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20[1] 2012 in review | needs analysisUnited Nations and PartnersSUDAN WORK PLAN 2012characterized by relatively low health indicators, poor infrastructureand severe limitations in human and financial resources.Access to, and coverage of, basic health care is poor in Sudan.The density of health care falls within the critical shortage zoneat 1.2 medical staff per 1,000 people, with areas affected byconflict and seasonal emergencies having fewer medical staffaccording to the World Health Organization (WHO). Limitedcapacity among health care providers also represents a seriousshortfall in the sector, including limited attention to improvinginfant and young child feeding practices.The low levels of maternal and child health care provisionremains alarming in many areas of Sudan, particularly in Darfur,South Kordofan and Blue Nile. According to the Health Sector,24.1% of women giving birth did not have access to medicalconsultation. Only 46.5% of women give birth attended by askilled birth attendant. Meanwhile, according to the WHO,the under-five mortality rate is 79 per 1,000 live births. Thepercentage of children fully immunized between the ages of12-23 months in Sudan is 49.4%.Several disease outbreaks were reported during the first halfof 2012, including outbreaks of diphtheria and meningitis inDarfur. While humanitarian actors were able to respond tocontain the outbreak, and vaccination coverage remains relativelyhigh throughout Sudan, improved disease prevention,surveillance and response is required to safeguard publichealth.Humanitarian organizations play a vital role ensuring peoplein need have access to primary health care (PHC) in Darfur.Approximately 50% of health staff in Darfur is provided byhumanitarian organizations. However, the pull out of severalhealth INGOs in Darfur over the last two years has createdsignificant gaps in access to health services. For example, in2012, two INGOs pulled out of West Darfur and transferred 33health facilities to the Government, placing further strain onthe already over-stretched public health services. Building thecapacity of national health actors is critical but often hamperedby difficulties in maintaining a supply-chain of drugs and otheressential medical supplies.Water and SanitationAccess to safe water continues to pose a significant challengein conflict-affected areas due to low investment in waterinfrastructure, inadequate maintenance, population increasesleading to unsustainable water usage practices and depletionsof acquifers as well as insecurity. During 2012, a shortage ofwater supply has been observed in some major IDP camps asthe camps have grown beyond the initial design and the waternetworks are no longer able to meet the current need.Critical water, sanitation and hygiene (WASH) service gapshave been reported in many returnee areas and rural communitiesin Darfur due to low rainfall last year. The prolongeddrought in parts of Darfur has led to a drastic decline in waterlevels of many water sources. To compensate, many camps arerelying on increased use of motorized water sources that areoften susceptible to technical problems. Critical WASH gapshave also been reported in places of new displacement inSouth Kordofan and Blue Nile.Access to sanitation and hygiene also remains a seriousconcern. Access to basic sanitation in rural areas has notincreased during 2012 primarily due to weak funding andinsecurity affecting access. Poor hygiene practices due to lackof awareness persist, including open defecation, improperuse and maintenance of latrines, lack of hand washing andinappropriate water collection and storage. This underlinesa continued urgent need for hygiene-promotion awareness,particularly in light of the high prevalence and risk of hygienerelateddiseases.Protection, Displacement and ReturnsMany vulnerable people in Sudan continue to require protectionassistance. Continued fighting and displacement duringthe first half of 2012 has continued to place women, girls, boysand men directly at risk of becoming victims of the conflict.Security continues to be an issue, not just from the conflict, butalso as a result of banditry, inter-tribal fighting and criminality.The need to increase protection activities for people of SouthSudanese origin currently in Sudan has significantly increased.For those wishing to stay in Sudan, there are protection relatedconcerns, as well as their rights to secure their residency, citizenshipand access to basic services. There is, however, expectationthat Governments of Sudan and South Sudan will sign anagreement of the four freedoms. For those wanting to returnto South Sudan, there are concerns over their ability to returnin safety and dignity. Further, there has been minimal publicdissemination of information related to upcoming deadlinesand registration procedures by local authorities. Many peopleof South Sudanse origin are equally not aware of the stepsrequired to acquire the necessary documentation for them tostay or return.Due to the limited options for return and the increasinglyexposed environment for the South Sudanese population,there is a continuing need to advocate for both governmentsto ensure the protection and welfare of people of South Sudaneseorigin in Sudan and Sudanese in South Sudan, and toopen safe corridors for those wishing to return to be able todo so.In Darfur, returnees have often faced significant challenges,including a lack of basic services in return areas, disagreementsover land ownership in some cases and lack of rule of lawinstitutions, such as the presence of police. The lack of basicservices provided by the Government of Sudan remains one ofthe key areas to be addressed to promote durable solutions.There is therefore a need to work with the Government andother sectors to ensure that those returning are provided withadequate levels of assistance and reintegration as required inorder for returns to be sustainable. Continuing support andmonitoring of the refugee population in eastern Sudan isrequired given further asylum seekers/refugee arrivals.