MSF in SUDAN - TEST
Field Staff: 4,590
Reasons for Intervention:
Since 1979, MSF has worked in Sudan where attacks and outbreaks of violence frequently occur, malnutrition is prevalent, and maternal mortality rates remain among the highest in the world. Tuberculosis (TB) and kala azar, also known as visceral leishmaniasis, are common here, as are large-scale outbreaks of meningitis, measles, cholera, and malaria.
Sudan’s latest civil war began in 1983 and ended in 2005 when a peace agreement was signed between the North and the South, presaging the January 2011 referendum that saw the people of South Sudan vote overwhelmingly for independence. Doctors Without Borders/Médecins Sans Frontières (MSF) medical teams were active throughout (and prior to) the civil war, providing emergency medical humanitarian assistance in multiple locations.
The conflict destroyed what little infrastructure there was in the South and contributed to the region’s appalling health indicators. It is estimated that 75 percent of people in the nascent nation have no access to basic medical care. One in seven women dies in childbirth. Malnutrition and disease outbreaks are perennial concerns as well. This accounts for MSF’s continued presence in many areas. In fact, MSF’s work in Sudan is one of the organization’s largest interventions.
A clinic in Kaguro provides immunizations, in- and out-patient therapeutic feeding centers, a women’s health clinic, and emergency surgery. MSF is the only healthcare provider in Kaguro.
MSF also provides primary care and nutritional support at five health posts in the isolated mountain villages of Burgo, Bourey, Lugo, Useige, and Bouley, near Kaguro.
In Shangil Tobaya, MSF supports a Ministry of Health hospital that provides primary and secondary healthcare, including pediatric care, reproductive healthcare, and counseling services. The hospital was recently caught in the crossfire during a surge in violence in the area.
MSF supports the Ministry of Health at Tawila Hospital.
MSF runs a primary healthcare clinic in Pibor town that provides emergency care, mother-and-child care, and reproductive healthcare. The clinic features a 42-bed inpatient facility.
MSF also runs outreach primary healthcare units in nearby Lekwongole and Gumuruk, sites only accessible by boat or plane during the rainy season. Complex cases are referred to Pibor.
In the remote northern area of Lankien, MSF serves around 127,000 people in a clinic that provides all levels of medical care. Teams also run outreach sites in Pieri and Yuai, treating people in the region for malaria, kala azar, tuberculosis, measles, and malnutrition.
In Aweil Civil Hospital in Northern Bahr-el-Ghazal State, MSF supports the Ministry of Health with surgery expertise, including Caesarian sections, and provides gynecological and obstetric care, as well as antenatal and postnatal consultations and vaccinations.
In Western Bahr-el-Ghazal State, MSF works in Raja County, focusing on emergency preparedness and reducing maternal and pediatric morbidity and mortality. Between August and December 2010, MSF treated 2,700 patients.
In Juba, southern Sudan’s largest city, in Central Equatoria State, MSF runs activities to prevent cholera outbreaks, including community outreach programs and clean water programs. An MSF team has drilled seven new boreholes, repaired ten, and quality-tested more than 200 existing ones. MSF also constructed a new water system for the Ministry of Health’s El-Sabah Hospital.
MSF supports Ministry of Health facilities in Ezo and Makpandu refugee camps in Western Equatoria State. In addition, staff run mobile clinics in and around Yambio and support Yambio Civil Hospital.
In Leer, an area close to the contested north-south border in Unity State, MSF runs a hospital that provides all levels of care. MSF opened a feeding program in Bentiu, the capital of Unity State, in July 2010.
In Upper Nile State, MSF runs a hospital in Nasir, a city close to the Ethiopian border, and a primary healthcare unit in Beneshowa. The Upper Nile region is southern Sudan’s epicenter for kala azar. Teams frequently respond to outbreaks throughout the region with treatment for patients and training for local health staff. MSF also assists the Ministry of Health in Malakal Hospital.
MSF built a primary healthcare center with inpatient wards, a pharmacy, and a laboratory in Gogrial West County in Warrap State. Teams also provide maternity, emergency, obstetric, and surgical care out of two inflatable clinics. An MSF team also supports an existing health center in Turalei, where MSF has a base.
In the volatile Abyei region, MSF runs a hospital with a fully functioning operating theater in Agok. MSF also runs five mobile clinics in the northern part of Abyei.
MSF runs a kala azar treatment center in the remote village of Tabarak Allah in Al-Gedaref State. Al-Gedaref state is the most kala azar endemic area in Sudan, according to figures from the Ministry of Health, the World Health Organization, and MSF. MSF also runs a nutrition program in Gala Al-Nahal and Al-Quereisha localities in Al-Gedaref State.
In the city of Port Sudan, the capital of the Red Sea State, MSF assists the Ministry of Health in Tagadom Hospital. Teams provide a range of services in reproductive healthcare, work in an operating theater on complicated deliveries and Caesarian sections, and run a community health program on the harmful medical effects of female genital cutting.
Map of MSF activities in Southern Sudan, current through June 2009
Southern Sudan bore the brunt of the years of chronic warfare from the time of Sudan's independence from the United Kingdom in 1956 to present day. In the south, few people have access to adequate healthcare. Insecurity, violence, and mobility of the population facilitate the spread of diseases such as malaria, diarrhea, respiratory infections, intestinal parasites, sleeping sickness (human African trypanosomiasis), and kala azar. Because there is little capacity to deal with the consequences, preventable diseases like malaria, acute diarrhea, and measles are common causes of death.
Following a January referendum in which 98.83% of the electorate voted for independence, South Sudan is expected to become independent on July 9. In April, however, Sudanese president Omar al-Bashir said he would not recognize South Sudan if it continued to claim Abyei, a highly contested, oil-rich border region where MSF worked since 2006.
While the elections in January were conducted in relative peace, sporadic fighting erupted in late February and March in Upper Nile and Jonglei states, as well as in the disputed oil-rich border district of Abyei—clear evidence that considerable tensions remain. In Abyei, for example, an outbreak of violence in late February forced tens of thousands of people from their homes. MSF’s hospital in Agok, 24 miles south of Abyei, treated 21 wounded people for gunshot wounds. MSF also donated drugs and equipment to the Ministry of Health hospital in Abyei, while mobile teams were dispatched to assess the needs of people displaced by the fighting. Two weeks later, following clashes in western Upper Nile State, an MSF surgical team at Malakal Hospital provided urgent medical care to 24 people and performed 18 surgical procedures for gunshot wounds. Only a month earlier, 33 wounded people had arrived at the same hospital, six of them in urgent need of surgery.
We have seen thousands of people—mainly women and children—carrying bags on their heads, or sitting on mats on the side of the road, exhausted by hours of walking.
—Raphael Gorgeu, MSF head of mission
Fighting broke out throughout Abyei again on May 20. The regional capital of Abyei Town lay empty by May 21, as tens of thousands of people fled toward the south. MSF suspended all primary activities in Abyei Town and focused on assisting the displaced as they fled, placing mobile teams along the roads. An MSF hospital in Agok, 24 miles south of Abyei Town, treated 50 victims of the violence over one weekend. Teams set up a rehydration point in Agok Hospital and have been providing medical assistance, food, and relief items like plastic sheeting, mosquito nets and shelters along the roads.
Violence is not the only issue, however. MSF clinics in the area admitted 13,800 patients suffering from severe malnutrition in the first 10 months of 2010, a 20 percent increase from the same period in 2009 and a 50 percent increase compared to all 2008. South Sudan also recently experienced the largest outbreak of kala azar in the region in eight years. MSF teams opened programs to support the kala azar treatment unit in Malakal Teaching Hospital and established five kala azar satellite clinics in neighboring Rom, Adong, Khorfulus, Atar, and Pagil, treating thousands of patients in the latter half of 2010.
Despite the peace agreement signed five years ago, conflict persists in south Sudan as the economic and political changes brought on by the agreement have resulted in violent struggles for power. Nonetheless, in anticipation of the January 2011 referendum on secession, hundreds of thousands of people journeyed back to south Sudan at the end of 2010, adding to the two million who had returned in the five years since the peace agreement.
In the south, few people have access to adequate healthcare. Insecurity, violence, and mobility of the population facilitate the spread of diseases such as malaria, diarrhea, respiratory infections, intestinal parasites, sleeping sickness (human African trypanosomiasis), and kala azar. Because there is little capacity to deal with the consequences, preventable diseases like malaria, acute diarrhea, and measles are common causes of death.
Since 2008, MSF has been working in the emergency, maternity, and pediatric departments of Aweil Civil Hospital, in Northern Bahr El Ghazal state,. More than 18,000 returnees moved to camps around the town in 2010. MSF helped the hospital cope with increased demand for medical care. Staff held more than 37,000 antenatal consultations, assisted more than 3,000 births, and treated some 2,600 children for malnutrition. In Western Bahr El Ghazal state, a team began working in the extremely isolated Raja County in August, focusing on emergency preparedness, emergency surgery, and maternal and pediatric care.
In Western Equatoria state, which borders the Democratic Republic of the Congo, MSF provided basic healthcare and mental health services to people who had experienced violence, including children who had escaped from captivity. MSF staff worked in mobile teams to reach both remote, settled communities and displaced people living in camps. A team also worked in Yambio Hospital. Many patients had been injured in attacks carried out by the Uganda-based rebel group, the Lord’s Resistance Army.
Working in seven states in south Sudan as well as in the territory of Abyei, MSF carried out more than 588,000 outpatient consultations and provided some 96,000 women with antenatal care. More than 25,900 patients received treatment for malnutrition.
The number of cases of kala azar (visceral leishmaniasis), which is endemic in Sudan, reached an eight-year peak in the south of the country in November. Transmitted by the bite of a parasite-carrying sand fly, the disease is deadly if left untreated. Timely treatment can cure most patients.
MSF treated 2,600 people for the disease in Upper Nile, Unity, and Jonglei states. Patients were treated with a new drug called liposomal amphotericin B, which significantly reduces the length of treatment and has fewer side effects than other drugs. In collaboration with the Ministry of Health, MSF also treated 1,100 patients at a newly opened kala azar treatment center in eastern Al Gedaref state.
For a detailed overview of MSF's activities in Southern Sudan in 2010, click here
Escalating violence and disease outbreaks led MSF to launch several emergency interventions in southern Sudan in 2009. Medical needs, which were already at emergency levels in many parts of the country, increased dramatically during the course of the year as clashes between different communities left hundreds dead and thousands displaced.
MSF led emergency interventions in Akobo, Torkej, Lekwongole, Panyangor, Duk Padiet and Terekeka. In the areas where MSF responded staff recorded that three times more people were killed than were wounded, and high numbers of women and children were affected. Surgical teams in Nasir and Leer performed more than 1,000 surgeries in 2009, more than half of which were for injuries caused by violence.
Throughout the year the Ugandan rebel group, the Lord’s Resistance Army, launched frequent attacks on villages near the borders of the Democratic Republic of Congo (DRC) and Central African Republic, and in DRC itself. These caused thousands of Sudanese people to flee their homes and Congolese refugees to cross the border to seek refuge in Western Equatoria State. MSF has been in this area since the end of 2008, and adapted its activities to meet the changing needs. Medical staff started to work in Ezo, Naandi, Yambio and Makpundu, providing assistance to around 45,000 people living in camps or integrated within host communities.
"Their homes have been burned, along with their food stock. The people who managed to flee have nothing with them—they ran for their lives so they couldn’t bring any clothes or cooking pots."
—Dr. Jonathan Novoa, MSF medical coordinator in Akobo county
In 2009 teams carried out 14,000 consultations and provided psychological support to more than 800 people in Western Equatoria. Materials such as plastic sheeting, jerry cans, blankets, pans and mosquito nets were distributed to nearly 1,000 families, and latrines and water points were installed in refugee camps in the area. In February MSF also launched an emergency response in Lasu, Central Equatoria State, providing medical care to more than 6,000 people.
Emergency medical needs
In October, there was a new outbreak of the deadly disease kala azar in Jonglei and Unity States. Teams had screened and treated more than 450 patients by end of the year.
These emergency interventions were in addition to medical care that MSF provides in its longer-term projects in southern Sudan. Throughout the year, 1,400 staff provided treatment and medical care to hundreds of thousands of people in seven states in southern Sudan and in the transitional area of Abyei. Nearly 435,000 people received care and more than 10,300 were admitted to MSF’s clinics. More than 62,400 women had antenatal consultations and 8,000 children were treated for malnutrition. More than 50,000 people suffering from malaria were treated and 130,600 people were vaccinated.
Clashes between armed forces and tribal militias along the disputed border of northern and southern Sudan, coupled with political tensions, led to the displacement of several thousand people in Bahr-el-Ghazal state throughout the year. In January, MSF opened a new project in the city of Aweil. Because many of the displaced people had to leave behind everything, staff initially focused on distributing kits containing essential items such as soap, jerry cans, mosquito nets, tarpaulins, and cooking sets to the most vulnerable, covering the needs of more than 15,000 people.
MSF also started working in Aweil hospital, providing nutritional aid and health care to mothers and children. Since malnutrition was a key concern, six additional outreach clinics were set up to try to reach as many people as possible. In the course of the year more than 21,000 outpatient consultations were provided and more than 6,000 children were treated for malnutrition.
In February, after an extremely violent attack near the town of Abyei, thousands of people fled to camps in northern Bahr-el-Ghazal state, and an estimated 10,000 people fled into the bush. In May, fighting virtually destroyed Abyei, displacing another 60,000 people. MSF teams have been working in Abyei since 2006 and were able to provide immediate emergency assistance. Owing to the large numbers of war-wounded, surgical, and post-operative patients, teams were sent to support the existing MSF team.
In order to reach the people who had fled to the bush, mobile clinics were set up in both Abyei and the nearby town of Agok, and mobile and inpatient nutrition programs were put in place. By the end of the year, 8,950 outpatient consultations had been given and more than 1,200 severely malnourished children had been treated. MSF also organized distribution of non-food items in Muglad, north of Abyei, for around 400 families. Teams remain ready to respond quickly to any further needs that might arise in this unstable area where people are struggling to survive.
Southern Sudan: Thousands Dead, Whole Communities Homeless
Towards the end of 2008, attacks by the Ugandan rebel group, the Lord’s Resistance Army, in Southern Sudan near the Democratic Republic of Congo (DRC) caused thousands of Sudanese people to flee their homes. Congolese refugees also crossed the border to seek refuge in Sudan. In response, MSF started supporting two primary healthcare clinics in Gangura and Sakura, in Western Equatoria state, close to the border with DRC. By the end of the year, 7,200 medical consultations had been provided to the residents and refugees in these two areas.
In other parts of Southern Sudan, MSF continued to provide care to hundreds of thousands of people. In Jonglei, Upper Nile, and Unity states, medical staff provide all levels of health care, ranging from consultations for respiratory tract infections to emergency surgery. In 2008, medical teams carried out more than 365,000 outpatient consultations; 19,000 antenatal consultations; 1,000 operations, many of them emergency surgical interventions for gunshot wounds; and admitted more than 8,000 people as inpatients.
Overall, MSF treated 9,000 children for severe acute malnutrition in Southern Sudan, as well as over 600 people for violent trauma. Where possible, MSF has handed over activities. In June 2008, MSF handed over to the local health authorities its activities in Bor hospital, Jonglei state, after two years. At the end of the year, MSF handed over its sleeping sickness program in Yambio, Western Equatoria state, to the Ministry of Health.
Emergencies and epidemics
In July heavy rains and flooding exacerbated a cholera outbreak in Aweil. Working with the Ministry of Health and other agencies, MSF treated more than 6,700 people suffering from cholera. More than 1,200 cholera patients were also cared for in Juba, the capital of Southern Sudan, where cases were first detected in May. Because vaccination coverage is low in Sudan, children are vulnerable when there are measles outbreaks. MSF vaccinated more than 19,200 children during two campaigns in July and November 2008 in Pibor county, Jonglei state.
For more on the outlook in Southern Sudan in 2008, click here
The nutrition situation in Bahr el Ghazal remained dire. The precarious nutritional situation was aggravated by the return of displaced people and refugees following the peace agreements. Tens of thousands of people returned to Aweil East county alone.
An outbreak of cholera in Juba, the town designated to become the capital of South Sudan in the 2005 peace agreement, infected 1,864 and killed 45 people between February 6 and 21. By March 22, the disease had spread elsewhere, to Malakal, a port town on the Nile River. In April, a surge in meningitis cases in Bahr el Ghazal further ravaged the region.
In Kajo Keji on the southern border, MSF began offering care to HIV-positive patients in January 2005. Treatment with life-extending antiretrovirals (ARVs) began in April, and soon 12 patients were receiving them. In Malakal, Upper Nile state, and in Um el Kher, Gedaref state, MSF provided voluntary counseling and testing as well as care for opportunistic infections for HIV patients co-infected with TB or kala azar. In addition, a new primary health care project began in April in the former garrison town of Pibor, Jonglei state. In early 2005, MSF was able to establish a permanent presence in the Upper Nile town of Nasir, which was previously cut off from all outside assistance.
In Wau county, Bahr el Ghazal state, MSF's primary health care center and four outpatient centers were handed over to health authorities and another nongovernmental organization in June 2005. Similarly, in the Walgak area of Jonglei state in Upper Nile province, MSF handed over five health care units and a kala azar clinic to another medical relief organization. And, after 10 years, MSF ended its project in the Nuba Mountains. Over the years, teams had provided basic health care, carried out measles- vaccination campaigns, responded to two outbreaks of West Nile virus, provided TB treatment, and distributed drugs. The organization also had undertaken considerable work to combat malaria, conducting a study on parasite resistance to malaria medications, introducing artemisinin-based combination therapy and distributing 25,000 bed nets. Because the impact of the disease was reduced and regional stability improved, the project was handed over to an indigenous non-governmental organization.
By July 2006, the expected increase in aid following the signing of peace accords was slow in arriving. Hundreds of thousands of Sudanese returning from the north or from camps in surrounding countries found a country ill-prepared for their homecoming, with no transportation system, hardly any health infrastructure, and occasional outbreaks of violence.
On April 10, armed militia attacked the village of Ulang, where MSF operates a clinic that treated 11,000 outpatients in 2005. Most of the patients and villagers, along with MSF staff, fled in search of safety. Thirty-one people were reported killed and dozens injured; 15 were treated in the MSF hospital in the nearby town of Nasir. Subsequent outbreaks and threats of violence forced MSF international staff to evacuate from Nasir and from clinics in Wudier, Lankien, and Pieri. In Pieri, most of the patients in the MSF clinic, including 120 patients being treated for tuberculosis (TB), were forced to flee. Medical equipment, drugs, and food for the patients were looted, leaving the clinic effectively destroyed. In November 2005, MSF was also forced to evacuate its sleeping sickness project in Tambura in the Western Equatoria region because of fighting.
Within this climate of violence, lack of healthcare continued to be the biggest threat to the people of southern Sudan. Health facilities were rare, and despite the opening of some areas with the end of the war, the absence of a transport system continued to hamper efforts at increasing access. Much of the country is only accessible by air, an option limited during a rainy season that reduces much of the Upper Nile region to swamp.
For a summary of MSF's activities in Southern Sudan current through January 2008, click here
MSF continued to battle malnutrition, inadequate healthcare access and outbreaks of meningitis and cholera through the early 2000's, as well as endemic kala azar and rampant insecurity. MSF worked throughout the region, in the Bahr el Ghazal, Equatoria, Lakes, Jonglei, and Unity/Western Upper Nile areas. Staff were forced to evacuate on several occasions after hospitals were attacked, villages were raided, and airstrips were bombed.
In Unity State (also called Western Upper Nile), a disputed region in south-central Sudan, MSF began work in the town of Bentiu in August 2000, caring for severely malnourished children, running a small in- and out-patient clinic, and treating kala azar and tuberculosis, in addition to the six primary health posts MSF also maintained in the region. MSF provided aid in several locations in the disputed province, offering basic health care, inpatient and outpatient care, therapeutic feeding, and tuberculosis and kala azar treatment. In April 2002, MSF brought attention to the miserable conditions of civilians in the region in the report "Violence, Health and Access to Aid in Unity State/Western Upper Nile, Sudan." Based on 14 years of work in Western Upper Nile, the report showed that repeated displacement and continued fighting, coupled with lack of access to health care and humanitarian aid, were slowly killing off the region's people.
Disruption of aid activities – only one element of the fatal consequences of Sudan's long-running conflict on Sudanese civilians – is all too common in Sudan. In an attack on the village of Nimne in Western Upper Nile in February 2002, an MSF compound was looted. Days later a local MSF health worker was killed when three bombs were dropped on the village. MSF was forced to suspend its program in Nimne. A health clinic in Bieh also suffered disruption following a helicopter gunship attack. In March, another MSF team in the area was evacuated due to shooting. The attack on Nimne came in the same days that government planes bombed Akuem in the southern state of Bahr el Ghazal, where MSF ran a primary healthcare program and a feeding center. In Akuem, where the MSF-supported hospital was the only health facility in the region, 47,543 consultations were realized and 2,527 people were hospitalized in 2002.
2002 also saw the beginning of a peace process between the Sudanese government and the southern rebels of the Sudan People's Liberation Army (SPLA). By 2004, the peace efforts had greatly improved MSF's ability to reach new areas and had reduced the displacement of groups of people fleeing violence. In 2003-4, as the conflict in Darfur spiraled into a full-blown humanitarian crisis, MSF continued crucial, basic services like supplying food, water, and sanitation to the southern part of the country, and also assisted people affected by measles, meningitis, malaria and other infectious diseases. MSF treated people with TB in the towns of Akuem and Mapel in Bahr el Ghazal province, Bentiu in Western Upper Nile province and in Lankien in Eastern Upper Nile province.
MSF focused on the crisis in Darfur for much of 2004 and 2005, in addition to maintaining its efforts against malnutrition and disease in southern Sudan, where an estimated six million people relied on food assistance. In January 2005, a peace agreement was signed between the northern government led by President Omar al-Bashir and the southern rebel groups. Despite the ceasefire, conflict continued in the Bahr el Ghazal region, as a failed rainy season in 2004 led to a spike in malnutrition and clashes between the two main ethnic groups in southern Sudan, the Dinka and the Nuer, over livestock and other food sources.
On April 6, 1998, MSF launched an emergency appeal to fund nutrition and health programs in the embattled southern region of Bahr el Ghazal, where the entire population was suffering from the effects of the previous year's poor harvest, irregular rainfall and years of war. MSF had a large medical presence throughout Bahr el Ghazal, with twelve primary health centers. Teams found severe malnutrition rates to be as high as 40 percent in some areas. On October 26, 1998, MSF, CARE International, Oxfam/Great Britain, and Save the Children Fund (SCF) urged the UN Member States of the Security Council to take an active role in ending the fighting in Sudan. In a joint statement issued at the UN meeting in New York, the four largest international humanitarian organizations working in Sudan stressed that the ongoing war and resulting crisis "have now reached an unimaginable and extraordinary level of tragedy....Peace is the only hope for progress and to prevent further humanitarian catastrophe."
For more on the food crisis of 1998, see testimonies from MSF staff in the field in the special report Southern Sudan: Testimonies of a Human Tragedy part 1 and part 2.
MSF has provided medical-humanitarian aid in the Sudanese region of Darfur since 2003, when government forces and allied militia began fighting rebel groups seeking greater autonomy and resourcing for the arid and impoverished region. By 2006, the political environment became increasingly complex, with the continued fragmentation of armed groups leading to outbreaks of violence and heightened insecurity. Aid organizations, including MSF, were the target of numerous attacks and robberies, at times making delivery of aid extremely difficult. Harassment from armed groups, increased banditry and clashes between nomadic tribes led to new population displacements. The United Nations estimates that up to 300,000 people have died and more than 2.2 million have fled their homes since conflict in Darfur erupted in February 2003.
Access to healthcare for people in the Darfur region of western Sudan was difficult in 2009, especially following the expulsion of 13 international aid agencies, including two sections of MSF, by Sudanese authorities. Shortly after the expulsions, four MSF staff were kidnapped in Serif Umra, North Darfur. They were released unharmed after a few days, but these kidnappings, the first of their kind in Darfur, marked the start of a spate of kidnappings in the region: 14 people had been abducted by the end of the year. This increased risk forced many of the remaining aid agencies to scale back their activities in parts of Darfur.
More than half of MSF’s programs were forced to close as a result of the expulsions. Two more projects in Serif Umra and Kebkabiya in North Darfur, and activities in Tawila, also in North Darfur, were suspended. MSF nonetheless provided nearly 129,000 consultations, more than 24,000 antenatal consultations, admitted nearly 2,000 people to hospital and treated some 4,000 people for malaria throughout the year. Teams handed over projects in Golo and Killin to the Ministry of Health in October, and in the same month were able to restart activities in Tawila. At the end of the year, MSF started working in a remote area of North Darfur, Um Baru, providing medical support to five rural health centers that care for very isolated communities.
Following the expulsion of the Dutch and French sections of MSF by the Sudanese government in March 2009, three MSF sections continued working in Northern Sudan, in the western region of Darfur, Al-Gedaref State, and the Red Sea State, providing a range of services, including primary and secondary healthcare, as well as responding to emergencies as they arise. Security remains a pressing issue in Darfur, as banditry, sporadic clashes and bombing between different groups, and kidnappings of aid workers continue to occur.
By the end of 2007, the number of displaced people in Darfur had reached close to 2.5 million. Darfur remains the largest humanitarian aid operation in the world, with more than 80 organizations and 15,000 aid workers—2,000 of whom are from MSF. Some parts of the region were blocked from assistance due to insecurity or isolation. And in the context of rapidly changing alliances among armed groups and increasing violence, still more people were at risk of being cut off from aid.
Access to medical care and emergency support is a constant problem for populations faced with ongoing violence in west Darfur, complicated by refugee arrivals from neighboring Chad.
2007 © Sven Torfinn
MSF ran mobile clinics in Foro Boranga on the Chadian border from June to November, caring for 20,000 people with general consultations, nutritional assistance, vaccinations and mosquito nets. Following a serious security incident, MSF had to shut down its activities in Fora Boranga in November. In Habilah, another border camp with over 22,000 displaced, MSF’s health center began providing mental health services in May 2007. MSF also continued to provide medical and technical support in projects at the Aradamata and Dorti displacement camps from a base in El Geneina.
MSF supported a hospital in the town of Seleia in the north of the province, providing reproductive healthcare and medical services for victims of sexual violence, as well as surgical care. At the end of the year, MSF evacuated its international staff after an increase in fighting between the JEM rebel group and the Sudanese armed forces.
In the mountainous, rebel-controlled region of Jebel Mara, MSF worked in Niertiti, where 23,000 of the 33,000 people are internally displaced, and in nearby Thur and Kutrum. On average, 5,500 consultations and 278 hospitalizations took place each month in Niertiti alone. Diarrhea, respiratory infections and malnutrition are the main causes of hospitalization. A 2007 polio and measles vaccination campaign reached nearly 10,000 children, and a February 2008 anti-meningitis campaign vaccinated over 28,000 people in five days.
MSF opened new projects in Golo and Killin in Jebel Mara in April 2008. In government-controlled Golo, teams worked in the town’s hospital, providing in- and out-patient care, obstetric and nutritional care. In rebel-controlled Killin, MSF provided primary healthcare in the town’s clinic and ran a small emergency room. Medical activities in the area focused on women’s health, malaria and malnutrition.
2007 © Sven Torfinn
In Zalingei, where the 130,000-person population is mainly internally displaced persons (IDPs), MSF supported the local hospital in pediatric surgery and in the emergency room. Teams also worked in two camps for displaced people around Zalingei, providing nutritional care and referring patients with complications to the hospital. Around 1,500 malnourished children were admitted to the nutritional program in the first half of 2008. Teams also distributed supplementary food to thousands of children in and around Zalingei during the hunger gap period in May and June, but due to government restrictions the program was interrupted.
MSF also began working in Hassa Hissa camp, providing mother and child healthcare starting in February 2008. Staff performed around 13,200 mother and child consultations in 2008.
2007 © Sven Torfinn
With a population of 100,000, Kalma is one of the Darfur’s largest camps for displaced people. Here, MSF runs an outpatient health centre providing 3,000 consultations a month. The project includes a special component for women’s health and a comprehensive mental health service providing counseling, workshops, support groups and community outreach. In July, the MSF clinic was set on fire by arsonists. Tensions in the camp in October forced up to 15,000 residents to flee and find refuge around the capital with little access to aid. MSF responded by providing medical care to these displaced people using mobile clinics.
In the southern town of Muhajariya, MSF provides inpatient and outpatient care, surgery, and treatment for victims of sexual violence to approximately 70,000 people. Mobile and inpatient feeding are integrated into the basic healthcare program to respond to the high number of malnourished children. In October, an intensive attack on the town caused the death of two Sudanese MSF staff. Following this tragic incident, MSF evacuated part of its team from Muhajariya.
MSF opened a new project to assist the residents and displaced in and around Feina, providing basic healthcare, antenatal care and a home-based feeding program. About 130 patients were seen daily and the feeding program averaged 60 new admissions a month. MSF also started running mobile clinics to access a population that remains scattered across a broad area.
2007 © Sven Torfinn
MSF returned to the region of Kaguro in April 2007, where insecurity had forced teams to temporarily halt medical activities in mid-2006. Kaguro’s 85,000 residents have been completely cut off from assistance since 2003, when the whole area was attacked and most villages were burned. Many areas are reachable only by donkey. In addition to reopening a dispensary, MSF opened five health posts and established a network of community health workers.
In Serif Umra, an international team returned to a local health facility that had been run entirely by Sudanese staff since an evacuation of international staff in 2006. The Serif Umra facility sees 7,000 outpatient consultations a month and refers cases to the Zalingei and El Geneina hospitals.
Teams began working in Tawila in August 2007, an area where approximately 35,000 IDPs living in three camps had been without health services since April, when insecurity forced the last relief organization in the area to leave. Teams evacuated in mid-September after several security incidents, but returned again in November. MSF runs mobile clinics focusing on nutritional care and mother-and-child health care, as well as a 25-bed inpatient ward. In 2008, MSF expanded its services to a number of villages in the area surrounding Tawila.
MSF cares for 28,000 displaced people and the constant influx of newly arriving refugees in the Shangil and Shadat camps in Shangil Tobaya, as well as residents of Shangil Tobaya village. Staff perform around 4,000 outpatient consultations and deliver 15 babies every month, run a therapeutic feeding program, and provide reproductive health services and treatment for victims of sexual violence.
2007 © Sven Torfinn
In the town of Kebkabiya, 150 km (93 mi) west of North Darfur’s capital of El Fasher, MSF supports two dispensaries and one health post, providing basic health care, vaccinations and treatment of malnutrition. MSF also supports the obstetric department of Kebkabiya hospital with comprehensive emergency obstetric care.
For a detailed breakdown of MSF's activities in Sudan current through December 2008, click here
By mid-2005, more than two million people had been displaced by the ongoing violence plaguing the region, including more than 200,000 people who fled to neighboring Chad, where outbreaks of meningitis ravaged the refugee population. The scorched-earth campaign of the previous year was replaced by less overt, but equally devastating forms of violence and intimidation against civilians, including sporadic fighting, beatings and sexual violence. In all locations where MSF provides medical care, teams continue to see a significant number of victims of direct violence. From January to May 2005, MSF staff treated more than 500 people for violence-related injuries and 278 women for rape. Rape and sexual violence remained pervasive, inflicted on women and girls who had to venture beyond the borders of camps to find firewood, water and food for their families.
Insecurity continued to threaten displaced people and hamper humanitarian efforts. Numerous attacks against humanitarian workers drastically reduced the ability to deploy aid and reach people in need. Despite ceasefires and peace agreements, over a million people remained in camps, totally reliant on humanitarian aid for their survival, whilst violence raged around them.
On May 8, 2006, a truck arrived at the MSF clinic in the town of Muhajariya, northeast of the South Darfur capital of Nyala. “The truck backed up towards the clinic,” described MSF nurse Lisa Blaker. “When the doors of the truck opened and the tarp billowed up, I saw injured people piled on top of each other.” Of the 46 patients, 30 were civilians, many requiring urgent surgery because of gunshot wounds to their abdomens, shoulders, arms, legs and chests. Two patients died as a result of their injuries. Some patients described how their husbands, children and other family members were shot down and killed in front of them. The team in Muhajariya admitted 127 patients with violent trauma in April 2006 alone. The 35-bed hospital is regularly overstretched with the volume of patients requiring care.
A number of new projects were opened in Jebel Marra, a mountainous area in the center of Darfur, in the spring of 2006. MSF began working in two health posts in Lugo and Bouley, with a referral system to an expanded health center in Kaguoro. Clinics also opened in Killin and Gorni. By July, security constraints required evacuations and prevented adequate access in this region. MSF was unable to respond to a cholera outbreak in Jebel Marra because of a lack of security, and the level of malnutrition in the area began increasing, as people were trapped in the mountains and difficult to get to.
MSF began working in Darfur in mid-December 2003, with an initial deployment of one team of six volunteers. By February 2004, it was clear that six international staff and several dozen Sudanese staff would not be enough to meet the needs of the hundreds of thousands of displaced people. Staff set up distribution of potable water and emergency non-food items like jerrycans, blankets, and soap. They also provided nutritional assistance and vaccinated children against measles, working first in Mornay and Zalingei in West Darfur and spreading outward as the crisis worsened.
By April 2004, MSF's presence in Sudan had increased to 40 international volunteers and hundreds of Sudanese staff who worked to treat the measles and malnutrition rampant throughout Darfur, as well as to provide basic services like water, food and sanitation. Medical teams conducted medical consultations and hospitalizations, treated victims of violence, cared for severely and moderately malnourished children, and provided water, blanket feedings, and other essential items throughout the region.
A June survey conducted by MSF and the epidemiological research center Epicentre in the town of Mornay, West Darfur State, where nearly 80,000 people sought refuge, found that one in 20 people were killed in scorched earth attacks on 111 villages from September 2003 until February 2004. Adult men were the primary victims, but women and children were also killed. One in five children in the camp were severely malnourished, while irregular and insufficient food distributions could not come close to meeting the basic needs of people weakened by violence, displacement, and deprivation.
MSF's Darfur presence had swelled to 200 volunteers and 2,000 Sudanese staff by the end of 2004. Teams worked amid escalating violence throughout the region, treating displaced, malnourished, and wounded people in refugee camps where malnutrition and mortality rates were often well above emergency levels. Teams also worked with victims of sexual violence. MSF continued to call on the international humanitarian community to increase assistance to the region.
For a detailed breakdown of MSF's activities in Darfur from December 2003 to December 2004, click here