February 24, 2012
South Sudan 2011 © Alfons Rodriguez
MSF has been working in the region that today constitutes the Republic of South Sudan since 1983. In 2011, MSF responded to several emergencies, including large-scale displacement, refugee influxes, inter-communal fighting, alarming nutrition situations, and peaks of disease such as malaria and kala azar. Working in eight states in South Sudan as well as the territory of Abyei, MSF employed more than 2,000 national staff working alongside nearly 200 international staff.
In 2011, MSF hospitalized 26,321 patients, performed 387,506 outpatient consultations and 58,216 antenatal care consultations, delivered 8,446 babies, treated 52,083 malaria cases, admitted 20,025 malnourished children, performed 4,109 major surgeries including Caesarean sections, and treated 2,478 kala azar patients and 998 tuberculosis (TB) cases.
While inter-communal cattle raiding in Jonglei has a long history, the violence involved has become more intense since 2009, with villages entirely destroyed and women and children targeted. As a result, many civilians have lost their lives and tens of thousands have lost all of their belonging and been displaced. In addition to the direct casualties from the attacks, there are long-lasting consequences: whole villages are displaced for months and people are forced to live in precarious conditions, becoming vulnerable to malaria, diarrhea, and malnutrition.
In the northeastern part of Jonglei, MSF runs a busy clinic in Lankien, which serves around 127,000 people. With outreach sites in Pieri and Yuai, MSF teams provide treatment at all levels of medical care, from respiratory tract infections to spear wounds. In northern Jonglei in Lankien, Pieri, and Yuai, 74,641 patients were treated in the outpatient departments in 2011.
In August 2011, MSF responded to a major raid on the town of Pieri and twelve surrounding villages in northern Jonglei State, treating more than 100 wounded patients in the town of Pieri and referring another 57 to hospitals in Leer and Nasir, the majority of whom were women and children with gunshot wounds. One of MSF’s South Sudanese staff members was killed, along with all of her household members. MSF’s compound and clinic in Pieri were targeted by raiders who looted medical equipment, drugs, and other valuable items and burned down parts of the MSF facilities.
In early December 2011 MSF teams observed a high number of malaria cases in Lankien, Pieri, and Yuai. In response, the teams increased their outreach activities in these locations and the surrounding counties. MSF treated 3,160 malaria cases in December 2011 and 4,575 cases in January, far above average of 300–400 patients per month.
In central Jonglei, MSF runs a hospital in Pibor town, with two outreach primary health care units providing basic care in the villages of Lekwongole and Gumuruk. MSF is the only provider of health care for Pibor County's population of 160,000 people, with the nearest alternative health care more that 93 miles (150 kilometers) away. In 2011, MSF provided 35,075 consultations in Pibor, Lekwongole and Gumuruk. The teams also provided 6,635 antenatal consultations and delivered 521 babies, treated 3,598 patients with malaria, treated 1,037 severely malnourished children, and provided care for 496 people with violence-related injuries.
In a series of attacks in this area of Jonglei in the last week of December 2011, the MSF hospital in Pibor was looted and ransacked and MSF’s clinic in Lekwongole was burned, leaving only the walls and roof remaining. Among the many residents killed in these attacks were a member of MSF’s South Sudanese staff and his wife. Thousands of people fled to the bush to seek safety where many remained for weeks, afraid to return home. MSF treated 103 people with violence-related wounds in the first month after the attack, many of whom were women and children. The lengthy displacement in the bush has led to a sharp increase in other pathologies; compared to the last three weeks of January 2011, the medical team saw a doubling of cases of severe malnutrition and of malaria in the same period in 2012.
The cycle of violence has continued since early January, with attacks taking place in the northern half of Jonglei, particularly in Akobo and Uror Counties. As of February 10, 2012, MSF has treated a further 35 gunshot wounded patients in its facilities in Lankien and Nasir. MSF has also responded to the displacement caused by these attacks in northern Jonglei and Upper Nile by carrying out mobile clinics and health assessments in areas such in Pathai and in Nasir, Upper Nile State.
This violence and displacement is taking place against a backdrop of worsening food insecurity country-wide. The food security situation throughout Jonglei is expected to worsen in 2012 compared to previous years due to cumulative effects of violent attacks, significant displacement, continued high food prices, and poor harvests.
Northern Bahr-el-Ghazal State
In Aweil Civil Hospital, MSF works to reduce maternal and pediatric mortality, treats malnutrition, and responds to epidemic outbreaks in the surroundings. Aweil Civil Hospital is the primary referral center for secondary pediatric care and obstetric emergencies in the state of Northern Bahr-el-Ghazal for an estimated 900,000 people.
Here MSF staff perform minor surgeries and Caesarean sections, and provide gynecological and obstetric care and mother and child health care, including ante- and post-natal consultations and vaccinations. In 2011, MSF teams delivered 3,665 babies, conducted 39,596 consultations, hospitalized 3,792 children and admitted 1,233 children in the inpatient therapeutic feeding center (ITFC).
Transitional Area of Abyei
MSF has worked in the transitional area of Abyei since 2006, providing primary health care and treatment of severe malnutrition for children under five years old through an outpatient clinic in Abyei town and running mobile clinics in the northern part of the area. However, in mid-May 2011, heavy clashes and bombing in and around Abyei between the northern Sudanese Armed Forces (SAF) and the southern Sudan People's Liberation Army (SPLA) forced MSF to evacuate the Abyei clinic on May 21, 2011. MSF is working to regain access to the population in the north of Abyei and improve access to primary and secondary health care.
In Agok, about 25 miles (40 kilometers) south of Abyei, MSF runs the only secondary health care center in the area, with surgical facilities, out- and inpatient care, reproductive health care, and treatment for severe malnutrition and TB. Here MSF works to respond to the needs of the most vulnerable in Agok and the nearby regions of Twic County and the South of Abyei Administration Area through mobile clinics and referrals of serious cases to MSF’s hospital in Agok.
The increased violence and hostilities in the Abyei region in mid-May caused a massive exodus of an estimated 100,000 people towards the south. MSF responded quickly by focusing on performing lifesaving surgeries, treating malnutrition, providing reproductive health care, vaccinating children, and providing access to secondary health care. MSF received 53 wounded in the Agok hospital in the first four days of the fighting and treated at least 2,300 people in the first two weeks. Agok and the surrounding areas became host to thousands of people displaced by the violence in Abyei, where most remain today.
In Agok and the surrounding areas, displacement and flooding has seriously affected people’s access to food and their ability to feed themselves. The added burden of refugees, returnees, and internally displaced South Sudanese; as well as widespread crop failure, flooding, trade disputes, and inflation in the local markets could potentially cause a food crisis in the region in 2012. As early as November 2011, MSF teams in Agok began receiving an unusually high number of malnutrition cases for that time of the year. In response, in December 2011 MSF launched a two-month preventative supplementary feeding program for children at risk of becoming malnourished in the months ahead. 10,200 children received this preventative care in the first round and 14,365 children did in the second. The aim of preventative supplementary feeding is to reduce the chance that children become so malnourished that they require therapeutic feeding, or, worse, hospitalization.
As of late December 2011, Unity State has received the highest number of returnees in South Sudan, with more than 87,000 displaced people coming back to the state. This influx of returnees; refugees fleeing fighting in South Kordofan, Republic of Sudan; violence and displacement of the population within the state; continued high prices and trade disputes; and late and erratic rains are all cause for concern and will likely contribute to a worsened food crisis in 2012.
In Yida, the northernmost part of Unity State, about 9 miles (15 kilometers) from the border of South Kordofan, Republic of Sudan, refugees are arriving from the Nuba Mountains as they flee ongoing conflict. As of December 2011, MSF is providing a broad range of inpatient and outpatient care in Yida for a target population of 20,000 people. MSF is monitoring the situation closely as the context in the north remains extremely volatile.
MSF is one of the few organizations providing medical care in Leer, an area south of the oil fields of northern Unity State with close borders to Warrap and Jonglei states. In Leer MSF teams run a hospital which provides all levels of care including emergency surgery, outpatient health care, and surveillance of and response to medical emergencies and outbreaks. In 2011, MSF teams conducted 80,771 outpatient consultations, treated 6,997 people for malaria, and admitted 3,604 people to the hospital, 391 of whom received surgery.
In 2010 MSF opened a feeding program in Bentiu, the capital of Unity State, as teams were seeing increasing numbers of patients from Bentiu seeking treatment in Leer. The nutritional situation in Unity State is extremely worrisom and it seems that the high levels of malnutrition cannot be attributed to the annual hunger gap alone. Continued insecurity, the absence of trade with Sudan, high returnee numbers, and displacement in Unity State are likely to directly impact people’s ability to produce and purchase food in 2012. MSF treated 8,503 children for malnutrition In Leer and Bentiu in 2011.
Upper Nile State
In November 2011, MSF launched an emergency response to a massive influx of refugees from Blue Nile State in Sudan to several locations in Maban County. In the Doro refugee camp, which hosts approximately 30,000 refugees, MSF has undertaken substantial emergency water and sanitation activities as well as running outpatient and inpatient health centers providing a range of primary and secondary health care services. Medical consultations have revealed a consistent pattern of malaria, respiratory tract infections, and diarrhea among the new arrivals, and MSF is starting to treat children with severe malnutrition.
In the Jamam refugee camp, which hosts approximately 30,000 refugees as of February 10, 2012, MSF is running emergency water supply measures, providing primary health care, and preparing to provide secondary health care. MSF is also prepositioning emergency cholera kits in advance of the approaching rainy season.
MSF teams have also been running outreach clinics in areas closer to the border where groups of refugees are gathering in Chata, El Fuj (around 20,000 refugees in January 2012), Khortumbak, and New Guffah.
From the start of MSF‘s emergency response in Maban County to February 5, 2012, MSF has performed more than 10,000 outpatient consultations, vaccinated 12,000 children between 6 and 59 months against measles, and is providing an average of 150,000 liters of water per day.
MSF runs a hospital in Nasir offering primary and secondary health care in this isolated region of Upper Nile State. In 2011, MSF teams provided 57,409 outpatient consultations. More than 1,269 people were treated for malaria, 2,310 children were treated for malnutrition, and 2,972 people were admitted to the hospital, of whom 273 received surgery. In Nasir, MSF teams work to address maternal mortality with more than 5,811 pregnant women receiving antenatal care and 605 babies delivered in 2011.
The wider Upper Nile region is the epicenter for the neglected tropical disease kala azar in South Sudan. In 2010, the largest outbreak of kala azar in eight years occurred, with MSF teams treating more than eight times as many cases than in the previous year. In 2011, MSF supported the Ministry of Health's kala azar activities in Malakal, Upper Nile State, and in Pagil, Atar, Khorfolus, Adong, and Rom, with technical and material support. MSF teams treated 1,251 patients for kala azar in 2011. After more than one year of support, MSF will hand over these medical activities to the Ministry of Health in the first months of 2012.
Renk in Upper Nile State is the first entry point for the vast majority of returnees coming from the Republic of Sudan. In late 2011, MSF assessed the returnee camps and opened an outpatient clinic in Abayok Camp in early 2012 where approximately 12,000 returnees have gathered.
In December 2009 MSF began providing health care in Gogrial West County on an outpatient basis. There was no hospital in the county so people in need of urgent surgery were forced to travel long distances at great personal expense. To meet the medical needs of the approximately 240,000 people living in this area, MSF built a primary health care center, with inpatient wards, a pharmacy, and laboratory. In 2010, MSF expanded the services to provide maternity, emergency obstetric, and surgical departments. In 2011, the MSF team in Gogrial provided 25,608 medical consultations, delivered 407 babies, and carried out 709 major and minor surgical procedures.
In addition to providing primary and secondary health care, MSF teams responded to several emergencies, including measles outbreaks and violence. In the first days of January 2011, an MSF team from the Gogrial project vaccinated 13,000 children in Kuajok to control a measles outbreak. A cattle raid in the Toch area of Gogrial East resulted in an influx of 18 gunshot-wounded patients in need of surgery to the MSF project in Gogrial on May 8 and 9.
A mobile clinic team runs a weekly outreach therapeutic feeding program at Akon South. More than 120 children have been admitted into the ambulatory program, and the trend as of early February 2012 is showing increasing admissions into the program.
Western Bahr-el-Ghazal State
MSF began working in Raja County in August 2010, focusing on emergency preparedness and reducing maternal and pediatric morbidity and mortality. MSF is supporting the Ministry of Health hospital in Raja in the inpatient and outpatient departments for children under the age of five as well as providing antenatal and maternal health care and treatment for malnourished children. In 2011, MSF conducted 15,627 outpatient consultations, supported the treatment of 10,155 malaria cases, delivered 648 babies, and admitted 2,041 patients.
Western Equatoria State
MSF is providing essential primary and secondary health care in Yambio. In May 2010, MSF began supporting the pediatric, outpatient, inpatient, and reproductive health departments of Yambio Civil Hospital. In 2011, MSF performed 20,992 outpatient consultations and treated 13,894 people for malaria in Western Equatoria State. MSF teams admitted 3,068 people to Yambio Civil Hospital and performed 119 surgeries.
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)