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MSF in Sudan, 2006/2007
Field Staff: 4,590
Reason for Intervention:
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in January 2005, the signing of the comprehensive peace Agreement between north and south Sudan ended decades of civil war. the Darfur peace Agreement was signed in May, 2006. And in the east of the country, a simmering conflict was brought to an end by a peace agreement in october 2006. Yet insecurity and displacement continue in Darfur and many people throughout the country lack access to the most basic healthcare.
All across the south, the health system has to be almost completely rebuilt and the Ministry of Health (MoH) lacks the capacity to deal with the major epidemics that frequently ravage this part of the country. MSF has responded to numerous outbreaks of cholera, measles and meningitis. In March and April 2007, MSF vaccinated approximately 700,000 children against meningitis.
In the Upper Nile State of southern Sudan, MSF maintains a number of projects focusing on primary healthcare. Because of a desperate shortage of infrastructure, reaching much of the region, especially in the rainy season, is particularly onerous and few NGOs are present on the ground. In the western Upper Nile, a former frontline area with increasingly significant oil exploitation, MSF runs a hospital in Ler town, offering in- and outpatient services, tuberculosis (TB) treatment, ante-natal care, surgery and feeding programs. Since December 2006, MSF has also provided antiretroviral treatment (ART) for HIV/AIDS. In the Upper Sobat, MSF runs a hospital in the former garrison town of Nasir and four outreach clinics in the northern Upper Nile area, accessible only by boat or air. In Jonglei and Eastern Upper Nile, remote rural areas without road access, MSF has clinics in the towns of Lankien and Pieri. In both places MSF provides basic healthcare with in- and outpatient services, TB and kala azar treatment and ante-natal care. Institutional and home-based feeding programsare also in place. Outreach teams cover four health clinics in the surrounding area. In Jonglei State, MSF conducts an average of 4,500 consultations monthly in the referral civil hospital in Bor, a “secondary level” care facility, including surgery, inpatient, outpatient and maternity services, whilst in Pibor, MSF runs one county referral health centre and two outreach clinics.
In Yambio, in the province of Western Equatoria, a new sleeping sickness project was opened in October 2006, focusing on community awareness and screening. A ward for the sleeping sickness treatment was set up in Yambio County Hospital. Since opening, a total of 2,500 patients have been screened and 78 treated.
In Bentiu, located in the oil-rich Unity State, MSF teams are treating patients co-infected with HIV/AIDS, TB, and the potentially fatal parasitic disease, kala azar. The number of patients has decreased in 2007 and MSF is preparing the handover of its activities by the end of the year.
In the east of the country, MSF continues to support Port Sudan hospital, whilst in the capital, Khartoum, MSF was able to close the Mygoma orphanage in December 2006. In Bahr El Ghazal, MSF withdrew in March 2007 from a hospital in Akuem, established seven years ago during the civil war, when people were unable to reach any other health facilities. The project had established primary and secondary healthcare, a nutritional center and treatment for TB. In 2006, nearly 60,000 people received medical consultations and 345 people were admitted for standard treatment for TB alone. A second project in Marial Lou was also closed in mid 2007.
The situation in Darfur has shown little or no improvement over 2006/2007. Four years into the conflict, over two million people remain in camps for the displaced, violence continues and swaths of the region are still largely inaccessible for aid workers. Over a year after the signing of the May 2006 Darfur peace agreements, various armed factions - both rebels and pro-government - have splintered. Increasing insecurity has caused MSF to temporarily reduce some of its work and repeatedly suspend clinics because of attacks on compounds or danger on the roads. Teams are sometimes forced to evacuate and MSF relies completely on air transportation through many areas. MSF has more than 2,000 staff working in the region.
The mountainous rebel-controlled Jebel Marra area of Darfur has been a particular area of concern. Violence against NGOs and a lack of security has made this area extremely problematic to reach with humanitarian assistance. MSF provides an average of 4,500 consultations and 200 hospitalizations per month in Niertiti, a town in the foothills of the Jebel Marra. Emergency cases are referred to the Zalingei hospital. MSF supplies technical support to this reference structure, which has an average of 600 hospitalizations monthly. In Kutrum, MSF runs a health centre, one of the only medical facilities serving the entire western part of the Jebel Marra, carrying out approximately 1,400 consultations per month. MSF also runs projects in Kaguro, Killin and Gorni in the same region, although temporary evacuations of international staff are common. Seleia was a site of ongoing fighting in 2006/2007. In early 2007, a four-person team set up a surgical facility to treat the wounded and assist in emergency obstetric cases. The team also provides support to the health center, and a mobile clinic is planned.
In El Geneina, the capital of West Darfur, MSF supports the emergency and surgery ward of the general hospital by providing medicines, medical materials and technical support. Fighting to the north of El Geneina led to the displacement of several thousand people in December 2006, 5,000 of whom arrived in the nearby Aradamata and Dorti camps. In Aradamata camp, on the outskirts of town, MSF set up a medical mobile unit to screen new arrivals, and more than 500 people were treated in less than a week. In 2006, MSF performed surgery on 574 people with violent injuries in the town of Muhajariya. When fighting erupted towards the end of 2006, causing the displacement of approximately 50,000 people, some 20,000 sought refuge in Saleah, where an MSF team provided food and outpatient services. Whilst MSF was able to close its projects in Shariya in April 2007, a new South Darfur project was opened to provide healthcare for the thousands of displaced in Feina. In Sherif Al Umra, North Darfur, despite numerous evacuations, MSF continues to provide healthcare to 40,000 displaced persons. MSF also continues to work in large camps for the displaced. In Habilah, a camp near the border with Chad, MSF runs a medical clinic with a 30-bed inpatient ward. The clinic provides therapeutic feeding for severely malnourished children and ante-natal care and assistance with deliveries. On average 35 babies are delivered each month in the health center. Outreach workers assist with health education and referrals. In 2006, 25,000 consultations were conducted in the outpatient department and 750 patients were hospitalized. Following a wave of insecurity in Chad in early 2007, thousands of people fled to the Foro Baranga area, to the south of Habilah. MSF set up a system of mobile clinics providing basic healthcare in five locations, targeting an estimated 35,000 people.
In Um Dukhum, also bordering Chad in West Darfur, MSF handed over its hospital, which was providing surgery for the conflict-affected population. In 2006 MSF carried out distributions of plastic sheeting and blankets for newly displaced arriving in the area. In the camp of Mornay, where 68,000 displaced people are still living, MSF handed over its medical activities in June 2007 after three years of emergency assistance. The Ministry of Health and other organizations already working in the camp were able to take over. In 2007, teams started working in the 75,000 strong Kass camp, located between Zalingei and Nyala. In North Darfur, MSF is the only humanitarian agency providing healthcare services for 25,000 displaced people living in Shangil and Shadat camps, and for the inhabitants of Shangil Tobaya village. MSF provides in- and outpatient services, runs women’s health and therapeutic feeding programs and assists victims of violence. The outpatient department carries out approximately 200 consultations daily.
With a population of over 90,000 people, Kalma remains one of the largest camps for displaced people in the world. MSF continues to provide medical assistance with a focus on mother and child care through a dedicated women’s clinic, where approximately 120 women deliver babies each month. A mental health program has also been established to help people cope with the psychological stress of violence and displacement.
MSF has worked in Sudan since 1979.