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MSF in Sudan, 2006
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Sudan is the site of MSF's largest operations, with hundreds of international and thousands of national staff working in over 30 separate locations.
At the end of 2005, whilst a much-heralded January peace agreement between the Khartoum government in the north and the SPLA/M rebel group in the south had held, sporadic fighting and a slow pace of change heightened fears that stability will not last the six-year period before the south votes in a referendum on self-determination. Armed conflicts continued to simmer in the south, east, and in the Darfur region to the west, where fighting and violence against the population has raged for over three years, driving over two million people from their homes.
“The health situation hasn’t improved and there are still only a few organizations that are offering medical assistance. For many Sudanese living in the areas where MSF works, life is just as difficult now as it was before the peace accord.”
Violence continues in parts of southern Sudan
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 10 April, 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 continues to be the biggest threat to the people of southern Sudan. Health facilities are rare and despite areas opening up with the end of war, the absence of a transport system is a huge barrier to access. This also represents a challenge for humanitarian work, since 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.
MSF offers primary healthcare in multiple locations including Marial Lou and Akuem in the Bahr El Ghazal province and Ler and Wudier in the Upper Nile. In the Upper Nile province alone, MSF treated 250,000 outpatients at six locations in 2005. MSF also operates a 200-bed hospital in Kajo Keji in Equatoria, where 200 patients were treated for sleeping sickness in the first half of 2006. This is the only hospital in southern Sudan providing HIV treatment, with 50 patients taking antiretrovirals as of July.
A new project was opened in April 2006 in Bor in Jonglei Province. The town of Bor has become host to thousands of people who have returned to the south following the end of the war. With only a dilapidated hospital and few medical facilities, the town is ill-equipped to deal with any influx. MSF is currently upgrading the hospital to be a referral structure with a fully functional surgical unit and capacity for 100 inpatients.
In the town of Pibor, several hundred kilometres to the east, MSF teams have carried out over 5000 consultations monthly, working out of tents during the construction of a new primary health center. This number includes outreach consultations in the smaller health units of Lekuanguole and Gumuruk, difficult to reach overland and obliging MSF to use boats if the river swells enough during the rainy season. In Unity State, an area still disputed between north and south, MSF works in the Bentiu hospital, where a total of 17,125 consultations were provided in 2005.
Responding to staggering needs in Darfur
In 2004, MSF launched the biggest humanitarian operation in the organization's history to provide assistance for the people in Darfur. Two years later, MSF still had 170 international and over 2600 Sudanese staff working in 18 locations, where health needs remained staggering. In North Darfur State in December 2005 alone, MSF carried out just under 20,000 medical consultations.
Numerous attacks against humanitarian workers have drastically reduced the ability to deploy aid and reach people in need. Despite ceasefires and peace agreements, over a million remain in camps, totally reliant on humanitarian aid for their survival, whilst violence still rages around them.
Examples are manifold. 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 also runs a hospital in Niertiti, a town of around 3000 residents and as many as ten times that number of displaced in the foothills of Jebel Marra. This hospital admitted 1128 patients in the first half of 2006.
Since 2004, MSF has worked in Mornay, a camp for displaced persons housing about 80,000 people. An MSF-constructed health center and hospital conduct an average of 4900 medical consultations monthly. Healthcare services are also provided by MSF for displaced living in the Shangil and Shadat camps and Shangil Tobaya village, though this project was evacuated on July 23 after a security incident.
Kalma is one of the largest displacement camps in the world, where MSF runs a primary health clinic with almost 1000 consultations weekly and a women's health center that includes treatment for sexual and gender based violence. The project is complemented by community outreach and a mental health program to help people cope with the profound psychosocial stress they are experiencing.
MSF also provides primary and emergency healthcare and nutritional support to more than 100,000 persons, more than half of them displaced, in the more stable government areas of Kabakabiya and Serif Umra.
Assisting marginalised populations in the east
Sporadic fighting also continued over the past year in Sudan's eastern Red Sea and Kassala states. On the outskirts of Port Sudan, MSF runs the Tagadom Hospital, which treats a marginalised population coming mainly from nearby shantytowns. The hospital includes a home visitor network, set up to care for displaced persons in the area, and a focus on maternal healthcare. By mid 2006, 5000 consultations were performed here each month.
Handover of Mygoma orphanage
Since 2003, MSF has been working in Mygoma orphanage, Khartoum, where the mortality rate of children was a staggering 80 per cent. After collaborating with local authorities, rehabilitating the institution and providing psychological, medical and nutritional care to these children, the mortality average within the orphanage was reduced to 2.9 per cent. MSF will hand the project to local partners by the end of 2006.
MSF calls for more humanitarian support in Darfur
The situation in the camps in Darfur continues to be precarious, with a reported 2.1 million people completely dependent on external aid. In May 2006, MSF issued an alert highlighting the dwindling donor interest in the crisis. With the World Food program forced to reduce food rations because of a lack of financing, a serious nutritional crisis also threatened displaced persons, whilst other vital services such as drinking water supplies and hospital support were also affected by budget cuts.
As of July 2006, ongoing security incidents caused MSF to continue to evacuate projects intermittently.
MSF has worked in Sudan since 1979.