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MSF in Sudan, 2007
Field Staff: 3174
Reason for Intervention:
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More than three years after the signing of the Comprehensive Peace Agreement, medical needs in south Sudan remain critical. In many areas, MSF is struggling to maintain primary healthcare services, while reinforcing secondary care and emergency outbreak response services.
In a country devastated by over 20 years of war, with little or no health infrastructure, where deadly diseases are common and outbreaks of meningitis and cholera frequent, the ability of MSF teams to respond quickly and efficiently to emergencies remains crucial.
When meningitis swept through southern Sudan in early 2007, MSF emergency teams responded immediately. Between January and April, the Ministry of Health reported 11,447 suspected cases of meningitis, including 632 deaths, in nine out of 10 states. MSF teams set up a surveillance system to monitor cases, supplied health structures with medicines, treated people and launched mass vaccination campaigns in all nine affected states. Around 2,000 people were treated, including 255 severe cases, and more than 630,000 people were vaccinated.
A country devastated by over 20 years of war, with little or no health infrastructure
MSF teams responded to several cholera outbreaks throughout the year by setting up isolation and treatment centers and reinforcing teams with additional staff. Some 2,400 people were treated for cholera. In July, MSF supported the health authorities in Wau, in Bahr-el-Ghazal state, after an increase in diarrhea cases. MSF teams also ran measles vaccination campaigns throughout 2007, vaccinating 47,500 children. After flooding in September, MSF staff distributed essential survival items, such as cooking sets, to 3,000 families in Ayod, Jonglei State.
The struggle to meet substantial needs
An absence of healthcare staff and health structures, roads and transport, other actors and investment means that MSF is the only medical organization present in many areas of south Sudan and struggling to meet the substantial needs. MSF teams worked in five states, providing medical care ranging from primary healthcare to surgery and treatment of malnutrition and sleeping sickness.
Staff in MSF’s health centers and hospitals in Jonglei, Upper Nile and Unity State performed over 350,000 outpatient consultations and more than 2,000 surgeries. In Unity State, around 150 patients operated on had to be airlifted in from remote sites. As well as working in fixed structures, mobile clinics and outreach teams are an essential part of MSF’s work, ensuring that people living in extremely remote areas without roads or transport facilities can receive medical care.
The security situation remains precarious. Outbreaks of fighting are frequent and the number of patients in MSF wards suffering from violent trauma is high, representing four out of 10 patients undergoing surgery in Bor Civil hospital (Jonglei State). In November, MSF was forced to withdraw staff temporarily from Bor when clashes between different tribes led to the death of four people within the MSF compound.
In some areas, MSF has been able to hand over or end its activities. In March MSF withdrew from a hospital in Akuem, Bahr El Ghazal State, which was established in 2000 during the civil war, when people were unable to reach any other health facilities. Services included in- and out-patient care, antenatal care, deliveries, treatment for TB and emergency interventions for meningitis, cholera, malaria and malnutrition. In the seven years MSF worked in the hospital, teams provided over 320,000 outpatient consultations and treated 1,187 people with TB.
In October, MSF handed over responsibility for Marial Lou rural hospital, in Warap State, to a partner organization and as a new hospital was opened in Bentiu, Unity State, MSF also decided to end its assistance in this area as well. Activities there had focused on kala azar, tuberculosis and HIV co-infections.
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 for the arid and impoverished region. in 2007, the political environment became increasingly complex, with 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. harassment from members of armed forces, increased banditry and clashes between nomadic tribes led to new population displacements. by the end of 2007, the number of displaced people in Darfur had reached close to 2.5 million.
2.5 million people are currently displaced in Darfur.
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. In June, MSF started working in Foro Boranga on the Chadian border, caring for 20,000 people living in difficult conditions whose basic needs included food and clean drinking water. Mobile clinics were started to provide general consultations, nutritional assistance, vaccinations and referrals for the seriously ill. Mosquito nets were also distributed. 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. The health center is being handed over to Save the Children, as their presence together with the increased involvement of the Ministry of Health in the area are sufficient to meet the needs of the population. MSF also continued to provide medical and technical support in projects at the Aradamata and Dorti displacement camps from a base in El Geneina.
Seleia, in the north of the province, has witnessed significant fighting. MSF supports a hospital in the town, providing reproductive healthcare and medical services for victims of sexual violence and 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 Zalingei, home to 100,000 displaced people, MSF opened two outpatient feeding centers and handed over some of its activities in the hospital, where there is an increased presence of Ministry of Health doctors.
In the mountainous rebel-controlled Jebel Mara, MSF provides healthcare in Niertiti, where 23,000 of the 33,000 population are internally displaced. On average, 5,500 consultations and 278 hospitalizations take place each month. MSF also travels to nearby Thur twice a week, consulting 200 patients a day.
In Kutrum, MSF staff perform around 1,900 consultations a month and refer emergency cases to Zalingei hospital. A polio and measles vaccination campaign reached nearly 10,000 children.
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.
MSF provides medical care to approximately 70,000 people in the southern town of Muhajariya. Services include inpatient and outpatient care, surgery and treatment for victims of sexual violence. 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, ante-natal 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.
In early 2007, newly displaced families began arriving in the Bulbul area from west and south Darfur in search of security. Approximately 25,000 people were in need of relief. MSF provided clean water and distributed essential survival items such as soap and blankets.
Many people were killed and most survivors fled to the surrounding mountains.
In April, MSF was able to resume medical activities in the dispensary in Kaguro, which had been on stand-by since a deterioration in security in mid-2006. Care is provided to almost 85,000 people completely cut off from assistance since 2003, when the whole area was attacked and most villages burned. Many people were killed and most survivors fled to the surrounding mountains. Activities were extended to five additional health posts at the end of 2007 and a network of community health workers was established. Transport and access remain a challenge and many of these health posts are reachable only by donkey.
An international team returned to the medical facility in Serif Umra in July. This has been run entirely by Sudanese staff since an evacuation of international staff in 2006. There are 7,000 outpatient consultations each month. Patients needing secondary healthcare are transferred to hospitals in Zalingei or El Geneina.
In August, MSF started working in Tawila, where approximately 35,000 internally displaced people had gathered in three camps. They had been without health services since April, when the last relief organization in the area had to leave due to security problems. MSF started mobile clinics and established a small inpatient ward in Tawila town. The team suffered several security incidents and had to be provisionally evacuated in mid-September. Activities resumed in November. All services are in place and an average of 3,000 consultations take place each month.
In Shangil Tobaya, MSF cares for 28,000 displaced people in the Shangil and Shadat camps and residents of Shangil Tobaya village. Services include inpatient and outpatient departments, a therapeutic feeding program, reproductive health services and treatment for victims of sexual violence. Malnutrition rose in 2007 because continued insecurity meant people still could not cultivate or grow crops.
MSF runs three health centers in Kebkabiya, assisting some 75,000 people, many of whom sought refuge in the city at the beginning of the conflict in 2003. Some 12,000 consultations take place each month. MSF also supports the Kebkabiya public hospital, mainly in the obstetric ward.
MSF closed its clinics in Killin and Gorni in the Jebel Mara. This area had been stable for many months and had a number of other health facilities. MSF also withdrew from the Mornay camp in west Darfur, handing over activities to the government and other organizations. In Um Dukhun, bordering Chad and CAR, MSF offered primary, secondary and surgical healthcare for refugees and displaced communities until the middle of 2007.
Until April 2007, MSF teams worked in Shariya, south Darfur, a government enclave where 27,000 people had regrouped before being systematically dispersed by attacks. MSF was compelled to scale down the program after repeated robberies from its mobile teams. MSF also ended outpatient services and a feeding program for displaced people who had fled Muhajariya in 2006 and had been living in Seleah and Yassin.
MSF has worked in Sudan since 1979, and in Darfur since 2003.