Christine Bimansha, a medical doctor from the Democratic Republic of Congo (DRC), is one of the experienced emergency staff working with Doctors Without Borders/Médecins Sans Frontières (MSF) in South Sudan. She is currently working at a camp in the capital, Juba, where 35,000 people have gathered to seek safety following a wave of violence. Here, she describes the climate of fear in the camp and the considerable health risks.

“I am currently working in an MSF mobile clinic in a United Nations Mission in the Republic of South Sudan (UNMISS) camp in Juba—this is the UN camp where a lot of people have gathered, probably 15,000 people.

Another 20,000 are gathered in another UN camp in the city, about 35,000 people in total. The population density in the camps is very high—our field coordinator calculated that it is up to ten times more than Mumbai.

The situation in Juba is back to a relative calm for the moment. We can move. Even if there is a curfew we can move around, but for the national people, people from the Nuer community in particular, they’re scared to go out. Even in the UN camp, especially the men, they don’t move out. The women will go in and out, but only during the day.

Urgent Water and Sanitation Needs

In the camp we have set up a clinic with a triage area, a consultation area with four of us doing consultations, and a small observation room with four beds, which is looked after by a nurse. Everyday we have around 220 consultations—today it was 235.

At the moment in the clinic we are seeing a lot of diarrhea and dehydration. Today almost half our patients had diarrhea—it’s the main issue in the clinic and the camp and it’s because of the sanitation problems there.

Water and sanitation is the biggest problem the displaced people are facing—they don’t have access to water or to enough latrines.

The little food they have is the food they brought with them from home. Some food distributions have started, but this is not enough for all the displaced. Those who have some money can still buy some food but the other people are hungry.

Organizations supposed to provide water to the displaced people are talking and looking into this, but it’s been almost two weeks now that people have been there and they only started building the latrines a few days ago. There are some water points, but until a few days ago the water wasn’t treated and there isn’t a sufficient amount for people.

Definitely, it is not enough in quantity or quality. If the water and sanitation conditions at the UNMISS camp remain the same the situation will get worse—if people don’t have water and we have an explosion of diseases like cholera, then that will be a big outbreak and a big problem.

Measles is also a significant threat and an outbreak would be difficult to stop in such overcrowded conditions.

"These people need assistance, more than ever"

There are a couple of patients that stick in my mind. The first was an adult with severe watery diarrhea. He was a tall man of about 28 years old with severe dehydration, and his diarrhea was very bad. He couldn’t control it or stand up and he felt so ashamed, he was almost crying because he couldn’t stop it. I remember that but after some treatment he got better and went back home so that was good.

And there was a small baby girl, about eight or nine months old, completely lethargic, almost comatose with severe dehydration. But we couldn’t find an IV line for her so we were pushing for the mother to put some ORS (oral rehydration salts) direct in the mouth of her baby.

After about 30 minutes the child started opening her eyes. The mother couldn’t believe that just ORS could save the life of her child and she was amazed and left happy.

I was in South Sudan in 2011 in Pibor when the MSF clinic was looted and closed. And I work in the emergency pool for MSF so I often work in places that are insecure and where there is no peace.

In this country, things are not going well. On top of the political violence, there are a lot of tensions between the different communities. Many aid organizations have pulled out their staff and suspended their programs in the country.

In MSF we have reduced the regular team to essential staff, but we have also brought in some experienced people to help manage our emergency response here. These people need assistance, more than ever.”