South Sudan continues to host refugees who are mostly fleeing from neighbouring Sudan (93%), the Democratic Republic of Congo (5%), Ethiopia (1%) and the Central African Republic (1%). By May 2018, close to 296,000 refugees and asylum seekers were registered in South Sudan. 52% of the refugee population is female and 62% of refugees are below the age of 18. Since the last JAM in 2015 the refugee population has grown by 8.8% or 60,000 people. Refugee numbers are likely to increase due to continued conflict and insecurity in neighbouring countries, specifically in Sudan, and natural growth. By the end of 2019, the population projection was estimated to be 334,400 refugees. The conflict in Sudan erupted in June 2011 between the Sudan Armed Forces (SAF) and the Sudan People’s Liberation Movement–North (SPLM-N) in South Kordofan State, which spread and reached Blue Nile State by September 2011, causing a mass exodus from these two states into Upper Nile and Unity States in South Sudan. Initially, refugees coming from Sudan settled in Maban (Doro, Yusuf Batil, Gendrassa and Kaya camps) and Yida. In February 2016, however, the Government of South Sudan announced the closure of Yida refugee settlement (effective June 2016) due to its proximity to the contested border, exposing refugee communities to protection risks such as forced recruitment, thereby compromising the civilian character of the settlement. Following this, transitional phase down of assistance delivery in Yida was initiated. This continues to be implemented through the Yida exit strategy. Joint Assessment Missions (JAM) are carried out roughly every two years to assess the food security situation among camp-based refugees and to make recommendations for programme review and/or adjustment. This JAM fieldwork was conducted by WFP, UNHCR, South Sudan Commission for Refugee Affairs (CRA) and partners working in the refugee camps from 28th May to 6th June 2018. The 2018 JAM assessed the food security, nutrition and related needs and services in the refugee settlements in South Sudan; it included an extensive secondary data review and analysis and primary data collection in seven refugee camps across the country (Ajoung Thok, Pamir, Doro, Yusuf Batil, Kaya, Gorom and Makpandu). Primary data was collected through focus group discussions, key informant interviews, household interviews and general observations. Since August 2015, all registered refugees in South Sudan receive a General Food Ration (GFR) at a 70% ration scale, representing 1491 kilocalories per person per day. The food assistance modality in late 2017 was expanded to the use of a hybrid basket (a combination of in-kind food and cash). This started by the provision of cash for milling in Maban and Jamjang in the fourth quarter of 2017 and in Makpandu from May 2018. In 2018 a hybrid basket is being provided in Makpandu from May and in Maban from July. Distribution follows a 30 days cycle with one distribution per month. Reliance on food assistance remains widespread. The food pipeline has improved due to prepositioning early in the year compared to last JAM, however, pipeline breaks due to access and security challenges remain a challenge. The 30% food ration gap, combined with lack of adequate livelihood options negatively impact on refugee household food security. Overall since the last JAM, the Food Consumption Score (FCS) has only improved slightly among refugees (from 43% with acceptable FCS in 2015 to 48.2% in 2018), with data suggesting that access to nutrition messaging and kitchen garden ownership had a positive impact on FCS. Despite an overall positive trend in FCS among refugees, 57.5% of female-headed households have poor or borderline food consumption compared to 49.5% in male-headed households indicating greater vulnerability to food shortages. According to the results of 2017 Standardised Expanded Nutrition Surveys (SENS) among the refugee population, the overall nutrition situation remains poor. Global Acute Malnutrition (GAM) prevalence ranged from 2.8% in Ajoung Thok to 8.2% in Pamir in 2017 with an average of 6.2% among the surveyed refugee population. Although below the 15% WHO emergency threshold, the 6.2% prevalence indicates a poor nutrition situation. This, however, has improved in 2017 as compared to the situation in 2015 where the average GAM prevalence was 11%. The improvement of the average GAM prevalence reduction can be possibly attributed in part to the maintenance and strengthening of the Community based Management of Acute Malnutrition (CMAM) and the prevention of malnutrition initiatives in place. Total anaemia prevalence among children aged 6-59 months at the end of 2017 was 48%, while anaemia among young children aged 6-23 months reported ranged between 58.1% - 78.1% which is categorised as high public health significance according to WHO classification. Although this improved slightly compared to 2015, the high levels remains of concern. The prevalence of global stunting was 44%, which is categorised as critical according to WHO classification. The later remained the same as that in 2015. Timely initiation of breastfeeding was practiced by majority of lactating women in 2017, which also improved compared to 2015. The timely introduction of complementary feeding from 6 months however, remained low, with only 52.8% of children introduced to complementary feeding in a timely manner. The high prevalence of anaemia and stunting can be attributed to a number of factors that characterise the refugee population including a diet poor in micronutrients and inadequate macronutrients, frequent infections and sub optimal child care and feeding practices among others. A strategy to address anaemia and other micronutrient deficiencies was developed in 2017. Several of the planned interventions are already in place but the entire strategy is yet to be fully funded to ensure a complete roll out. Continued promotion of appropriate IYCF practices and optimal feeding of children is essential for the reduction of chronic malnutrition. Maintaining the current treatment-based service provision for the management of acute malnutrition is likely to ensure that the nutrition situation does not deteriorate. The JAM recommends strengthening and expanding malnutrition prevention in an integrated manner, to tackle the root causes of malnutrition through a more holistic approach that includes all the complementary sectors (livelihoods, WASH, shelter and health). Refugees have access to primary health care services, which are provided at the refugee camps or at government health facilities. Improvement of health seeking behaviour is supported by a comprehensive community health programme that focuses on health, nutrition, HIV/AIDS, water, sanitation and hygiene promotion. Mortality trend monitoring using the UNHCR Health Information System (HIS) at the end of 2017 indicated that mortality rates were below the emergency threshold of 2/10000/day for under five Death Rate (U5DR) and 1/10000/day for Crude Death Rate (CDR). Diarrhoea, malaria, respiratory tract infections, skin diseases, eye diseases, and intestinal worms remain the top morbidities seen in the refugee camps/settlements. These are all linked to the environment, the shelter situation and WASH practices in the camps and are likely to affect the nutrition situation negatively. This highlights the importance of multi-sectoral interventions to address health, WASH, shelter and nutrition issues. Camp populations remain vulnerable to disease outbreaks as a result of congestion, cross-border movements, and frequent outbreaks affecting the rest of the country. The end of 2017 WASH reports noted that the average individual water consumption among the refugee population met the SPHERE minimum standards of ≥15l/p/d, but only 50% met the UNHCR standards of ≥20l/p/d. All refugees reported spending less than 30 minutes to collect their water. Since 2016, potable water accessibility has generally improved through the introduction of innovations such as solarisation of boreholes and upgrading (solar/generator) hybrid systems. Water needs for uses other than domestic water use has increased in the camps. This is linked to livelihood and environmental activities such as kitchen gardens and brick-making. Sanitation and hygiene promotion in the refugee camps remains a work in progress. Approximately 77% of refugees had access to a drop-hole latrine by the end of 2017. The crude latrine coverage ranged from 6 to 20 people/latrine drop hole. Soap provision by UNHCR has been below standard since the last JAM. Refugees receive 250g of multi-purpose soap per month instead of 500g. Refugees reported selling part of their GFD in order to purchase it from the local markets. Sustainable livelihood and self-sustainability opportunities remain a challenge for refugees in South Sudan. This is exacerbated by the current context of insecurity and civil war. Farming remains the most viable option for promoting self-reliance. Refugees have access to some land for farming and are provided with the seeds and tools necessary to utilise the land. The demand for agricultural land, far outstrips allocation. Agricultural output is further limited by harsh climatic conditions, limited access to irrigation water, poor post-harvest techniques and diminishing soil fertility. Insecurity surrounding the camps hampers secure access to land for cultivation, making women and girls especially vulnerable to harassment and rape. Kitchen gardening among refugees is rain fed and limited to the planting season when agencies provide farm inputs for cultivation. Agriculture production should be intensified and integrated into wider nutrition, health and other livelihoods programmes. Some refugees have received skills trainings through the various NGO vocational training centres but opportunities to fully exploit the skills acquired is limited by insecurity, market saturation, lack of start-up capital and high inflation. There is poor or non-existent formal access to loans/start-up capital to begin or expand a small business and widespread poverty in the areas where camps are located. This negatively impacts sustainability of business enterprises. Furthermore, poor employment opportunities in the camp and surrounding areas fuel tensions between host and refugee communities, with negative perception amongst host communities that refugees receive preferential treatment when it comes to jobs in the camps. The major source of cash income for the refugees living in the camps remains firewood collection (risky business done largely by women and girls). Based on data analysis during the JAM, it appears that refugees in South Sudan are unable to adequately meet the food gap based on agriculture alone and the other limited non-agricultural livelihood support such as entrepreneurship and microfinance. Deforestation in and around the camps was noted as a major concern during the JAM. This is largely a result of burgeoning population (in and out of the camps) and its over-reliance on natural resources for fuel, construction and as a source of income (in the form of wood and charcoal). Refugees in all camps/settlements are increasingly having to buy firewood and/or charcoal due to the limited availability of firewood in the forests and the limited access to it due to insecurity. It was noticed that low utilisation of fuel-efficient cooking methods are being used by refugees. Majority of refugees use fuel in-efficient open three-stone fire for cooking. The adoption of energy-saving stoves interventions over the years has been relatively low. Better understanding on context-specific causes of the low adoption and utilisation of alreadydistributed stoves needs to be established. This is to guide the introduction of locallyappropriate fuel efficient stoves. Refugees in South Sudan are at risk of protection violations by virtue of their refugee status, especially girls and women. As with all other aspects of refugee life in South Sudan, this is heightened by the prevailing context of insecurity in and around the areas where refugees live. SGBV results from deeply rooted, pervasive and harmful gender inequalities both at country of origin and in South Sudan. This is further accentuated by poverty and limited livelihood opportunities, insufficient nearby access to firewood and cultivatable land near the refugee camps/settlements, poor camp-level lighting, militarisation of the camps and surrounding areas. Early marriage of adolescent girls is common across the camps with high rates of adolescent pregnancies which invariably causes girls to drop out of school. Support from social networks that used to exist in countries of origin have been weakened as a result of displacement. Refugees reported limited capacity and willingness to assist each other in a context where everyone struggles to sustain his/her own family. Persons with Specific Needs (PSNs) including the elderly are among the most vulnerable people in the refugee camps/settlement. Their ability to fill the 30% food assistance gap was noted to be quite often impossible. Girl’s enrolment and retention in school remains suboptimal. Lack of school feeding was raised as one of the primary reasons for absenteeism, along with the shortage of school supplies, distance to school and infrequent distribution of sanitary ware. Discussions with refugees indicated that children were more likely to start missing school in the third week of the ration cycle, when food stocks started to dwindle at the household level. An independent parentteacher-driven school feeding initiative in Makpandu appears to allow better school retention. The possibility of implementing this in other schools was proposed. For new arrivals to South Sudan, a one-time standard NFI kit comprised of emergency shelter and basic core relief items is provided by UNHCR. There is infrequent NFI replenishment, with some refugees in Gorom refugee camp citing distributions of certain NFIs as far back as a decade ago. Due to resource constraints, UNHCR has adopted a targeted approach, responding to the needs of the most vulnerable first. Longer-term/protracted refugees that are not categorised as PSNs are, therefore, rarely able to qualify for NFI replenishment despite their status not necessarily equating to improved self-sufficiency and the ability to procure NFIs. Gaps in the provision of NFIs continue to oblige refugees to compromise their food purchases and consumption at the expense of non-food items. The potential monetisation of certain NFI commodities through cash based interventions may ease the pressure on food at the household level by preventing the sale of the GFD to fill the gap. Since the last JAM in 2015, widespread conflict, insecurity, and militarisation of the areas where the camps are located has posed great challenges to refugees, humanitarian agencies and partners providing services in the various refugee locations. High staff turn-over, as a result of insecurity and the remoteness of the camps, has resulted in institutional memory loss and low morale among staff delivering services in the challenging operational context. At the country level, some key staff positions are not filled in a timely fashion which negatively affects the implementation timelines. Insecurity and limited access have sporadically hampered food distributions and have at times led to pipeline breaks.