South Sudan: Research Terms of Reference – Integrated Public Health Rapid Assessment in Luakpiny/Nasir County, Upper Nile State, September 2026 (SSD2610, V1)

Please refer to the attached file. 2. Rationale 2. 1 Background Luakpiny/Nasir County is located in Upper Nile State, South Sudan, and shares borders with Ethiopia to the southeast, Maiwut County to the east, and Baliet and Ulang counties to the west. The county is situated within the Sobat River Basin, with the Pibor and Baro rivers converging along its southern boundary before flowing into the Sobat River, which passes through Nasir town. These interconnected rivers serve as important riverine transportation routes, providing critical links for movement, trade, and humanitarian access, particularly given the limited road infrastructure and seasonal flooding challenges affecting the county. The county’s extensive river systems and flood-prone environment significantly influence local livelihoods, access to services, and humanitarian operations. During the rainy season, flooding frequently disrupts transportation networks, limits access to health and nutrition services, and affects agricultural activities and household food security. In March 2025, violence escalated again in Nasir when the White Army attacked a government military position. The fighting subsequently triggered wider military operations and heightened political tensions between forces aligned with the government and the government in opposition. The escalation resulted in displacement, insecurity, and significant disruption to civilian life and humanitarian access. The renewed conflict has compounded existing vulnerabilities in Luakpiny/Nasir, particularly through population displacement, restricted movement, disruption of markets and livelihoods, and reduced access to basic services. The area therefore remains highly sensitive to further insecurity and conflict-related shocks. Livelihoods have been critically disrupted. Most households have lost access to farmland and livestock, while functional markets and income-generating activities have been severely impacted. Access to clean water, adequate shelter, and health services has deteriorated significantly, with overcrowding in highland areas contributing to rising public health risks and increasing disease transmission. Preliminary reports indicate suspected cases of acute watery diarrhoea, malaria, and respiratory infections, linked to contaminated floodwaters and poor sanitation. Humanitarian operations have also been heavily constrained. Partners such as Relief International (RI) report service delivery disruptions due to ongoing conflict and submerged facilities, inaccessibility, and movement restrictions. Health facilities in low-lying areas are non-functional, and mobile clinics operate intermittently. The latest IPC analysis (April 2026) indicates persistently severe acute food insecurity and acute malnutrition in Luakpiny/Nasir. During the April-July period, Luakpiny/Nasir was classified in IPC Acute Food Insecurity (AFI) Phase 4 (Emergency), while acute malnutrition was classified in IPC Acute Malnutrition (AMN) Phase 5 (Extremely Critical), based primarily on MUAC evidence. The IPC analysis also identified populations in Catastrophe (AFI Phase 5) and a risk of Famine in Luakpiny/Nasir under a plausible worst-case scenario. 2. 2 Intended impact This assessment aims to generate timely, site-specific, and multi-sectoral evidence on humanitarian needs among IDPs and host community members in Luakpiny/Nasir County, particularly in Kuetreng-ke Payam. Data collection will occur in Torechkey, Thuokwath and Bhordeng settlements, where partners report IDPs and host communities are residing together. The findings will inform evidence-based advocacy and strategic decision-making at the national level, including inputs into ongoing deliberations within the Needs Analysis Working Group (NAWG), the Inter-Cluster Coordination Group (ICCG) and the Integrated Food Security Phase Classification (IPC). In addition, the results will support targeted advocacy with relevant clusters and partners to address critical service gaps and prioritize life-saving interventions for one of the most vulnerable populations in Upper Nile State.

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