There is great diversity and change within communities and people do not fit into a pre-determined and unchanging cultural box or stereotype. The information presented here will not apply to all people from Sudan† in Australia and this profile should be considered as guidance only. For example, while the 2011 Census provides useful and reliable data on a large number of characteristics, the dynamic nature of the communities means that important demographic changes may have occurred since 2011.

Key things to know:  There are important differences  Most Sudanese asylum seekers and between communities from Sudan refugees in Australia identify as and , which became South Sudanese, but people from independent from Sudan in 2011 Sudan may also have a history of after years of civil war.‡ trauma and displacement.i  The most common language  People from Sudan may be spoken in Sudan is Sudanese unfamiliar with the Australian Arabic. Sudanese Arabic is different health system. to standard Arabic. Dinka is more  Sudan-born people may wish to commonly spoken in South Sudan. take traditional medicines to help  It is very important to provide an them recover from some illnesses. interpreter when needed, and to  Make sure patients feel make sure the interpreter speaks comfortable to ask questions the right language. People who about their treatment if needed. speak Sudanese Arabic may not be  People from Sudan, especially able to communicate with a women, may prefer to be seen by standard Arabic interpreter. health staff of the same gender.  The most common religion in  Cost of services or treatments may Sudan is Islam. Christianity and be a concern for Sudan-born indigenous beliefs are more people. Make sure patients know common in South Sudan. about out-of-pocket costs up front.

For an interpreter, call 131 450 for the Translating and Interpreting Service (TIS). If you don’t know your TIS client code, contact the Multicultural Health Policy Unit by phone on (02) 6205 1011 or email at [email protected].

† Excludes people born in South Sudan (3,486 people in Australia in 2011),i although country of birth figures as completed by individuals at the time of the 2011 Census may not fully reflect Sudanese or South Sudanese affiliations, given South Sudan’s independence in the same year.† ‡ More information about South Sudan can be found in the ACT Health Community Profile – South Sudan.

Sudan

2011 Census data: Sudan-born people Population (Australia): 19,369 peopleii Population (ACT): 364 peopleii Gender ratio (Australia): 103.2 males per 100 femalesiii Median age (Australia): The median age of Sudan-born people was 28 years compared with 45 years for all overseas-born peopleiii and 37 years for the total Australian population.iv

Age distribution of Sudan-born people (ACT, Sudan -born arrivals, past five yearsv 2011):iii Age (years) Number Per cent Year Australia ACT 0-19 73 20 2009 868 16 20-39 197 54 2010 643 18 40-59 79 22 2011 598 21 60+ 13 4 2012 347 8 2013 523 5 Migration history Sudan’s first civil war began shortly after While the population of Sudan predominately independence from joint British-Egyptian descends from both indigenous African groups administration in 1956 and continued until 1972. and Arabs, today (post-South Sudanese A second civil war broke out in 1983 and independence) Arab culture predominates.xii continued until 2005.vi,vii Language Sudan also experienced major famines largely as Arabic and English are the official languages of a result of extended periods of drought in the Sudan, and most people speak Arabic. Sudanese 1980s and 1990s.viii War and famine combined Arabic is a distinct dialect to other forms of are estimated to have caused almost two million Arabic. Other languages, such as Nubian, Ta deaths and four million displaced people.ix Bedawie and Fur, are also spoken.xiii,xiv Large numbers of Sudan-born refugees have fled to neighbouring countries, and many were Religion resettled in Australia. Before 2001, Sudan-born The vast majority of Sudanese people are Sunni people arriving in Australia were mainly skilled Muslim (97%), with a small proportion of migrants. By 2001, when the Census recorded Christians.xv 4,910 Sudan-born people in Australia, more than 98 per cent had arrived under the Humanitarian Ancestry, language and religion Program. in the ACT (2011 Census data)ii Arrivals to Australia peaked between 2002 and Please note: 2011 Census data is reported by 2007. South Sudan gained independence from country of birth, but this may not reflect Sudan on 9 July 2011.x community affiliations given the recent establishment of South Sudan. For example, Ethnicity Sudan-born people who are Christian and/or The concept of ethnicity in Sudan is complex and speak Dinka at home may identify as South is often based on cultural affiliations. There are Sudanese, although their country of birth (at the many different ethnic and tribal groups in time of their birth) was Sudan and is reported as Sudan.xi such.

Sudan

The most common ancestry responses§ of Communication and respect Sudan-born people in the ACT were: If an Arabic interpreter is needed for a Sudanese Ancestry Percentage of Australian person, a Sudanese Arabic interpreter population should usually be arranged. The Sudanese Arabic Sudanese 51 dialect is distinct and the person may not African, so described 11 understand an interpreter using another Arabic xvi South Sudanese 7 dialect. Arab, not further defined 5 There may be a reluctance of Muslim men and Peoples of the Sudan, nfd 5 women from Sudan to shake hands with An additional 71 people in the ACT, who were members of the opposite gender outside their not born in Sudan, identified Sudanese ancestry; family. Sudanese women often prefer to be xvii and an additional 23 people identified ancestry treated by female health care providers. as peoples of the Sudan (nfd/nec). Members of the same family may appear to have The most common languages spoken at home by different surnames in Australia as a result of the Sudan-born people in the ACT were: recording of names during immigration. In Sudan, family names are silent and, as a result, Language Percentage of many Sudanese will have their population middle name recorded as their surname on Arabic 49 official documents.xviii Dinka* 33 English 7 Health in Australia African languages, nfd 2 In 2012, average life expectancy in Sudan was 63 African languages, nec 2 years (61 years for males, 65 years for females) *There may be significant differences in accent compared to 83 years for the total Australian and vocabulary among Dinka speakers. population (81 years for males, 85 years for females).xix Sudan-born people in the ACT spoke English at the following levels of proficiency: Current research on common health issues for people in Australia from Sudan specifically (as Proficiency Percentage of opposed to South Sudan) is rare. The following population information may be more applicable to people Very well 39 from South Sudan rather than Sudan, and should Well 33 be used as a guide only. Not well 15 Not at all 1 In a study of common medical conditions Not stated/not applicable 12 diagnosed in newly arrived African refugees in , the major health issues included a The most common religions of Sudan-born lack of immunity to common vaccine- people in the ACT were: preventable diseases, vitamin D deficiency, Religion Percentage of infectious diseases (such as gastrointestinal population infections, schistosomiasis and latent Anglican Church of Australia 34 tuberculosis) and dental issues. Musculoskeletal and psychological problems were common in Islam 28 xx Western Catholic 14 adults. Coptic Orthodox Church 5 Presbyterian 4

§ At the 2011 Census, up to two responses per person were allowed for the ancestry question. These figures represent people that identified the given ancestry in either response.

Sudan

A Western Australian infectious disease Female genital cutting (FGC), also known as screening study of over 2000 refugees and female genital mutilation (FGM) or female humanitarian entrants in 2003-2004 also circumcision,xxvii is known to occur in Sudan. reported a high prevalence of infectious diseases However, not all women from Sudan will have in people from sub-Saharan Africa including undergone this practice. hepatitis B, syphilis, malaria, intestinal infections The term FGC comprises procedures that involve (including giardia, schistosomiasis, hookworm partial or total removal of the external female and strongyloidiasis), and tuberculosis.xxi genitalia, or other injury to the female genital Other health concerns for Sudanese refugees organs (such as small cuts or nicks) for include complications of broken bones and other non-medical reasons.xxviii injuries that have occurred as a consequence of FGC can affect women’s reproductive health, torture, flight or accident. Common health although some women who have undergone the concerns in women include the physical and practice do not experience complications. psychological consequences of rape, menstrual Impacts of FGC can include complications in problems and pelvic pain. Women may have not pregnancy and childbirth, difficulties with had any preventive screening such as Pap tests, menstruation and urination, pain during sexual breast examination or mammography.xxii intercourse, chronic infections, and damage to Sudanese refugees settling in Australia have the reproductive system, including infertility.xxix been shown to have high rates of depression, FGC may also have psychological and mental anxiety and post traumatic stress disorder. health impacts such as anxiety, depression However, many Sudanese Australians may report phobias and post-traumatic stress disorder more concern about current stressors such as xxx (PTSD). Women should be forewarned and well employment, housing and transport than past prepared around any interventions that involve trauma.xxiii this area of their bodies. Health beliefs and practices Many women prefer the term ‘female genital Sudanese refugees may be unfamiliar with a cutting,’ as ‘female genital mutilation’ can be formal health system, Australian medical seen as offensive or stigmatising.xxxi It may be practices or being treated by a doctor of the appropriate to ask questions such as, “I opposite gender.xxiv understand that female circumcision happens in your country – have you ever been cut down Traditional medicine is widely practised in Sudan there?” or “Are you closed/open?” and has roots in Islamic and West African medicine. There is wide experience with the use It is illegal to undertake FGC in Australia.xxxii of herbal medicines, which are an integral part of Health providers should notify Care and the health care system. Many families specialise Protection Services (CPS) if you have concerns in herbal medicines and this knowledge is passed that a female child is at risk of FGC, following the on from one generation to another. Patients may ACT Health Child Protection Policy and Children travel to different regions to consult herbalists, and Young People Act 2008. especially for difficult diseases.xxv More information on FGC can be found in ACT Sudanese Muslim patients may fast (i.e., not eat, Health Standard Operating Procedure – Female drink or take medicine) from sunrise to sunset genital mutilation.xxxiii during the month of Ramadan. This may affect the treatment of conditions such as diabetes.xxvi Social determinants of health The overall literacy** rate in Sudan in 2011 was 72

per cent (81 per cent for males, 63 per cent for females).xxxiv

** People aged 15+ years who can read and write.

Sudan

In 2011, 44 per cent of Sudan-born people aged Barriers to health care access included language 15 years and over in Australia had some form of difficulties, lower levels of education and literacy, higher non-school qualifications compared to 56 financial disadvantage, lack of health per cent of the total Australian population. Of information, and limited understanding of how the Sudan-born aged 15 years and over, 30 per to seek help and access health services.xxxviii cent were still attending an educational A study of Sudanese, Afghan, Pacific Islander and institution. The corresponding rate for the total Burmese people in Logan, , revealed Australian population was 9 per cent. issues common to all four communities: (1) Among Sudan-born people aged 15 years and unfamiliarity with health services and difficulty over in Australia, the participation rate in the accessing them; (2) the need for doctors to labour force in 2011 was 49 per cent and the accept traditional healing methods alongside unemployment rate was 25 per cent. The orthodox medicine; and (3) language problems corresponding rates in the total Australian impeding effective communication with health population were 65 per cent and 6 per cent professionals. respectively. Sudanese study participants’ views of the The median individual weekly income in 2011 for Australian health system were generally positive, Sudan-born people in Australia aged 15 years although they did feel that they needed more and over was $294, compared with $538 for all information about their treatment (e.g., often, overseas-born and $597 for all Australia-born. more blood is taken for testing in Australia than The total Australian population had a median in Sudan, and this concerned participants). They individual weekly income of $577.xxxv also reported that Australian health professionals often overlooked or responded negatively to Utilisation of health services in their health beliefs, cultural values and Australia traditional health treatments. Integrating The use of hospital services among people born traditional and Western treatments would help in refugee-source countries, including Sudan, is them to develop trust in the Australian health lower or similar to that of the Australia-born system. Participants also stated that they population.xxxvi,xxxvii preferred to use face-to-face interpreters when visiting their GP.xxxix A small study of sub-Saharan African refugees, including from Sudan, showed difficulties in accessing health care in , including at times when a family member was sick. Adapted by ACT Health Multicultural Health Policy Unit (2015) from Queensland Health Multicultural Services (2011) Sudanese Australians: Community Profiles for Health Care Providers. Brisbane: State of Queensland (Queensland Health). A full list of references is available on request from the Multicultural Health Policy Unit at [email protected] or (02) 6205 1011. Date for review: March 2020

i Tempany M (2009). What research tells us a bout the mental healt h and psychosocial wellbeing of Sudanese Refugees: A literature review. Transcultural Psychi atry 46(2): 300-315. ii Department of Immigration and Border Protection (2014). The People of the Australian Capital Territory: Statistics from the 2011 Census. Canberra: D epartment of Immigration and Bor der Protection. iii 2011 Census data retrieved from Australian Bureau of Statistics (n.d.). TableBuilder. A ccessed 4 July 2014 at http://www.a bs.gov.a u/websitedbs/censushome.nsf/home/tablebuilder iv Australian Bureau of Statistics (2013). The ‘average’ Australian. 4102.0 - Australian Social Trends, April 2013. A ccessed 15 May 2014 at http://www.abs.gov.au/A USSTATS/[email protected]/Lookup/4102.0Main+Features30A pril+2013 v Settlement Database data retrieved fr om D epartment of Immigration and Bor der protection (n.d.). Settlement Reporting. Accessed 17 June 2014 at http://www.i mmi.g ov.au/settlement /srf/ vi Ethnic Council of Shepparton and District Inc. (2010). Sudanese Community Profile. Shepparton: Ethni c Council of S heppart on and District Inc. vii Williams A (2003). Fact sheet - Sudan. Adult Migrant English Pr ogram Research Centre. Accessed 4 July 2014 at http://www.ameprc.mq.edu.a u/__data/assets/pdf_file/0019/46135/SudanProfile.pdf viii Teklu T, von Braun J, Zaki E (1991). Drought and famine relationshi ps in Sudan: Poli cy implications. Resear ch Report 88. Internati onal Food Poli cy Resear ch Institute. Accessed 4 July 2014 at http://www.ifpri.org/sites/default/files/publications/rr88.pdf ix Department of Immigration and Citizenship (2007). Sudanese Community Profile. Canberra : Commonwealt h of Australia. x Department of Social Services (2014). The Sudan-born Community. Accessed 4 July 2014 at http://www.dss.gov.au/our -responsibilities/settlement-a nd-multicultural -affairs/programs-policy/a -multicultural -australia/programs-and-publications/community-infor mation-summaries/the -sudan-born-community xi Department of Immigration and Citizenship (2007). Sudanese Community Profile. Canberra : Commonwealt h of Australia. xii United Nations Development Progra mme (2013) About Sudan. A ccessed 4 July 2014 at http://www.sd.undp.org/content/sudan/en/home/countryinfo/ xiii Central Intelligence Agency (CIA) (n.d.). T he World Factbook: Sudan. Accessed 4 July 2014 at https://www.cia.gov/library/publi cations/the -world-fa ctbook/geos/su.html xiv United Nations Development Progra mme (2013) About Sudan. A ccessed 4 July 2014 at http://www.sd.undp.org/content/sudan/en/home/countryinfo/ xv United Nations Development Progra mme (2013) About Sudan. A ccessed 4 July 2014 at http://www.sd.undp.org/content/sudan/en/home/countryinfo/ xvi South Eastern Region Migrant Resource Centre (2007). Sudanese in south east Melbourne: Perspectives of a new and e merging community. Melbourne: South Eastern Region Migrant Resource Centre. xvii Queensland Health and M onash University Faculty of Medi cine, Nursing a nd Health Sci ences (2009 ). Cultural dimensions of pregnancy, birth and post-natal care: Sudanese ethnicity and background. Brisba ne: Queensland Health. Accessed 4 July 2014 at http://www.health.qld.g ov.au/multicultural/heal th_workers/sudanese-preg-prof.pdf xviii Kuyung M (2011). Review of Cultural Diversity Profile - Sudan. Personal communi cation; 21 February 2011. xix World Health Organization (n.d.). Global He alth Observatory Data Repository – Life expectancy: Li fe tables by country. 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