Security has improved in Southern Sudan since the 2005 peace deal with the north, but many say little has changed outside the capital, Juba. Many women and children remain vulnerable to poor and often deadly conditions possibly worse than Darfur.
Recently in the Southern Sudan state of Bahr el Ghazal, a 20-year-old woman walked 13 kilometers to a health clinic. There, she delivered her baby. Two hours later, she walked home.
Kate Foster of the International Rescue Committee says while it may sound shocking, it's not unusual.
"She has other family obligations. Her husband is probably away from home trying to find work or tending cattle out in the field. So she needs to get back home to look after her other children. So she sees her obligation very much to get back and to help the rest of her family," she says.
She took no time to recover or to ensure that she and her baby received follow-up medical care.
Foster is the IRC's deputy director of programs in Southern Sudan and is based in Juba.
Pregnancy can be dangerous
"Around one out of every seven women who becomes pregnant in Southern Sudan will probably die from pregnancy related causes, which is absolutely shocking. Another way of actually translating that indicator is a 15-year-old girl is more likely to die in childbirth than she is to complete primary education," she says.
Many pregnancy complications arise from unhygienic conditions in rural areas. It can result in Tetanus - a bacterial infection of the muscles and nerves that can be fatal if not treated. And there's also a shortage of trained midwives.
It's not Darfur, but…
Foster says poor health conditions are made worse by a lack of funding and infrastructure, as well as a lack of awareness.
"The country is in an incredibly bad situation…. We're not saying the situation in the south is worse than Darfur. Some of the health indicators are," she says.
She says some estimates say only 20 percent of people in Southern Sudan have access to primary health care – about the same percentage as before the peace agreement.
The agreement ended more than 20 years of civil war between the north and the south. And in 2011, southern Sudanese will vote in a referendum on whether to break away from the north.
Since the peace deal, it's estimated some two million people have returned home from neighboring countries. But they often lack health centers, schools and jobs, along with clean water and sanitation.
Foster says, "There's been quite a lot of investment in the infrastructure in Juba, in the capital, but outside of the capital...there's relatively little. So, for example, in Northern Bahr el Gazal…there is only on referral hospital that could do complicated surgical operations."
Disease takes a terrible toll on kids
"Child mortality for children under five is one of the worst in the world as well. And this means that one in every seven children will die before their fifth birthday.... And the main causes of death here are pneumonia, malaria and diarrhea," she says.
Foster says the government is trying to improve the situation by basing health care efforts on successful NGO programs.
"The program that we deliver trains rural villagers to recognize and also to provide first line treatment to children. Now this means that children get very, very quick treatment. They get it in the area they live and it's free," she says.
The villagers are trained to refer very serious cases to primary health care facilities.
Other NGOs are planning such things as community-based ambulance services, consisting of motorcycles with sidecars. A lack of paved roads and vehicles has made transport to health clinics difficult.