January 23, 2014

In the past month alone, more than 89,000 South Sudanese people have fled the country and crossed into Kenya, Ethiopia, and Uganda to escape fighting in their homeland. At present, there are still more than 1,000 people per day undertaking long journeys by foot, bus, or truck, bringing only what they carry, and arriving across the border short on food and in need of medical care.

In response, Médecins Sans Frontières/Doctors Without Borders (MSF) has sent emergency teams to provide medical and humanitarian aid to South Sudanese refugees in the surrounding countries, each of which has its own challenges to overcome. 

In Uganda, MSF is currently setting up water and sanitation facilities, running inpatient and outpatient services, providing maternity care, vaccinations and nutrition support. “Most of the refugees in Uganda fled the fighting in Bor and walked for four or five days to reach Juba, where they took a bus or truck to the border,” says Ruben Pottier, MSF’s head of mission in Uganda, which is now home to a total of 46,000 South Sudanese refugees. 

More than 25,000 refugees are crammed into the Dzaipi settlement, a camp built for just 3,000 people. It is hot and dusty, and living conditions are terrible for those who are sheltering under the trees or inside a school. “We are treating serious cases of malaria, diarrhea, and respiratory tract infections,” says MSF’s Dr Fredericke Dumont. “There are women suffering complications during pregnancy and some cases of malnutrition.” 

Women and children make up the vast majority of the refugee population, in fact. “It really strikes you when you walk around the camp that there are very few men,” says Pottier. In the coming weeks, 20,000 people from Dziapi are set to move to a permanent camp in Numanzi, and there are plans to build three more camps in the coming weeks as well. As new camps are built, MSF will expand its activities. 

“Because there are now large numbers of people living in a region that has frequent epidemics of cholera and meningitis, we will be closely monitoring the health situation in the camps,” says Pottier.

In Kenya, where some 10,000 South Sudanese refugees have arrived in recent weeks, MSF is working at the Nadapal border crossing. Teams see firsthand how refugees are arriving tired, hungry and dehydrated after their journeys; others have sold what few personal belongings they were carrying in order to pay for transport. 

Tok Maker Tot, 20, fled Juba with his mother and ten siblings after seeing students at his university get shot (his father stayed behind in the city). “Two students from our class were shot,” says Tot. “All the students have now fled. Those who have money have gone to Nairobi, others went to Kampala, others went to Ethiopia. But we, who do not have anything, are trying to go to Kakuma [a refugee camp in northwestern Kenya].” 

“When people cross the border there is relief and often hope,” says Guilhem Molinie, MSF’s head of mission in Kenya. “But you can see that people are used to tough realities. At the border I met a refugee who was pleading with officials to let him back into South Sudan. He wanted to find his mother, who was blind. I met another family who had been so scared before they left home that they had hidden under a bed for seven days.” 

MSF is working with the Kenyan Ministry of Health to screen all refugees arriving at Nadapal for measles. So far, the team has screened 6,000 people and vaccinated more than 1,000 children against measles and polio. Seven suspected cases of measles have been referred to the local hospital for treatment. “With cases of measles having been reported at the camps in Juba, where most of these refugees transited through, it is of the utmost importance that we do all that we can to prevent an outbreak in Kenya” says Molinie.

MSF has also distributed more than 11,000 liters of water in Nadapal.

In Ethiopia, MSF is establishing services for the roughly 5,500 refugees who have settled temporarily in Tirgol. MSF will provide outpatient care, maternity care, immunizations, and nutrition care, and will continue to do so after the refugees are moved to a permanent camp in Leichure, which is currently under construction.

People, Tensions, Moving from South Sudan to Uganda
 
Many South Sudanese refugees arriving in Uganda are brought to Dzaipi, a transit camp just a few miles from the border with South Sudan. Most have already walked for four or five days, then hitched a ride on a truck for several more hours until they reached the border crossing at Elegu. 
 
Designed to house 3,000 people, Dzaipi is now struggling to accommodate more than 25,000, the vast majority of them women and children. “People had to shelter under trees, or at best inside the building of the local school, without access to basics such as water, food, latrines or healthcare,” says Ruben Pottier, MSF’s head of mission in Uganda.
 
In an attempt to lessen overcrowding, new arrivals are now taken to nearby Numanzi camp, where they spend two or three days in communal shelters before getting a plot of land on which they can set up a tent. Numanzi has space for 20,000, but with an average of 700 new arrivals each day, it is likely to be full very soon. There are concerns about how many more refugees the region can cope with, particularly because there are tensions between ethnic groups in the camps.
 
Most crossing at Elegu are ethnic Dinkas. Ethnic Nuers are mostly crossing into Arua, a neighboring district, and settling in the Ocea transit camp, where 10,000 refugees have been registered. There is overlap, however, and, says Pottier, “people bring their ethnic divisions with them.” These are particularly visible around the water tanks. In Dzaipi, Pottier says, “The Dinka majority stopped the Nuers from fetching water from the tank, so we had to set up another water tank in the Nuer area of the camp.” 
 
The humanitarian response to the refugee influx in northern Uganda has been slow, thus far involving just a few aid organizations. “MSF has covered 90 percent of the clean water provision in Ocea, Dzaipi and Numanzi camps so far,” says Pottier. MSF teams are also running clinics in Ocea and Numanzi camps, screening children under the age of five for malnutrition, and vaccinating new arrivals against measles and polio.