In the last three years, the continuous conflict between government and opposition forces in South Sudan’s oil-rich Upper Nile State has forced many families to make a desperate decision: stay and risk being killed, or leave and risk having their property stolen.
Across the border to the north lies Sudan’s more peaceful White Nile State, to which many South Sudanese people have fled to escape the violence. Earlier in 2016, the rainy season brought a brief lull to the fighting in to the south, but now hostilities have resumed between the warring parties. The renewed fighting has pushed many more families to migrate to safety across the border. Currently, six refugee camps host 83,000 people in White Nile, with many more living outside these designated zones.
In response to the growing needs, MSF runs a 40-bed hospital in White Nile State. It is based just outside Al Kashafa Camp, where over 17,000 refugees have been allowed to settle. A wide range of services are provided in the hospital’s inpatient and outpatient departments. The most common concerns relate to reproductive health issues, respiratory infections, and malnutrition.
“We Didn’t Stop to Think, We Just Ran”
“When the armed men came to Kaka they showed no mercy,” says Mary, a refugee from the town in South Sudan’s Upper Nile State. “Neither the young nor the old were spared. As soon as we heard that the killing had started we didn’t stop to think, we just ran from the village taking what we could carry, embarking on our frightening journey.”
“To pass through some of the military checkpoints we had to lie about the tribe we belonged to, otherwise we would have been stopped and the worst would have happened,” she explains. “We feel very lucky, as miraculously nobody was hurt.”
Mary’s four-year-old daughter is a patient in the MSF hospital because she arrived malnourished. “She became sick on the journey and stopped eating, had diarrhea, and started coughing,” says Mary. “When we got here the doctor told me that she needed help and put her on the special nutrition program run by MSF. I hope that this will make her strong again.”
“By far our biggest cause for concern is the sanitation and hygiene in the camp,” says MSF project coordinator Mohamed Jibril. “People are living so closely together [in the camp] and there aren’t enough toilets and latrines. They are openly defecating near their shelters and their neighbors.”
“There is a huge risk of multiple cases of measles or acute watery diarrhea spreading throughout the community,” says Jibril. “Young children are particularly at risk, as they play in these unsanitary conditions with their friends. The hospital is always ready to deal with an outbreak, despite our limited capacity. The only solution is to upgrade the sanitation facilities.”
MSF is contributing to such an upgrade with the construction of latrines in two camps (Al Kashafa and Joury). Community health promotion activities are also part of the package offered by MSF, with the aim of increasing awareness of healthy hygiene and behavior.
The hospital also serves as a referral point for other camps, and is the only nutritional stabilization center in the area. The most serious cases of malnutrition are referred to Kosti Hospital, some 50 miles away.
The MSF medical facility is not just being used by the new arrivals. Nearly half of all consultations are for local people living outside Al Kashafa Camp, which includes the host Sudanese community and refugees from the other five camps.
Before MSF arrived, the local community had very few options when it came to medical care, and the MSF hospital became a point of reference for the local population as well. Elizabeth, from the local village of Alseror, explains why she came to the MSF hospital: “For weeks I was suffering from a very bad headache and a sore throat. My family wanted me to try some traditional medicine. It’s all they could suggest, but I knew it wouldn’t work. So I came to the MSF hospital, where the treatment is free and the doctors know what they are doing.”
Many of the refugees living in the camps find themselves in unique circumstances. Until 2011 Sudan and South Sudan were one country, and until recently the authorities in Khartoum gave those raised in the south the rights of Sudanese citizens. As many have family in Sudan (North), understand northern culture, and speak Arabic, they may choose to move on to one of the larger towns in White Nile State. Refugees with the money and family connections to do so might even go as far as Khartoum, where they can start a new life.
Those without connections will stay in the camp, hoping for the situation to improve. Life in the camps remains hard—while international nongovernmental organizations provide basic education for children, there is little for adults to do. Some try to eke out a small income by selling fish or trading in the local market. Others find work laboring on local farms. This enables their families to supplement their food rations and maybe save a little for a better life.
The future remains deeply uncertain for many of the refugees in White Nile State. If things improve then many might go home. For now this is only wishful thinking.