly affected the women, the elderly, disabled and other special groups e.g. the lactating women found it difficult to walk for registration- a total of 8 hour journey to and fro- only to have to subsequently collect the food the following week making another 8 hours journey.

21 WASH Water: Maluak is almost an island surrounded by swamps. There is a functional hand pump in the community but residents are opting to use the swamp water over the water from the borehole reportedly due to taste and colour. Water is not treated and there is no water management committee in place. There are very few water storage containers which IRC observed to be very dirty. Sanitation: There are no latrines in the community. All fgd s report that members practice open defecation. Similar to all locations, there are no bathing facilities. Community members report using the swamp or waiting for nightfall to take bath outside. Hand washing is barely practiced according to the fgd discussions. As there is no market, soap is lacking or very pricey when found. Women manage their menstruation periods traditionally. PROTECTION General safety and security is reported to be good with no incidents reported in the past four months. Like other assessed areas, there is nearly no service available in the community. There has been no assessment carried out in the boma and there has been no NGO working in the area since the conflict began. Access to health is reported to the biggest challenge facing the community. The nearest health facility is the Nyal PHCC located 4 hours away on foot. This is most challenging for any urgent cases and especially so when the patient is immobile since communities have to walk through swamps and mud. While canoes are available, the cost is prohibited at 200SSP one way. Considering the community is not engaged in any income generating activity such an amount is nearly impossible to come by. The community is currently accessing water from the swamp. Although there is a hand pump, most of the households reported that they preferred the taste of the swamp water. The distance to the swamp is minimal with an average of 7min to the swamps. The routes to the swamp are safe expect with the main reported risks being snakes. The swamp water is untreated and posses significant health risks considering it is the same water used for bathing, washing and shared with animals. Lack of privacy is

22 reported to be a challenge for women and girls who report having to wait for nightfall in order to take a bath or defecate. Access to registration and distribution is a serious concern. Registration and distribution is only done in Nyal- 4 hours away excluding many vulnerable persons. Lack of access to registration and distribution is reported to have mostly affected lactating mothers, the elderly and households with large families. Exclusion from registration affects the households in 2 main ways 1) All family members have to be physically verified in order for the household to receive a ratio sufficient for the them. In many cases it is impossible for the whole family to travel and get registered thus only few households members are registered resulting in receiving a very small ration. 2) A complete exclusion of vulnerable groups- mostly with no support structure- especially single lactating mothers and elderly persons who are unable to make the 8 hour journey. The community receives information in the security situation and available assistance from the chiefs. The community reports that they are still organized as they used to be before the conflict and have the same leaders.

23 YUP BOMA/VILLAGE IN NYAL PAYAM Located north of Nyal, Yup village/boma a 3 hour walk from Nyal Payam headquaters and 2 hours walk to Maluak. The estimated population is 4000 individuals with 54 individuals classified as vulnerable. Administratively, the boma is under the Nyal Payam administrator. No major security incidents have been reported in the past four months. The last incident is reported to have occurred in February where all community members had to flee as a result of the cattle raiding to nearby islands. Most communities have since returned and no further population movements are expected. The community leaders report that there a few IDPs but these have integrated into the community. It is worth noting that in most cases those reported as IDPs are from Bentiu but the locations they are currently displaced to are their ancestral homes. Yup does not have a functional market and is dependent on Nyal for all supplies. The main income activities are said to be agriculture and fishing. Agriculture like most of the locations visited has suffered a serious blow due to the flooding. On the other hand lack of fishing equipment makes is impossible to obtain sufficient fish for trading or comsumption. Following the February cattle raiding incident, the community reports they lost all their cattle yet another challenge the community is facing. Communication from this location is only by satelite phone. There is no other organization operational in the area. No assessment has been conducted in the location since the conflict started and the community totally feels alienated. Frustrations were evident during the discussions with community members. Despite having to walk for very long hours to seek/access health, nutrition and food the community seems to have developed some positive coping mechanism to ensure on the limited services and goods. IRC observed the communal systems in place- very few members of households where in the homes mostly because they were out farming, working jointly to repair or make new dykes to reduce the amounts of water getting into the community. The community reports that those most affected by the recent conflict are children and the elderly. The elements affecting these groups are lack of food and mobility challenges especially since the community has had to move over long distances in search of food and assistance. The most prioritised concerns for the community are access to clean water, access to health services and access to food for both the general population and the special groups HEALTH There is currently no health facility in the boma. The PHCU was closed before the conflict- in 2009 and remains closed to date. The building used as the PHCU has two rooms and is in need of repairs. No personnel available in the facility. There are no drugs, no data on epidemiologic surveillance is in place. There has been no immunization campaign in There is no referral mechanism in place with

24 the nearest facility being Nyal. The community reports that patients are dying on the road during the referral due to the pure condition of roads full of floods and mud. YUP PHCU NUTRITION Food and livelihood situation: Yup completely relies on Nyal for supplies as it does not have a market. The amount of food consumed by family members is reported to have reduced significantly to 1 meal per day. Notably the quantity consumed in a day is food gathered within 24 hours with near zero food stocks in most households. The prices of commodities are reported to have more than doubled since the conflict started. In addition to the flooding that is making the place inaccessible, food distributions are inconsistent. The last food distributions stocks are reported to have lasted between 7 to 10 days. It was reported that the main source of livelihood is farming (maize, simsim, and ground nuts) and fishing though lack of tools and poor fishing methods are reported to be a hindrance to increased productivity. Lack of a functional market has worsened the food security component by missing out on very basic food commodities, the caretakers also reported challenges with feeding children especially the less than 2 years of age, optimal feeding practices were not adhered to; as mother spent most of the day away from the children, food supplies were reduced thus limited feeding options for the same age group.

25 WASH Water: Community members report accessing water from the swamp. Households report that water is not treated. There reportedly used to be a borehole in the community but this has collapsed and a new one needs to be drilled. Water storage is also a challenge as most households report that they lack jerry cans. The few containers IRC saw are extremely dirty. Sanitation: No latrines are observed in the community. household report using open defecation. With the rains expected to increase in October and November, the community is vulnerable to many water borne diseases. PROTECTION Yup boma is reported to be safe with no security incidents reported in recent months. Overall, there are very limited services are available in Yup boma. The health facility has been closed since 2009 while the school has been closed since the conflict began. Households report that they access water from the swamps. A borehole in the community has reportedly collapsed and a new one needs to be drilled. As there are no latrines in the community, households report openly defecating. This is reported to be a major challenge for women who have to wait till nightfall to defecate or bath. Access to food is reported to be only accessible to the able bodied. Food distribution was only conducted in Nyal-3 hours away and most vulnerable persons were unable to register and consequently were left out of the distribution. Lack of access to the food distribution is reported to have mostly affected blind and disabled persons who cannot reach the registration and distribution points. The community reports that they receive information on available services and security from the boma administrator and water technician. The community reports that they have the same structures and leaders that were in place before the conflict. Community organization is however reported to have reduced as compared to before the conflict as everyone is now focused on taking care of their family.

26 MACHAR BOMA/VILLAGE IN KOL PAYAM Is located south of Nyal headquarters with an estimated population of 5,000 individuals. There are 14 villages in this particular area with approximately 300 IDPs and 100 vulnerable people in the boma. Machar is a 7 hour walk from Nyal or 5 hour walk from Ganyiel. Machar can also be access by a combination of footing and canoe- 4 hours by canoe from Nyal to Kol and 2 hours on foot from Kol to Machar. Fighting is reported to have started in Machar with several houses destroyed and burnt down. It is reported that at the height of the conflict almost the entire population was displaced to islands or Ganyiel. The population slowly started to return in March and has stabilised as of May. No further major populations are expected except occasional movements made in search of food and assistance. There has been no security incidents since February and the place is reported to be relatively safe. Burnt down houses in Machar The main income activities are agriculture and fishing. There is no market in this location and the community have to travel to Kol to access the market. Other than the GFD conducted in Nyal and Ganyiel no assistance has been provided in this location. IRC is currently implementing CCM and nutrition activities and there are no NGO s working or providing any services in this area. Communication from this location is only via satelite phone. HEALTH There is no functional health facility in the boma. The PHCU was not functional prior to the conflict. There is one building that is barely functional with only a roof available- no walls. The rehabilitation and completion of the building is a high priority.

27 All the essential components of a healthy facility are lacking namely; no medical personnel, no drugs, no data collection system, no epidemiologic surveillance. There has been immunization campaign in the area in 2014 targeting children under 5. The immunization was polio, measles, vitamin A and deworming. Machar PHCU Referrals are possible to either Nyal a 7 hours walk during the rainy season. During the dry season referrals are also possible to Ganyiel located at 5 hours footing. The community prefers to refer cases to Nyal during the rainy season because the Ganyiel route, although shorter is extremely muddy and almost impassable. It is important to mention the fact that Machar is about 2 hours away on foot to Panyinjar headquarter hospital. The county hospital is reported to have been looted or destroyed. Reviving health services at the county level is a matter of priority. In the community, there are 10 trained TBAs. All the deliveries are home based. NUTRITION Food and livelihood situation: The last general food distribution was carried in July which is a major concern as the registration and distribution were carried out in Nyal which is 7 hours away. The community reports that some people missed out as they could not walk to this far location. Those most affected were pregnant women, women with young children and the disabled. In addition to the inability to access food, even the little that was received reportedly lasted for only 1 week. Households report that due to lack of access to food they have reduced food consumption with most families having only 1 meal a day. This is reported to be most distressing for lactating mothers, breastfeeding children of less than 6 month- this age group is pre-disposed to both chronic and acute