As South Sudan marks its first year of independence on 9 July, room for optimism looks limited: the economy is in free-fall, development plans are on hold as humanitarian crises take precedence, and there is a real fear of a major escalation of hostilities with Sudan.
IRIN takes a look at some of the key challenges facing the world's newest country, one still struggling to emerge from the devastation wreaked by decades of civil war.
What are the prospects for defusing tensions with Khartoum?
Months of talks led by the African Union have yet to bear fruit. In early April, the two Sudans embarked on a month-long war on the undefined border they had agreed to start demarcating. South Sudan occupied oil fields in a disputed area that produces around half of Sudan's oil output, while Khartoum's counter-insurgency operations have included bombing raids allegedly up to 70km inside South Sudan.
Security agreements, including on a demilitarized zone along the border, have stalled, and each side claims the other is funding rebel groups within its borders.
Sudan has repeatedly accused South Sudan of supporting rebels in the border states of South Kordofan and Blue Nile who during the 1983-2005 civil war were part of the southern Sudan People's Liberation Movement/Army. Juba maintains that the northern wing of the insurgency, SPLA-N, has operated independently since secession.
As well as these security issues, rapprochement also depends on reaching agreements on sharing oil-revenue, demarcating the border, and establishing citizenship rights.
Border clashes started just days before the two countries were supposed to sign a deal that would respect the "four freedoms" regarding citizenship. In April, some 14,000 people awaiting transport to South Sudan were evicted from the Sudanese river port of Kosti, White Nile State, forcing aid agencies to bus people up to Khartoum and fly them to Juba.
Up to half a million Southerners are still living in Sudan.
What about internal conflict?
Ethnic clashes and cattle-rustling in a country awash with guns are a serious threat to stability. Thousands of people have been killed in cattle rustling incidents and related violence.
In late December, up to 8,000 youths from the Lou Nuer ethnic group, joined by some Dinka, marched on members of the minority Murle in neglected Jonglei State, killing hundreds, according to the UN, and thousands according to local officials.
The violence displaced over 160,000 people, and spawned a host of smaller attacks in which hundreds more were killed. This prompted a large-scale civilian disarmament operation in Jonglei State.
While South Sudan has followed a policy of "paying for peace" by integrating militias into its already swollen army, analysts say a worrying trend in the politicization of ethnic groups could see the nation turn on itself if the government fails to prosecute those responsible for attacks.
Where is the economy heading?
When South Sudan seceded in July 2011, taking with it 75 percent of the former Sudan's oil wealth, hopes were high that the new nation could start building a rudimentary infrastructure and provide basic services to its people.
However, a row over how much Juba should pay Khartoum in transit and other fees (the oil is exported from Sudan), led South Sudan to halt production entirely in January 2012 – a move that turned off 98 percent of Juba's income and led to a package of austerity measures. But even before the shut-down, few South Sudanese outside Juba or the security forces – who account for an estimated half of government expenditure – had benefited significantly from the oil revenue.
The latest government figures showed year-on-year inflation at 80 percent in May. Food and fuel prices are particularly affected since these are for the most part imported and, in the absence of oil income, there are far fewer dollars available to pay for them.
How serious is corruption?
Corruption is rampant in a country which for a while enjoyed billions of petrodollars but is still setting up financial management systems.
A 3 May letter from President Salva Kiir to 75 former and current officials requested that US$4 billion looted from the state's coffers be paid back "partial or full" to a government bank account in Kenya.
"We fought for freedom, justice and equality… yet once we got to power, we forgot what we fought for and began to enrich ourselves at the expense of our people," the letter reads.
Development interrupted
The oil shutdown and corruption have shaken donors, with many starting to switch development funds to humanitarian assistance in a country which has seen about 30 emergencies in its first year of existence.
The $6.4 billion 2012-2013 budget which takes effect this month is down from $10.2bn last year, and "less than half of it they may have resources for", said George Conway, head of the UN Development Programme (UNDP) in South Sudan.
"Long-term and emergency efforts to help nearly half the population who don't have enough to eat could be derailed by an economy out of control," Oxfam warned in a 6 July statement.
"We must not allow the large investments in agriculture, water, education and other services to be undone by the economic crisis and increase in conflict. The longer this crisis drags on, the greater the risk South Sudan's development will slip backwards, and its vast potential will be unrealized," said Helen McElhinney, an Oxfam policy adviser in South Sudan.
Is the health service up to scratch?
UNDP says the health sector has seen little improvement, with aid agencies, rather than the government, still providing the bulk of services. At Juba Teaching Hospital – the country's finest – an acrid smell pervades the gloomy, packed wards.
"The [580-bed] hospital is so small and the [patients] just keep increasing," said CEO Akajomsuk Moi.
"As you can see, there are people lying on the floor," he said, gesturing to people sprawled on thin mats all over the compound, some with drainage bags coming out of their sides and others crying out in pain.
With 2,000 deaths per 100,000 live births, "it is still the case that a 15-year-old girl has more chance of dying in childbirth than completing school," said Conway.
UNDP says one of South Sudan's successes has been to reduce child mortality, but the UN Children's Fund (UNICEF) says not enough has been done. "Despite a decrease in under-five mortality, an estimated one in nine children die before their fifth birthday and 20 percent are malnourished," it said.
South Sudan has one of the highest maternal mortality rates in the world, and donors often compare the dire health situation here to Afghanistan's.
"According to the Ministry of Health, South Sudan has about 120 medical doctors and just over 100 registered nurses for an estimated population of nearly nine million people," the International Committee of the Red Cross (ICRC) said in a 6 July statement. This is 10 times fewer doctors per thousand people than in neighbouring Kenya which has 14 doctors per 100,000 people, it said.
Doctors say that during frequent power cuts they sometimes operate by mobile phone flashlight, as there is no money to buy fuel for generators.
Nadim Philip said that when he came to work at the Juba hospital four years ago, he saw mothers dying in childbirth every few days. Now, such deaths were occurring every few weeks or months, due to simple measures such as teaching staff to stop blood loss by giving oxytocin. But the real lack of training for medical staff was still causing needless deaths, he said. "Sometimes you write a prescription and it's not followed. The nurses are not trained."
UNDP says nearly 30 percent of the population still has no access to primary health care, and that as austerity bites, state hospitals will struggle to buy medicines.
"The country is prone to diseases, with meningitis, measles, yellow fever, and whooping cough endemic in many areas. Preventable diseases such as malaria and acute respiratory infections are the leading causes of ill health. River blindness, sleeping sickness, and cholera are also common," says ICRC, which is also concerned about the rising number of admissions of malnourished children to its hospital in Malakal, Upper Nile State. It adds that there is very little help for an estimated 50,000 disabled people.
"Seventy percent of children aged 6-17 have never set foot in a classroom, and the completion rate in primary schools is barely 10 percent," UNICEF said in a 7 July statement.
"Girls remain particularly disadvantaged when it comes to their opportunity to [get an] education and are vulnerable to harmful social practices of early marriage and early child-bearing", it added.
School enrolment has doubled since 2005, but according to Gerald Magashi, the acting country director for Plan, an NGO, "there are serious questions as to whether these eager children are receiving any learning at all."
At 27 percent, the country also has one of the lowest literacy rates in the world.
Despite the government's pledge to safeguard education spending (about 6 percent of the budget), UNDP fears that education gains could be reversed by the watering down of government plans to build schools.
What are conditions like for refugees?
The UN says some 175,000 people have fled to South Sudan from South Kordofan and Blue Nile states since conflicts there broke out in June and September 2011 respectively.
In Jamam camp, in South Sudan's Upper Nile State, aid agencies fear for the survival of around 40,000 refugees from Blue Nile who have faced chronic water shortages since the start of the year resulting in many diarrhoeal diseases.
Heavy rains in early July left the camp underwater and flooded latrines, contaminating water sources and leading to increased cases of hypothermia and malaria. "Living conditions in Jamam are now simply unacceptable," said Médecins Sans Frontières emergency coordinator Tara Newell.
"What's needed is for all agencies involved, led by the UNHCR, to join together to come up with a solution that can remove these refugees from the health risks associated with the dire living conditions in the camp. We have to proceed with a great sense of urgency," Newell added.
Meanwhile, in neighbouring Unity State, UNHCR recently voiced concern about the deteriorating health situation in Yida camp, where since April 500-1,000 people have been arriving daily from Sudan's South Kordofan State.
The site has grown by a third to around 60,000 refugees in recent months, as people flee hunger and bombs in South Kordofan.
"Health partners are reporting increasing cases of diarrhoea among refugees [in Yida], raising grave concerns about the risk of disease outbreak," said Marie-Helene Verney, head of UNHCR's Bentiu office in Unity State.
How can food insecurity be eased?
Nearly half of South Sudan's 9.7 million people are food insecure, meaning they lack reliable access to food sufficient to maintain an active healthy life.
A combination of poor rains, the return since October 2010 from Sudan of more than 400,000 citizens, internal conflict and a spike in food prices has prompted the World Food Programme to foresee feeding around 2.7 million people this year.
"Some people are living on one meal a day, and double the number of people are in need of food aid compared to last year", said Oxfam's McElhinney.
With refugees still streaming over the border, the economy plummeting and rains cutting off 60 percent of the roads in South Sudan, the number of people needing emergency assistance looks set to rise.
The government has urged people – in a nation that imports 70 percent of its food and where only 5 percent of the land is cultivated – to start planting.
"South Sudan has the potential to feed itself, and could be a breadbasket for the region. Instead, renewed conflict and severe economic downturn means more people face food shortages now than since the 2005 peace deal," said McElhinney.
IRIN
