Introduction
Sudan is the largest country in Africa and the tenth largest country in the world by land area. The entirety of the United States east of the Mississippi would fit within Sudan’s borders. As the gateway to the Middle East from the Horn of African, Sudan has a rich history as a crossroads of cultures, though its contemporary history is one of civil war and bloodshed.

Sudan is well known for its diverse languages, particularly in the south.  There are 134 languages spoken in Sudan, more than 500 dialects (with an additional 8 extinct tongues), and 597 ethnic sub-groups The population as of 2006 is estimated at nearly 40 million, though a census has not been performed in over a decade and millions of Sudanese have fled Sudan to border countries due to regional violence (Sudan is bordered by Egypt, Eritrea, Ethiopia, Kenya, Uganda, Democratic Republic of the Congo, Central African Republic, Chad, and Libya.)  While a fragile peace exists today between Southern Sudan and the North, violence still continues in the Western area of Darfur.

History: Colonial Rule and a Divided Sudan
From 1899 until Sudan’s independence in 1956, Britain and Egypt administered all of present Sudan.  Within two decades of colonization, Northern and Southern Sudan were administered as separate colonies with restricted movement between the two regions.

In 1924, Britain passed closed district ordinances that required passports to travel between the North and the South. English was the official language of the South, while in the North both Arabic and English were used. Islam was discouraged in the South where Christian missionaries were encouraged to work and convert from local tribes, including the Dinka, Bari, Nuer, Latuko, Shilluk, Azande and Pari (Lafon).  Colonial governors of South Sudan attended colonial conferences in East Africa, not in the northern capital of Khartoum. The British hoped to add Southern Sudan to their East African colonies, while at the same time they focused on developing the economy and infrastructure of the North.  Therefore, Southern political arrangements were left largely as they had been prior to the arrival of the British. 

In order to establish their authority in the North, the British promoted the power of Sayyid Ali al-Mirghani, the head of the Khatmiyya sect, and Sayyid Abd al-Rahman al-Mahdi, the head of the Ansar sect. The Ansar sect evolved into the Umma party, and Khatmiyya became the Democratic Unionist Party Sudan.  In February, 1953, Britain and Egypt signed an agreement providing for Sudanese self-government and self-determination. The transitional period toward independence began with the inauguration of the first parliament in 1954. With the consent of the British and Egyptian governments, Sudan achieved independence on January 1,1956, under a provisional constitution. However, the Arab-led Khartoum government reneged on promises to southerners to create a federal system, which led to a mutiny by southern army officers that sparked seventeen years of civil war from1955 to1972. A tenuous truce from 1972 to 1983 dissolved into a second civil war that raged from 1983 until 2005.

History: Civil War
The Sudan war is reported to have been the longest civil war in the world and is rooted in ethnic, racial and religious differences, intensified by colonization.  Competition over oil and land has only intensified it.

In 1972, a cessation of the civil war was brokered under the term of the Addis Ababa Agreement, following talks that were sponsored by the World Council of Churches.  This led to a ten-year hiatus in the national conflict.  In 1983, the civil war was reignited following President Gaafar Nimeiry’s decision to circumvent the Addis Ababa Agreement and the establishment of the Sudan People’s Liberation Army (SPLA).  (The SPLA is also referred to as the Sudan People’s Liberation Movement: SPLM.) The SPLA was lead by Dr. John Garang and engaged in a bloody arms struggle with the mainly Christian black African people of Southern Sudan to reject the sectarian and Islamist Northern administration that was dominated by a clique of Muslims who ruled the country under restrictive Sharia law. Violence again returned to southern Sudan.

Peace talks between the Southern rebels and the government made substantial progress in 2003, and then in early 2004 and armistice was consolidated with the official signing by both sides of the Nairobi Comprehensive Agreement.  The agreement granted the Southerners self autonomy and allowed the North and the South to split oil revenues equally, and in addition left the northern and southern armies in place. Eventually, when a Comprehensive Peace Agreement was signed in Kenya in 2005 between the official Sudanese government and the SPLA, it provided greater autonomy to Southern Sudan along with a promise of general elections in 2009 and a referendum on southern cessation scheduled for 2011. 

Impact of Civil War on Health
Southern Sudanese people currently suffer from a lasting legacy of war that has made many negative social, economic, political and cultural impacts – most strikingly around health and well being.  The immediate effect of limited food, water and sanitation, coupled with the destruction of the health care infrastructure, has enabled preventable diseases such as typhoid, cholera, and malaria to claim many lives in Sudan and among the displaced communities who have been forced to leave their country. Long-term health impacts, including the physical and psychological effects of post-traumatic stress and the spread of sexually transmitted diseases such as HIV/AIDS, are also serious problems that have for too long gone unrecognized and unaddressed. 

In addition, while Sudan has the highest rate of urbanization in the African Saharan, there has been widespread displacement caused by the ongoing civil war. The pattern of political instability, poor programming, and lack of accountability have exacerbated the rural to urban exodus. This has lead to a state of severe poverty and inadequacy of common basic food, shelter, clothing, and education. Over 90% of the Sudanese population lies under poverty line. More troubling, recent research indicates that the trend of poverty is apparently increasing.

Sudan is one of the poorest countries in the world, with a report of the Committee on Eradication of Poverty publishing in Al-Ayam daily newspaper in 2000 that 48% of population die before the age of 40, 30% have no accesses to health services, 60% have no healthy drinking water and 34% of children under 5 years are underweight.  The humanitarian needs in this conflict-affected region include limited and inadequately equipped and supplied health facilities.  Children’s vulnerability to epidemic diseases due to limited Eradication of Poverty Index (EPI) coverage sends a disturbing message and mortality is high due to risk of epidemics. In addition, education is seriously disrupted, where a whole generation of children has been deprived of schooling, in particular in the Southern part of the country.  In SPLA controlled areas, maternal and child mortality are very high due to poor quality of traditional birth attendants as well as high prevalence of sexually transmitted infections owing to the wide spread of rape incidences.

Sudanese Diaspora
Until 2005, the most pronounced and devastating affects were felt throughout the South, leading to the deaths of over 2 million men, women and children and the internal displacement and international migration of over 4 million Sudanese.

Currently, over 500,000 Sudanese men and women have been forced to live outside of the Sudan in transitional refugee camps; neighboring parts of Kenya, Uganda, Chad and Egypt, countries of the Middle East such as Lebanon and Syria, and in western countries of UN refugee resettlement such as the United Kingdom, Australia, Canada, and the United States. Indeed, the U.S. has emerged as one of the largest receiver countries for Sudanese refugees. Washington State has been receiving refugees from southern Sudan for over a decade and communities of between 700 and 1000 Sudanese men and women have settled throughout the State. Sudanese immigrants in the United States bring great diversity and richness to U.S. society and contribute to the country’s overall economic and social wealth. However, the health issues that affect those who remain living in and around Sudan do not always escape those who leave as refugees. New arrivals to the U.S. are often without the family community network of support and unable to access health care and social services. HAH-S aims to address these urgent needs in the post-conflict era, both in Sudan and among the diaspora.

HAH-S Operations
In the U.S., HAH-S efforts are currently focused on the Southern Sudanese community living in King County (Seattle and Puget Sound environs) with eventual plans to expand to other areas in the U.S. where large populations reside such as the Northeast.  

©2007 Washington State Association of Counties

In Southern Sudan, our work will initially focus on rural Kajo Keji County, birthplace of HAH-S cofounder Harriet Dumba.  Harriet has already set in place much of the support needed in order to implement reproductive health workshops in this area as well as in Torit and Bor, other rural Southern Sudanese counties. 

Counties of Southern Sudan

Kejo Keji is located on the southern border with Uganda and covers an area of roughly of 113,000 square kilometers.  Nearly all of its inhabitants are peasant farmers and speak a local dialect Kuku. The local citizens are called Kuku and are also known as the Bari speakers in a larger context.  Bari speakers make up 20% of the state population.