January 05, 2011

While the focus now on the political situation in southern Sudan, the region remains in the midst of a humanitarian and medical crisis,



Sudan 2010 © Kate Geraghty/ Fairfax Media

A mother with her son, who is getting treatment for malnutrition at MSF's inpatient theraputic feeding center in Agok.

While the focus is now on the political situation in southern Sudan ahead of a January 9 referendum on self-determination, the region remains in the midst of a humanitarian and medical crisis, with more than 75 percent of the population lacking access to basic health care. Upon his return from Abyei and Agok, Laurent Ligozat, Doctors Without Borders/Médecins San Frontières (MSF) deputy director of operations, offered his thoughts:

Why did MSF decide to intervene in Abyei and Agok?

When we arrived there in April 2006, we knew we could help given the scope of the need and the eventuality of treating victims of violence. In May 2008, the population of Abyei fled following clashes between the Sudan People’s Liberation Army (SPLA) and the Sudanese army. With thousands of people displaced, MSF pulled back to Agok, a town farther south where we put together an 80-bed hospital with an operating unit and where we treated dozens of war wounded. In Abyei, an MSF clinic that is open during the day offers basic health services on an outpatient basis. The medical teams are watching closely for any changes in the level of need. MSF can increase its presence in Abyei depending on what happens in the future.

In 2010, the teams overseeing these two projects conducted 49,733 outpatient consultations, saw more than 6,189 pregnant women for prenatal consultations, screened 15,317 children for childhood malnutrition and treated 2,723 in MSF facilities.

What types of care do MSF medical teams provide?

MSF offers essential, basic care for free to the population because health care services in the Abyei region are limited and uncertain. The hospital run by the Ministry of Health operates with few trained medical and paramedical staff and has an insufficient supply of medicines. As is always the case in similar situations, women and children are the first to be affected. Infant mortality and the death rate for women during childbirth are terrible.

MSF’s intervention, which brought trained staff, quality medicines, and free primary and secondary care, had an impact on the most vulnerable groups. In Abyei and Agok, MSF provides maternity services, pediatric care, and general medicine. We also treat malnourished children under age five.

In the Abyei region, an area contested by the north and south, the population is on the front lines. Emergency preparedness plans are currently being implemented by our teams of volunteers in the field to respond to both the flood of wounded and population displacements. Whatever the outcome of the referendum, access to care remains a priority in Abyei.

How would you assess the humanitarian and medical situation in South Sudan?

For many years south Sudan has been confronting a humanitarian and medical crisis characterized by a significant lack of access to health care, chronic malnutrition, regular epidemics, avoidable epidemics, and insecurity that has led to the population being displaced. South Sudan is emerging from 40 years of almost uninterrupted conflict. In this health care desert, the Sudanese are dying of malaria, respiratory infections, or simply diarrhea—all diseases that are easily cured if access to care wasn’t so difficult.

Our teams try to better respond to the population’s most urgent needs, whether they be food, shelter, or health care. Leading up to the referendum, the return of tens of thousands of people from South Sudan, who were refugees in the north or in neighboring countries, is also of concern. These people are going to be exposed to diseases that are endemic to south Sudan, such as malaria, measles, meningitis, and tuberculosis. Managing the return of these displaced people will be an additional challenge for this region, where resources are already very limited, whether it’s food, drinking water, or health care.

Finally, we can’t forget insecurity, which is always omnipresent in South Sudan. In 2010 the violence led to more than 900 deaths and 215,000 people being displaced.

What is the situation in Abyei and Agok?

Uncertainty reigns in the Abyei region. The population has to decide whether to join south Sudan or north Sudan in a separate referendum scheduled for 9 January but just postponed to a later date. With the deadline nearing, tensions are high between the ethnic Dinka Ngok and the Misseriya.

In recent weeks, MSF has set up a support base in Turalei, two hours farther south of Agok by road. Surgical supplies have been put in position, and a team is ready to leave. We have also recruited doctors, surgeons, and anesthesiologists. In the event of population displacements, tents, basic supplies, and equipment for transporting and purifying water have also been readied.

What have MSF teams in the area observed?

For the moment it’s quiet. Nevertheless, our teams in Abyei are seeing trucks and buses full of returnees with their belongings. Tens of thousands of people are returning to their home villages in South Sudan. Some of these people are being helped by South Sudanese officials, who are organizing their return and aiding them when they arrive. Many of them were born in Khartoum and have never set foot in South Sudan.

Nearly 10,000 people have already returned to the Abyei region, but most of the returnees continue further south to their home villages, especially in the states of Warrap and Northern Bahr el Ghazal, and even to the city of Juba.

Since the peace agreement was signed in 2005, the city of Juba, which would become the capital of south Sudan in the event of independence, has gone from 150,000 people to at least 600,000 today. No one knows for certain. Underequipped and lacking qualified staff, the city’s only two civilian hospitals are unable to meet the needs. The situation will be all the more serious since Juba’s new residents, who migrated from the countryside or who returned from north Sudan, are poor. Right now this vulnerable population doesn’t have access to care. MSF is examining the possibility of opening a new health care facility.

How do the various communities of Abyei view MSF?

Right now the tension among the communities is such that we can no longer access the area north of Abyei with our mobile clinics from the city. Our constant concern is to provide basic care to all the communities in region.

Given this situation, MSF’s role is crucial: to provide aid and medical care to Sudanese in need, and to promote independent humanitarian action. It is essential we maintain our independence toward all parties in order to have access to the most vulnerable civilian populations no matter what their origin, gender, or religion.

MSF has been operating in Sudan since 1979, providing the population with emergency medical and humanitarian aid. MSF currently oversees 27 projects in 13 Sudanese states. The organization offers a wide range of services and runs a multitude of programs: primary and secondary health care, emergency response, nutritional aid, reproductive health care, treatment for kala-azar, and psychological, surgical, pediatric, and obstetric care.

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