Sudan observed the first case of COVID19 on March 14, and on March 16 the Security and Defense Council declared a state of health emergency in all parts of the country.** To this date, Sudan has been noted as the country with most registered cases (9,767) in Eastern Africa** and by the end of June the number of deaths came to 608.
All land borders have been closed since March 16, and the airport continuous to be closed for all international and domestic passenger flights until 12 July 2020. Internal state travels and issue of travel permits have been suspended, with the main bridges linking Omdurman and Khartoum North closed. There are partial lockdowns in most of the 18 states, but in Khartoum state more strict measures have been taken with people only being allowed to access neighborhood shops, bakeries and pharmacies between 06:00 and 15:00 with curfew in the remaining hours. In addition, the Ministry of Awqaf (Religious Endowments) has suspended prayers in mosques and church services in the state during the lockdown period. All schools are closed with a total of 8,375,193 students affected.
The capacity of Sudan’s health systems is very weak. Availability of medicine is at 43% (this is far lower in Red Sea and Northern States) and only 24% of health facilities offer the complete basic healthcare package. COVID19 surveillance system and monitoring capacity covers less than 40% of the health facilities nationwide. Moreover, there is a lack of isolation units, intensive care units, and infection control supplies, and with the COVID19 outbreak the system has been severely depleted, with access to lifesaving Sexual Reproductive Health (SRH) services vastly impacted. This directly impacts SRH parameters such as Maternal Mortality Rates (MMR), antenatal care (ANC), postnatal care (PNC), contraceptive prevalence (CPR), emergency obstetric care (EMONC) and primary health care (PHC) service coverage which were already operating under limited capacity pre-pandemic. Furthermore, the provision of all other primary health care services has been significantly reduced as a precautionary measure to contain the spread and as resources are diverted to cover the COVID19 response. As a result, the ANCs services were interrupted, and adversely impacted the detection of the ‘at risk’ pregnancies. This limited access to ANC services observed an increase in cases of rupture uterus. Other SRH services were also interrupted as a result of temporary suspension of the PHC services, such as family planning and STI management and critical lifesaving services like the Clinical Management of Rape (CMR) services for survivors of Gender Based Violence (GBV).
The dearth of GBV data and information remains a challenge across Sudan. However, the extent of GBV risks is present across the country. Prior to the pandemic it was estimated that a total number of 45,408 survivors of sexual violence would seek care during 2020 with 34% of women and girls aged 15-49 years being subjected to domestic violence4. Due to reporting stigma, it is hard to get precise data while observing trends GBV is expected to increase by roughly 50% including an estimate of 325,000 of unintended pregnancies.
Women and girls are particularly vulnerable to violence and a 2018 study from Darfur found that 80% of the women interviewed in Darfur identified domestic violence as a problem. The COVID19 pandemic is likely to undermine efforts to end GBV as a result of reduced prevention and protection efforts, social services and care. This includes affecting the efforts to end harmful social practices like Female Genital Mutilation/Cutting (FGM/C) and Child marriage.
GBV survivors may experience challenges accessing services due to movement and access constraints, or resources being diverted to the health interventions. The potential loss of household income may have a long-term economic impact on women, especially women working in informal sectors, and may increase the risk of exploitation and sexual violence. Financial challenges due to limited livelihood opportunities during the outbreak may increase tensions in households, which may fuel domestic violence and other forms of GBV. Furthermore, the closure of schools may expose girls to additional caregiving roles, which may also expose them to COVID-19 infection.
Other vulnerabilities are also present in the country, affecting such as 1.87 million IDPs and 1.1 million refugees, asylum seekers and an unknown number of returnees and IDPs in SPLM-N controlled areas of South Kordofan and Blue Nile States. About 300,000 of the 1.1 million refugees live in crowded settlements and for those, including the urban poor, physical distancing is simply not feasible. Additionally, there are inadequate water and sanitation services, pre-existing protection challenges and a high risk for loss of livelihoods and general interruption in basic services. The capacity for intensive care management and referral mechanisms in these settlements is weak due to resource constraints and can be aggravated by the remoteness posing communications and logistics challenges.
All in all, the COVID19 outbreak has exacerbated an already fragile situation characterized economic crisis, protracted conflicts, displacement, hazards and a lack of basic services and life-saving services services incl. protection services.
The COVID19 pandemic will have a negative impact of the three transformative results UNFPA aims to achieve by 2030: 1) the ending of preventable maternal deaths, 2) the ending of unmet need for family planning and 3) the ending of GBV and all harmful practices.
UNFPA Sudan is addressing some of these challenges for the COVID19 response, through 5 strategic priorities.
1) Continuity of sexual and reproductive health services and interventions; 2) Addressing gender-based violence (continuity and adaptation of GBV services and GBV prevention and mitigation measures); 3) Risk Communication and ensuring protection of the health workforce; 4) Specific Covid-19 interventions for IDPs, refugees, migrants; 5) Priority: Youth engagement through outreach Strategies and leave no-one behind.