International Organization for Migration (IOM) Mission in the Republic of South

Wuntho Border crossing point, IOM, 2020

RAPID ASSESSMENT COVID-19 PREPAREDNESS IN WUNTHOU BORDER, ,

Conducted by Technical Working Group on Points of Entry (POE) TWG 14 - 20 May 2020

OVERVIEW

On 31 December 2019, a cluster of pneumonia of unknown etiology was reported in Wuhan City, Hubei Province of the People’s Republic of China. One month later on 30 January 2020, the World Health Organization’s (WHO) Emergency Committee (EC) convened and announced that the pathogen known as the 2019 Novel Coronavirus (2019 n-CoV), now constituted a Public Health Emergency of International Concern (PHEIC). The COVID-19 outbreak soon after declared pandemic is fast becoming the largest public health and mobility crisis ever seen. While the number of cases continues to increase rapidly, it is also changing mobility and trade patterns as well as immigration and border management practices.

South Sudan confirmed its first COVID-19 case on 5 April 2020. Since then, more than 800 cases have been confirmed by the time of writing of this report, most of which locally transmitted. Furthermore, the government of South Sudan has set up a whole-of-government responses with its operating technical working groups, among which is Technical Working Group on Points Of Entry (hereinafter TWG) whose primary responsibilities is to identify critical gaps at POEs and responds to such gaps. As it stands, the TWG has identified 16 prioritized locations for POE establishments based on 5 criteria of “covid 19 transmission risks” namely; 1. Areas in South Sudan with high incoming population flows from outbreak affected areas in neighboring countries. 2. Entry points receiving long distance commercial and general travel (Including supply routes). 3. Convergence points (Major urban centers and IDP & Refugees camps and camp like settings). 4. Entry points with significant links to major populations centers (Major urban centers and IDP & Refugees camps and camp like settings) in South Sudan. 5. Areas of diversion of population movement due to border closure (Alternative Routes).

Renk County is included within the 16 prioritized locations and marked as “immediate” for assessment. After four weeks of delay due to ever-changing policies on movement restriction, finally on 14th – 20th May, the TWG deployed an assessment team consisted of staff from the Ministry of Health (lead), Ministry of Interior and the International Organization for Migration (IOM), who were joined by staff from Renk-based organizations namely Care International on behalf of UNHCR, World Vision International, Medair, World Food Program, REACH, World Health Organization (WHO), and official from State Ministry of Health. The team conducted a rapid assessment in Renk County covering Renk Town, Wunthou official border, Imtidad (25kms east of official border) and River Port.

The overall objective of this assessment was to identify the current capacities and level of preparedness at the PoEs, specifically; • To asses institutional capacities (government and non government) on COVID-19 preparedness and response in Wunthou, Renk POE. • To identify and assess critical infrastructure responding to COVID-19. • To assess coordination structures within and across the border. The ouput of the assessemnt is a set of recommendations for an effective prevention, detection and responses to COVID-19 and other public health risks.

Methodology : • Key informant interviews with Renk’s Health officials (CHD), State officials, border authorities such as Immigration, border police, customs, Security, cross border traders. • Observation of port health facilities, holding facilities, laboratories, quarantine facilities and isolation wards and spot checks on informal border crossing points and marketplaces.

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• Observation of safe practice measures in place especially where gaps were identified such as how to safely isolate suspected travellers, collect information from the suspected travellers and monitor mobility of migrants at POEs.

FINDINGS

Border Management at Wunthou Border Crossing Points South Sudan has a total 26 official borders across its administrative territory. Six of those are located at the North bordering with Sudan, namely; Wunthou, Kaka, Taswin, Majok, Railway, and River port in Renk County. Additionally, South Sudan operate official borders located in Amiet, North of , location disputed by both Sudan and South Sudan.

Fig 1: Wunthou Border Crossing Point Generally, South Sudanese government has limited capacities in managing its 26 borders. These limited capacities are characterized by (among others); insecurity and armed conflict impeding territorial border security and migration management; incomplete demarcation of borders where some border posts location are in disputed area such as in the border with Sudan (i.e. Abyei); insufficient capacity of agencies with border roles such as immigration, border police, customs, etc; limited infrastructure due to its remoteness and porosity of borders; lack of collection of mobility data to inform policy priorities; visa system does not respond to patterns of movement such as for labor, visitation, education, health, pastoralist movement, border community movements, and humanitarian movements; lack of official border management protocols on preventing the spread of cross border pathogens and epidemics.

Wunthou (lat :12.262900, long: 32.766373) border is located in the northern most border crossing into Sudan, along the River about 60 Kilometers (1 hour drive) North of Renk town bordering three Sudan’s States, namely; (North), Senar - Mazimum county (North East), Blue Nile - Bouth County (East).

Like many other official borders Wunthou also faces limited capacities in managing its borders. The Wunthou border operates from from 8 am – 6pm and are manned by immigration officials, police, Fig 2: Immigration Office South Sudan National Security, CID, and local authority. From 6pm – 8am, the Army takes over manning the border.

Permanent infrastructures are non existance, its immigration office, Medair-run Public Health Care Unit (PHCU) and pharmacy are made of grass thatch with limited to non minimum security standard

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applied (i.e. lack of fencing). There is one dilapidated prefab donated by Custom for custom-related activity currently used as accommodation for officials working at border. WASH facility only operates within PHCU with supply of water coming from the river, regularly chlorinated by Medair

Due to the current demarcation dispute with Sudan, cross-border cooperation is officially non- existent. Movement across borders are non-coordinated, thus intelligence sharing is non-existent which impacts on lack of crime prevention and mitigation. The immigration office records incomings and outgoings manually and conduct temperature screening for Covid19. Neither border officers nor immigration officers require covid 19 health certificate and/or 14 days quarantine from incoming travelers. .

Mobility Analysis While at the time of assessment Renk County had no confirmed cases of Covid-19, Wunthou can be considered at heightened risk given its geographical location as a convergence point for cross-border routes between Sudan and South Sudan. Long-distance commercial and humanitarian (WFP) trucks bringing in essential life-saving food and medical supplies from Port Sudan, and Kosti transit through Wunthou on their way to Renk and other locations further inside South Sudan. Wunthou is also linked to significant population centers in Sudan, including Jebellein, Rabak and Kosti. Jebellein is an urban area hosting a sizeable population of South Sudanese refugees and a node for the oil pipeline to Port Sudan, whereas Rabak and Kosti (3 hour drive to Khartoum), twin cities separated by the river Nile, are located on a major trade route to Khartoum. Currently, due to the mobility restrictions imposed by the Government of South Sudan, only cargo - mostly humanitarian trucks and oil trucks are permitted to enter through the official border. Approximately 40-50 trucks are estimated to cross the border each week, corresponding to an average of 20 individuals per day in each direction, virtually all of whom are male. Prior to the introduction of mobility restrictions, Wunthou was also an important crossing for refugee returns to South Sudan. Some returns reportedly continue along unofficial routes. Communities living along the borders and beyond, including from Renk town, converge to trade at market places along the border area, as they have for decades. Despite the restrictions, men and women – including boys and girls - continue to cross the border through unofficial routes in order to engage in this informal trade, with local convergence points identified at the cross-border market in Imtidad (located approx. 8 km south-east of Wunthou) and at Renk River Port. Other people travel with the intention of receiving treatment from the PHCU facility at the border. Elderly, persons with disabilities and pregnant women are among the people crossing through these routes. Prior to the border closure, some children used to attend school in Sudan, but this has now stopped. Overall, nineteen informal cross-border routes were reported in the area by the Renk County Health Director (CHD). People living along the border areas also travel south to the rest of Renk County to work in commercial plantations. Following the assessment, IOM DTM established a flow monitoring point at the internal check point (11.780607° and Long: 32.811666) located north of Renk town on the road to Wunthou. This location is strategically located to capture both trucks travelling along the official route and movement along informal routes converging on the main road on the way to Renk town. The flow monitoring point will enable regular collection of disaggregated data on areas of departure and destination, traveller intentions and their demographic profiles. Current Capacities: Institutional Response

Whole-Of-Government Response

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Renk County (former Northern State) has established a task force in responding to COVID- 19 headed by the Secretary of State1. Memberships include; health office, police, RRC, Army commander and NSS. This taskforce meets weekly but there seems to gaps in the coordination with the national task force, nor has it operational terms of reference which can guide state task force in their responses. However, this does not translate well at the borders. It seems there is no Integrated Border Management Committee2, an institutional framework whereby all agencies operating at official border crossing points can cooperate formally. In most cases, coordination is done through informal engagement with no reporting mechanism, nor regular meetings. Cordination between CHD and security actors is weak, lack information sharing, nor having shared action plans despite the leadership has been shown by secretary of the state about the importance of coordination and whole of response.

Stakeholder Analysis

There are currently eight agencies (government, UN and non-government) operating in Renk County and at the border. Among those, three agencies have presence at the border, they are; REACH, Medair, and Care International operating on-behalf of UNHCR. The remaining operate in Greater Renk County, further away from POE site. They provide basic services such as health provision and nutrition for local communities, some have also shifted existing resources in responding to Covid 19 such as conducting training on Covid-19 protocol, purchasing PPE for their staff members, and provision of wash facilities. However, resources are still inadequate and these agencies will require further support to strengthen their responses in line with the NSC pillars. Below are current programs conducted by the organizations:

GOVERNMENT AGENCIES MINISTRY OF HEALTH County Health Director is appointed focal point to coordinate Covid-19 response. MoH also provided sensitization to border officers on screening. MoH also provided Information, Education and Communication (IEC) materials to be placed at the border. But, it lacks IEC in local language which is Arabic. CHD issued policy on Covid-19 response such as assigning two medical doctors from County Healthcare Facility to respond to Covid- 19 should outbreak occurs. CHD is also responsible for management of isolation facilty.

SECURITY ACTORS The security actors are conducting screening of travelers at the checkpoints. NSS manages the screening related to Covid-19, while Immigration issues clearance documentations. There is no visa issuing. Customs service (National Revenue authority) has not deployed to the border.

1 The Taskforce was set up by Secretary of State of the Defunct Northern Upper Nile State. At the moment, this State is on transition back to Upper Nile State with serves as capital. The current Malakal-based Taskforce is still operating under the Defunct Central Upper Nile State. They do not cover Renk in their response for now. When the new governor for Upper Nile State is announced, the two taskforces (Renk and Malakal) will be coordinated under Malakal. 2 Integrated Border Management Committee is a whole-of-government response with memberships from 18 agencies set up to discuss general issues such as security, trade facilitation, health, procedures, relations with community.

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HUMANITARIAN AGENCIES (in alphabetical order) CARE INTERNATIONAL Care International records refugee returnees on behalf of UNHCR MEDAIR Medair manages one PHCU at the border, it is manned by one medical assistant who provides primary health care to beneficiaries. Medair conducts screening of incoming patients and provide medication. Medaira also runs pharmacy located at the border. In responding to COVID-19, MEdair trains its staff on IPC and conducts primary health promotion among their beneficiaries. They have limited PPE alocated for its staff. A total of 5 staff (F: 2, M:3) are currently working at the PHCU, working from 8:00 am - 5:00 pm. Medair has no capacity to conduct border health surveillance as it is not within their mandate. REACH REACH conducts Road and Port Monitoring at three transit sites in Renk Town, two road points (Sukjima and Zero bus stations) and one port (Renk Port) WFP WFP transports humanitarian essential life-saving food and medical supplies through Wunthou borders, the contracted truck drivers and assistants upon arrival in Renk Town are screened and required 14-day quarantine. At Wunthou border, WFP provides handwashing and isolated rest areas for their drivers and assistants away from the community for an overnight before they leave the following day to Renk Town. WFP plans to move cross-loading to the border instead of Renk town, although it is not yet confirmed. Over 100 drivers currently work under WFP contracts. WHO WHO stations its staff working on addressing polio (screening, promotion and training). WHO staff is also equpped to be the one conducting contact tracing should a case be identified. WORLD VISION World Vision manages 10 primary health care units that operate from 8am – 5pm around Renk County. None of those located at the areas within POEs prioritization. Wold Vision has rotating doctors who conduct visitations of those 10 primary health care units. In responding to COVID, World vision conducts IPC trainings to their staff, purchased PPE for their staff as well as donated to Ministry of Health,

Critical Gaps Relative to Individual & Institutional Capacities in Covid-19 Preparedness

Human Resource Currently, there is a shortage of qualified health personel stationed in Renk County, the Ministry of Health only has one focal person who is coordinating covid 19 response, who is also the County Health Director. As a focal point, one of the main responsibilities is to ensure all agencies operating in Renk County share information and resources. Renk county also has two medical doctors currently working in the County hospital who are allocated to work on covid 9 response should there be confirmed cases. There is no dedicated port health personel at the border to conduct border health surveilance. Rapid response team is non existance. Wunthou border is operated by 15 staff (F: 1, M: 14). There are six officers on duty (M: 6: F: 0).

Primary, Secondary Screening, Detection, Isolation Border officials working at Wunthou border has limited understanding of dealing with health, border and mobility especially in response to Covid-19. Although all truck drivers are screened at border using Covid 19 assessment form, there are not secondary screenings taking place. Screenings are conducted

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by security personel who have received basic screening training by CHD but they do not have capacity to do secondary screening. The PHCU managed by Medair within the border vicinity where ill travellers (non-covid related) can be referred to but has no capacity to respond to treat Covid-19 suspected cases. Long distance truck drivers and truck assistants are allowed entry into South Sudan without Covid-19 test nor 14 days self quarantine. Although both are required to cross into Sudan. For secondary screening, the border officers are required to contact CHD. So far, there has not been any reports on follow up secondary screening required. CHD has placed hand washing stations at limited locations. No follow up procedures on notification, and isolation/case management.

Sample Testing, Case Management There is no trained personel on sample collection and testing for Covid-19 in Renk. For the region of including , there is only 1 health personel who is trained in administrating of Covid-19 test and is based in Malakal. There is no partner on the ground prepared to support case management.

Operating Guidelines on Screening and Referral Mechanisms Renk county does not yet have access to Standard Operating Procedures on Covid Fig 3: PHCU & Pharmacy 19 preparedness. The Pillar SOPs are yet to be finalized at national level. None of the key informants have been trained on covid-related responses i.e. surveilance, reporting and referral, testing, quarantine, and isolation. This includes humanitarian/development agencies and government actors operating at the borders.

Coordination Coordination at the border seems to be a gap among operational agencies. Even though agencies meet on adhoc basis, there is no clear Terms of Reference that guide the coordination of these agencies, nor does it have reporting mechanisms in place.

Awareness & Capacity Building The border officers are generally aware of Presidential orders on Covid-19, but they are limited to just implementing the order on border closure with exception of trucks carrying essential cargos. They do not keep up with various instructions coming from . Hence policy at Juba level may not be well- understood not enforced at field level. Sensitization on Covid 19 is generally limited, responses related to risk communication should also target front line government officials. Border officials are relying on their basic military training. Specialized trainings which are required for the officers such as training on Integrated Border Management (IBM), an essential training for border officers to understand the complexity of issues at the borders, management skills, including on aspects related to cross-border cooperation. Other specialized trainings include; detection, investigation, screening and responding to transnational organized crimes, protection, human rights-based policing are seen as essential. Capacity building on Covid-19 is highly critical to be provided for not just government officials but also all stakeholders including humanitarian partners, communities, and community leaders.

Critical Gaps Relative to Technical Capacities in Covid 19 Preparedness

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Description Status Criticality

INFRASTRUCTURE Quarantine facility There is one facility dedicated for quarantine accomodating High

up to six people. It is missing essential needs, trained personel to man the quarantine facility. It is located at the edge of the check point . There is minimum to none security operating standard compliance and basic supplies such as: feeding, bedding are non existanceIt can hold upto six beds.

Isolation facility High During drafting of the report, as informed by World Vision the TWG for case management has designated the Renk County hospital as the Isolation facility, however, because of distance from border, local officials have earmarked a nearby facility dedicated as isolation center, it is located in El-Gerger Payam headquarters (Lat.11.984811.Long :32.762537), approx.10 kilometers South of the border. This facility has running water, it can accommodate 6 beds, it has fences that require minor fixes. Lavatory is available for men and women, however, it requires refurbishment as they currently are not adequate to use. Nor it is secured for women to use. There is not yet SOP in place nor referral procedure.

Ambulance Services N/A. The existing ambulance car is not functioning, it requires High maintanace. Health Facility Health faciluties are run by government, World vision, and High Medair. The only health facility that may have capacity to treat covid patient is the County Hospital. The rest of the facilities are inadequate hence requiring capacity enhancement. The Outpatient facility in Renk Town does not have triage nor isolation facility Emergency Non-available. High Service/Rapid Response Team WASH • WASH facilties are set up at PHCU High • Limited WASH facilities at the borders exept for one lavatory (with no lighting and no gender disagregated lavatory). • Waste is managed locally. Facility has running water. It does not go through regular cleaning time. • None of the staff working at the borders have received hygiene training. • There are two hand washing stations at the border EQUIPMENT

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Thermometer gun 1 for primary screening High Electronic border N/A. No electronic data of incomings or outgoings trucks and High management passengers are collected. This may be an important tool for equipment contact tracing purpose. PPE PHCU staff, border officials, security actors, law enforcers are High lacking PPEs SUPPLIES Hygence Supplies There are two hand washing stations, with soap and cloth Medium towels at the border Disinfectant Stored in PHCU. It is not accessible to everyone High Water Supplies Medair has water treatment facility Medium Lavatory supplies Bar soap, cloth towel, chlorinated water, cleaned daily Medium PROTECTION CONCERN Lavatory No lavatory dedicated for women nor for persons with High disability. Only one lavatory with no lighting available Handwashing station There are two handwashing stations both are inaccessible for High persons with disability. Risks to sexual There is high risk to sexual violence as currently the infra- High violence structure is not build to ensure protection to women for example there is only one lavatory with no lighting and it does not have functional locks. Food There is a need to source food supplies should the quarantine Medium and isolation be set up at the border Safe & Private Space There is currently no private space for accommodating High for people needing migrants needing protection. At the time of the assessment, protection the movement of people across official border was halted, the assessment team did not observe vulnerable migrants crossing the borders. However, in unofficial border crosisngs, the assessment team observed a mixed-population were seen crossing borders for reasons that could not be visibly identified. The movement was presumably for trade reasons as it happened at cross-border market places.

Community-based Intervention: Risk Communication Limited number of IEC materials are visible at the border supplied by CHD. Although, they need to be translated into Arabic. The cross-border movement of people do not observe covid 19 protocol. Social distancing is not adhered to despite banning of such gatherings, people still gather in large groups in restaurants, market places, and burials. There is a need to conduct public sensitization at the cross border markets, and where the truck drivers and their assistants congregate. Risk communication is highly needed targeting communities and front line officers. Movements of Border Community in unofficial border crossings/through farmlands and at places such as Imtidad cross border community market is going on without screening. No awareness raising taking place targeting vulnerable communities i.e. women, persons with disabilities, and elderly persons.

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Protection Concern • Renk is a border town with high cross border movement of traders, refugees, IDPs, pastoralist as well as a major route for agricultural and oil producing commodities. There’s no agency in place responding to protection needs given repercussion of border closure policy. The emergence of unofficial routes may have impacted on the increase of transnational organized crime such as trafficking in persons and smuggling of migrants. It exacerbates given no protection actors are operating at the border except for Care International whose work exclusively for refugees. Assistance to the rest of vulnerable migrants remains a gap. • Referral mechanism is not in place. Should the border officials identify vulnerable migrants, there are no agencies to refer them to.

RECOMMENDATION

Systems 1. Urgent need to set up POE at Wunthou. 2. Develop referral pathway and share relevant SOPs (which have been developed or being developed at Juba level) across the various pillars to be shared in Renk State and ensure relevant personnel are trained on its use and implementation. 3. Draft terms of reference for task force which can include clear communication lines, regular coordination meetings and responsibilities per agency. This referral pathway should also address protection concerns of mobile population. Hence, engagement of Ministry of Gender and Social Protection and Border Management actors as part of the Covid-19 Task force is critical. 4. Rapid Response Team is a critical gap discussed by the task force. Ideally, the RRT should be closer than one-hour drive to the border. At the time of the assessment, the county hospital have staff who can be trained to function as RRT, but it is located one-hour drive from the border. 5. Commence testing of truck drivers and their assistants and require 14 days quarantine at Wunthou before allowing entry into South Sudan. 6. Enhance capacities of PHCU within the vicinity of Wunthou Border post to response to Covid- 19 secondary screening and referral. A partnerneeds to be identified for management of the PHCU. 7. Set up of a flow monitoring point along the Renk-Wunthou road to monitor local cross-border mobility trends3 Human Resources 8. Urgent need to support the CHD to deploy Port health officer to oversee health surveillance 9. Urgent need for leadership role in enhancing Border, health and mobility management. Infra-structure, Equipment and Supplies 10. Urgent needs of supplies of PPEs and IPC/WASH for front line actors. 11. Urgent need of setting up quarantine facility near the borders especially for truck drivers requiring screening. 12. Urgent need to equip and setup isolation facility. Need to conduct further assessment for location ear-marked by the local authority for this facility. 13. There is urgent need for enhancing and upgrading border management facility with more permanent structure (with sun-shade) equipped with vehicles for rapid response, electronic data collection tools such as Migration Data Management Intelligence and Risk Analysis

3 The flow monitoring point was set up as part of the assessment.

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(MIDAS), minimum security operational standard, and other equipment needed for effective management of the borders. 14. Set up handwashing facilities at critical convergence points. The handwashing stations should also include risk communication IEC materials. Capacity Development 15. There is a need for training on Covid-19 and other thematic areas for stakeholders on; migration health, IPC, Communicable Diseases, and basic training required for the officers such as training on Integrated Border Management (IBM), an essential training for border officers to understand the complexity of issues at the borders, management skills, including on aspects related to cross-border cooperation. Other specialized trainings can include; detection, investigation, screening and responding to transnational organized crimes, protection, GBV and human rights-based policing. 16. There’s urgent need to sensitize border officials on Covid-19. 17. There is an urgent need of enforcement of guidelines and regulations set forth by National Taskforce on Covid-19 Cross border cooperation 18. There is a need for UN to facilitate cross border cooperation with Sudan. 19. Capacity development of border officials from Sudan and South Sudan will need to happen to ensure both provide minimum standard of response to Covid 19. Risk Communications 20. Unofficial border crossings such as Imtidad and farmlands where citizens are crossing daily should be targeted for risk communication. 21. Risk communication and community engagement with border community and vulnerable communities based in Wunthou Migration corridor border need to be conducted. 22. There’s urgent need to sensitize border community and vulnerable community based in Wunthou Migration corridor on COVID-19. 23. There is need to further improve Water and Sanitation facilities and Hygiene promotion among travellers and to communities living along the border area Protection 24. The assessment team saw immediate need for protection response. The protection and GBV sub cluster to advise whether there is already a referral system in place so that the partners are informed about it. 25. Referral mechanism for protection cases needs to be set up starting with screening for protection concerns 26. Frontline officers do not seem to be aware of protection concerns, despite their acknowledging of receiving some complaints, but limited understanding of protection concerns. 27. There is a need to train officials and other humanitarian actors on PSEA.

CONCLUSION This needs assessment is intended for all concerned stakeholders who currently working on the ground to address collectively urgent needs identified during the assessment. The assessment team acknowledged the efforts of all parties/stakeholders/agencies currently working on the ground and wish to further strengthen the current capacities. It is expected the findings and recommendations can be used to strategize these collective efforts going forward.

… see annex 1: Assessment Team

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Annex 1: Assessment Team

No. Name Designation/Partner Email Phone 1 Dr. Zacharia Modi Team Lead- MOH [email protected] 0925803233 2 Mading N Ciengga International [email protected] 0912379581 Organization for Migration (co-lead) 3 Lodiong Edward International [email protected] 0915615644 Organization for Migration (IOM) 4 Dr. Ibtihal County Health 021704506 Mohamed Director (CHD) 5 Dr. Denis Okoya World Vision [email protected] 0921262479 6 Wedyan Meshreky Medair [email protected] 0917842100 7 Jenifer Ariye WFP [email protected] 0926596769 8 Simon Othom Care Int [email protected] 0927997786 9 Mark Dhieu REACH [email protected] 0929222210 10 Robert Sakaya WHO [email protected] 0920196391 11 Rose Achan World Vision [email protected] 0920196391

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