A/HRC/40/CRP.1 level of care, only 20 percent of people can reach a hospital within 24 hours. 259 Even where health care is accessible, many rely on volunteer health care workers with limited training beyond treating basic illnesses.260 Despite the need for investment by the Government in health care, the 2018/2019 budget only allocated 2.2 percent of expenditures to health as compared to almost 20 percent on security spending (see Figure 1 above).261 Approximately 80 percent of the health care in South Sudan is provided by NGOs. 262 One of the factors behind the large number of non-functional health care facilities has been the high level of attacks on health care workers and facilities. In 2017, there were at least 37 events that affected health care, including 20 attacks on health workers and 11 on health facilities.263 Eleven health facilities were looted, two totally destroyed, and three damaged. With respect to attacks on health care workers, 12 were killed, six were kidnapped, 11 injured or assaulted, six arrested, and there were three instances of health workers being threatened or intimidated.264 Such attacks have continued in 2018. For example, on 23 July, a group of men broke into the Médecins sans frontières (MSF) office and compound in Maban, Upper Nile and looted the organization’s and staff’s property, burned down a tent full of equipment and destroyed most of the vehicles and communication devices.265 As a result, MSF temporarily suspended most of its services in Maban. South Sudan is obliged under CEDAW to ensure access to health services for all women, including reproductive health. 266 Women and girls continue to be affected disproportionally by the lack of access to health care. This is even more critical due to the high level of gender and sexual violence and the high mortality rate associated with pregnancy and birth in the country. Early marriage contributes to violations of the right of health as it puts girls at greater risk of death or ill-health as a result of early pregnancy and childbirth. Their children also face higher mortality rates. More generally, security and structural barriers impede women’s access to maternal healthcare services. Some reasons are directly linked to the conflict, relating mainly to security concerns, but others are structural and relate to the availability, quality of care provided, and associated costs, especially in public health facilities. Traditional social norms also contribute to some women being hesitant to seek pregnancy related health care. 267 b) Mental Health The conflict has also taken a serious toll on mental health in South Sudan. A study on the mental health situation in South Sudan after the first year of the conflict found that almost 41 percent of people surveyed exhibited symptoms of probable post-traumatic stress disorder (PTSD).268 This number can be expected to have increased over the following years of the conflict as more people have witnessed and experienced traumatic incidents. Indeed, MSF documented more than 51,500 people seeking psychosocial support in 2017, a 35 percent increase from 2016.269 Examples of traumatic incidents included having a child abducted, a ICRC, “Facts and Figures: South Sudan, January – June 2018”. Watchlist on Children and Armed Conflict, “Everyone and Everything Is a Target”, 2018. 261 Republic of South Sudan, Ministry of Finance and Planning, FY: 2018/2019 Approved Budget. The Security entry of the budget makes up 19.5 percent of the budget, but when the Police budget is added to that, it is accounts for 22 percent of the budget. 262 OCHA, 2018 Humanitarian Needs Overview: South Sudan, November 2017. 263 Safeguarding Health in Conflict, “Violence on the Frontline, Attacks on Health Care in 2017”, May 2018. 264 Safeguarding Health in Conflict, “Violence on the Frontline, Attacks on Health Care in 2017”, May 2018. 265 MSF, “South Sudan: MSF suspends most medical activities in Maban after attack”, 24 July 2018. 266 Convention on the Elimination of All Forms of Discrimination against Women, Article 12. 267 Human Rights Watch, “This old Man Can Feed Us, You will Marry Him”, Child and Forced Marriage in South Sudan”, 2013; Mugo et al., “‘The system here isn’t on patient’s side’ – perspectives of women and men on the barriers to accessing and utilizing maternal healthcare services on South Sudan”, BMC Health Services Research, 2018, 18:10; Gee et al., “‘We need good nutrition but we do not have money to buy food’: sociocultural context, care experiences, and newborn health in two UNHCRsupported camps in South Sudan”, BMC International Health and Human Rights, 2018, 18:40; Kane et al., “Too afraid to go: fears of dignity violations as reasons for non-use of maternal health services in South Sudan, Reproductive Health”, 2018, 15:51; G. Vincent and F. M. Alemu, “Factors contributing to, and effects of, teenage pregnancy in Juba”, South Sudan Medical Journal, Vol. 9, No. 2. May 2016, pp. 28-31. 268 Lauren C Ng, Belkys López, Matthew F. Pritchard, David Deng, “Posttraumatic stress disorder, trauma, and reconciliation in South Sudan”, Social Psychiatry and Psychiatric Epidemiology, 2017. 269 Mednick, S., “South Sudan: ‘The whole country is traumatised’”, IRIN, 21 January 2019. 259 260 38