February 17, 2015

Since the end of November 2014, Doctors Without Borders/Médecins Sans Frontières (MSF) has been responding to a spike in measles cases in the Yida refugee camp, in South Sudan’s Unity State. The virus is primarily affecting children, many of whom recently arrived in Yida after fleeing with their families from Sudan’s Nuba Mountain region, where bombardments and fighting between rebels and Sudanese government forces have recently intensified.

MSF has been working in Yida since 2011, which is now “home” to some 70,000 Sudanese refugees. The crowded living conditions make the refugees more susceptible to the measles virus, which spreads through contact with droplets from the mouth or nose of infected people. Children under five years of age and pregnant women are most at risk due to their weaker immune systems.

“In a refugee setting, one single case of measles is considered an outbreak,” says Ahmed Mohama Mahat, MSF vaccination coordinator in Yida. “And these people arriving in Yida from the Nuba Mountains are in very bad conditions. They have not been vaccinated for a long time.”

In response to the latest crisis, MSF teams have admitted 93 patients with measles and launched a mass vaccination campaign in collaboration with the International Rescue Committee (IRC) and the United Nations High Commission for Refugees (UNHCR). The goal is to vaccinate 90 percent of the children in the camps and the nearby host communities between the ages of 6 months and 15 years—an estimated 35,000 children in all—over a period of five days. This will both increase the immunization coverage in the area and protect people from future outbreaks.

“Mass vaccination campaigns in emergency situations during outbreaks or for displaced populations often target a large number of people,” says Mahat. “The challenge is to be able to achieve this rapidly in order to control an epidemic or the risk of epidemic.”

More than 100 people have been recruited from the camp’s population to assist with the campaign, bringing the total number of staff up to around 140. Nine vaccination sites have been set up throughout Yida, each managed by teams of 12 comprising a supervisor, vaccinators, preparers, watchmen, crowd controllers, and mobilizers (community health workers who help MSF with health promotion, outbreak detection, referrals to the open patient department in the hospital, and tracing of tuberculosis treatment defaulters.)

“The community health workers are very important for our work here and especially for the success of a mass vaccination campaign like this,” says Mahat. “They are the eyes and ears of MSF in the community, and the link between the hospital and the community. They are well-respected, so they are the force behind the community’s awareness of our facilities and of the vaccination campaign.”

Faisa Said is just the sort of person the campaign is designed to aid. She recently brought her two-year-old daughter, Nana Wii Said Kuku, to the MSF hospital in Yida with a high fever and the dry, wheezing cough typical of measles. She had also developed secondary pneumonia and a rash was starting to spread over her body. A machine supplied concentrated oxygen through a tube in her nose to help her breath.

“I took my daughter to the hospital when her temperature went up and she started to cough,” says Faisa.  “I recognized the symptoms of measles since my sister had it some weeks ago. She was treated and recovered in this hospital.”

Faisa hopes the outcome will be the same for her daughter, but measles is just one of many challenges her family must contend with. They first fled the violence in the Nuba Mountains in 2012 but went back home a year later, hoping it was safe. When the fighting and bombing worsened once again, they were forced back to Yida. Faisa does not yet know if or when she can return home, but she is grateful that her daughter can get treatment.

The MSF facility in Yida, featuring outpatient and inpatient wards, began operating in 2011. More than 100,000 consultations have been performed since, along with close to 2,600 hospitalizations in 2014.    

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