South Sudan: Latest MSF Updates
- South Sudan: Treating HIV-Positive People Affected by Conflict
- South Sudan: Endless Cycles of Displacement Continue Along the Northern Frontier
- South Sudan: Growing Risk of Malaria as Rains Begin
This information is excerpted from MSF’s 2016 International Activity Report.
More than three years of ongoing conflict, which has included extreme violence against civilians, has forced millions of people across South Sudan to flee from their homes. MSF continued to respond to urgent medical needs and maintained essential programs across the country despite growing challenges, including attacks on health care facilities.
In February 2016, the MSF-run hospital at the Malakal Protection of Civilians (PoC) site was attacked, and more than 25 people were killed, including two staff members. MSF published a report on the events and launched an international advocacy campaign calling on the United Nations Mission in South Sudan to provide credible security to civilians under its care and improve conditions at the site. In June, MSF completed a new 60-bed hospital on the site to replace the existing structure and opened a medical center in Malakal town.
After fighting broke out in July 2016 in the capital, Juba, MSF set up a surgical facility and ran mobile clinics across the city. In the first month, one outreach team treated 9,242 people. MSF staff also helped the Ministry of Health (MOH) set up and run a cholera treatment center.
In Greater Upper Nile Region, the MSF clinic in Pibor provided maternity and emergency services. Looting in February 2016 temporarily halted activities, but the clinic was operational again by April. The team started to offer surgery at the end of the year. MSF staff provided medical care to the 50,000 Sudanese refugees in Doro camp and the local community in Maban county.
The MSF hospital in Lankien, the only functioning medical facility in the area, admitted 1,068 patients to its therapeutic feeding program in 2016. Teams also provided treatment to 1,530 patients for kala azar (visceral leishmaniasis), a potentially fatal disease spread by sandflies. Malaria was the main morbidity at the hospital and in the primary health care center in Yuai; teams carried out 116,944 consultations.
MSF ran a 160-bed facility at the Bentiu PoC site, where 120,000 displaced civilians took shelter at the end of 2016. It was the only hospital on site, providing a range of services and running outreach activities in the POC and Bentiu town.
MSF set up emergency services in Leer and Mayendit counties as intense fighting displaced thousands of people, mostly into nearby swamps. Mobile teams provided care and treatment for survivors of sexual violence. In July, medical activities were temporarily disrupted when the MSF compound in Leer town was looted. In Yida, MSF offered inpatient and outpatient services, vaccinations, and HIV and TB treatment to refugees from South Kordofan, Sudan. MSF also ran facilities in Mayom county, Wau Shilluk, and Fangak.
In Equatoria Region, following an increase in violence, MSF set up a clinic in Yei. An MSF project set up in Mundri was suspended after an armed robbery. Despite clashes in the Yambio area, MSF continued its HIV program.
Aweil hospital, the only secondary health care facility in this area of Bahr El Ghazal region, served 1.5 million people. In 2016, the team provided maternal and child care and responded to a sharp peak in malaria. Further south, in Wau, MSF carried out around 42,000 consultations when violent clashes displaced more than 60,000 people in June.
Agok hospital provided specialist and emergency care to more than 140,000 people in the remote Abyei Special Administrative Area. Teams carried out around 50,000 consultations and treated more than 40,000 people for malaria in isolated villages.
Renewed Fighting in Former Upper Nile Resulted in Multiple Displacements and Humanitarian Crisis
Continued fighting over the past three months has forced 30,000 people to flee from Wau Shilluk and later from Kodok northward toward Aburoc, and toward refugee camps across the border in Sudan. Desperate living conditions and a pattern of violence in which territory rapidly changes hands has left civilians with few places to turn to for safety. Multiple displacements and lack of adequate food, clean water, and shelter have left the population vulnerable to malnutrition, dehydration, diarrhoea, and exhaustion.
In late April, close to 25,000 people were displaced when fighting erupted between the South Sudan People’s Liberation Army (SPLA) and Agwelek forces around the town of Kodok. Médecins Sans Frontières/Doctors Without Borders (MSF) was forced to temporarily suspend operations of two mobile units and a field hospital in the area. Other humanitarian actors also suspended operations.
MSF called on parties to the conflict to protect civilians and ensure their access to essential humanitarian services. The organisation’s staff traveling with the displaced population carried with them essential medicines and supplies, allowing them to provide basic treatment in the field.
The spreading violence and dire living conditions in Aburoc resulted in a second wave of displacement in May. Thousands of Aburoc’s internally displaced persons (IDP) fled for Sudan, where camps along the border have become increasing overcrowded. MSF is providing primary and secondary medical care at a field hospital in the area.
Both staying and leaving involve risk. Those remaining in Aburoc are almost entirely reliant on humanitarian assistance for their basic survival. With the rainy season at hand, transport of additional humanitarian aid to the area has become impossible. Lack of safe drinking water is a major concern that has led to numerous cases of diarrhoea. Food, shelter, and hygiene are also in short supply. In May and June MSF responded to a cholera outbreak in Aburoc and vaccinated over 11,000 people against cholera.
The journey northward toward Sudan is also fraught with risk. The 250-kilometre route by truck or by foot, offers little opportunity for food and water. Those who survive the journey are often suffering from dehydration, diarrhoea and malnutrition. Upon arrival, they find Sudan’s camps overcrowded and with limited supplies of water, sanitation, shelter, and non-food items. MSF manages a hospital in Sudan’s White Nile State, and since the beginning of the current emergency, has deployed an additional team of 30 medical staff to Khor Waral in order to support Sudanese authorities.
Thousands at Risk of Cholera and Malnutrition in Pieri
MSF teams continue to respond to the needs of displaced communities who have settled in villages around Pieri after having fled fighting which started in February. Many arrived with few belongings, living under trees as their only source of shelter. The dire living conditions have severely increased health risks, yet access to drugs and other medical supplies is limited as transport to the region becomes difficult with the arrival of the rainy season.
Poor hygiene and lack of safe drinking water have left many children sick, and cholera has become a major source of concern among the population. Beginning in May, MSF observed an increasing number of suspected cholera cases. MSF teams working in three areas are providing essential medical care and working to raise awareness on safe hygiene practices to combat the cholera outbreak. A cholera treatment unit has been set up in Pieri. MSF has also set up oral rehydration points in seven locations, including Pieri, Pathay and Modit.
Malnutrition is also a rising concern. In search of food and water, many people regularly make the four-hour walk to Pieri to collect humanitarian distributions for themselves and their families. These are often insufficient to feed an entire family, and many resort to eating tree leaves to supplement whatever food they can find. In June, one third (33%) of all children that attended our clinics were malnourished; 20% of the children screened were moderately malnourished and 13% were severely malnourished. In June and July, a total of 324 children from Pieri and around have been treated for severe acute malnutrition.
MSF Celebrates World Blood Donor Day
In celebration of World Blood Donor Day on June 13th, MSF organised several activities throughout South Sudan and Abyei Special Administrative Area to encourage blood donations. In Agok, where MSF has maintained a blood bank since 2015, events included a football competition and a show by traditional dancers.
The activities marked an important occasion for MSF to highlight how blood donations can help save lives and provide assistance to those in need. Blood banks in the country often run low and patients who urgently require transfusions cannot receive them, especially during peak malaria season. MSF staff therefore raised awareness about the process of giving blood by explaining that it is free, voluntary, and that the only requirement is that people be in good health. After the events, those who were willing to give blood were referred to hospitals where they could then have their blood taken.
MSF health promoters will continue to encourage blood donations for the remainder of the year at hospitals, health care centres, villages, and markets throughout South Sudan and Abyei Special Administrative Area.
MSF Operations in Response to the Medical Needs in South Sudan
MSF condemned the outrageous violence in the Malakal Protection of Civilians (PoC) site on February 17 and 18, 2016, which claimed the lives of 19 people, including two MSF staff. The violence left humanitarian facilities destroyed and thousands of civilian shelters burned to the ground. The population of 47,000 who were sheltering in the camp at the time of the attack had already suffered through two years of conflict and displacement and were living in inhumane and overcrowded conditions. With large sections of the camp now destroyed, protection of civilians and a sustained humanitarian effort is required to provide basic life-saving services to the affected population. MSF strongly condemns the attack, which is yet another instance of brutality in a conflict marked by utter lack of respect for the lives and dignity of civilians. At the same time, MSF calls on all armed actors to respect the provision of medical assistance to vulnerable populations in the wake of the unacceptable looting and ransacking of its medical center in Pibor. Thousands of residents fled to the bush to escape the violence with no access to assistance. In this moment of immense medical need, MSF has launched an urgent response, but its capacity to respond to medical needs in Pibor, Lekuangole, and Gumuruk has been severely diminished as a result of this unacceptable looting.
MSF Condemns Outrageous Attack in UN Protection Site in Malakal
Two MSF staff were among 19 people killed during brazen and unacceptable violence in the PoC site in Malakal on February 17 and 18. At least one of the two MSF staff died while attempting to assist the wounded. In total, MSF treated 108 people injured in the fighting, 46 of whom suffered from gunshot wounds. MSF has received further reports that other people who tried to put out fires or help the wounded were targeted and shot. Large sections of the camp were destroyed, including medical and humanitarian services, as well as thousands of civilian shelters. MSF had warned previously that living conditions in the camp had already been overcrowded and jeopardized the health of the population due to poor hygiene, sanitation, and access to water. This was of particular concern as the 47,000 people seeking protection in the camp were already extremely vulnerable, having endured two years of displacement, conflict, violence against civilians, and destruction of their properties and livelihoods. Now, the population confronts yet another, far more severe humanitarian crisis.
In the wake of the destruction in the PoC, thousands of people are living in dire conditions, in sections of the camp not designed for human habitation and without adequate access to hygiene, sanitation, or shelter. The MSF hospital provides the bulk of the secondary health care available to the population. Teams are already seeing increased numbers of patients admitted for respiratory tract infections and diarrhea, illnesses which are associated with poor living conditions. A further 5,000 displaced people are now living in Malakal town, where MSF has begun to provide mobile clinics to provide basic primary health care to the population. Protection of the population, which continues to fear for its security, must be assured and the humanitarian response in the immediate aftermath of this tragedy must be sustained to improve the conditions of the population and prevent outbreaks of disease.
MSF Launches Urgent Medical Response in Pibor
After being forced to evacuate from the MSF compound amid heavy fighting in Pibor from February 23 to 25, MSF has resumed minimal medical operations in its looted facility in response to urgent medical needs. Amid intense fighting, the MSF team was forced to evacuate to the UN base due to the imminent possibility of being caught in the crossfire between armed groups. In the immediate aftermath, the medical team supported treatment of 36 wounded patients, including one six-year-old child suffering from a gunshot wound who died because it was impossible to provide the intensive care treatment needed. The team established a medical clinic and temporary hospitalization ward in the UN base, where 2,000 people are seeking shelter in substandard conditions, and almost two thirds of MSF’s patients are children under five years old suffering from malaria, respiratory tract infections, or diarrhea.
In Pibor town, the MSF medical center was thoroughly looted in the wake of the fighting. Medical equipment, fuel, patients’ beds, life-saving medicines, and therapeutic food used for treating malnourished children have all been stolen. MSF recently relocated back from the UN base to the MSF compound, where medical teams have resumed limited medical services. Thousands of people fled to the bush amid the recent fighting, where they have no access to medical assistance. MSF completed an assessment mission to Verthet, where teams treated three patients and encountered significant unmet health needs. However, the unacceptable looting of MSF’s medical center has greatly reduced its capacity to respond to present needs or to sustain its programs in Pibor, Lekuangole, and Gumuruk at the level and scale that was previously provided. MSF strongly condemns this unacceptable attack on the provision of medical assistance. The situation on the ground remains tense and MSF demands that all armed actors respect the provision of health care.
Responding to Urgent Needs in Leer and Mayendit Counties
MSF is providing urgent medical assistance to vulnerable, conflict-affected populations in Leer and Mayendit counties with clinics in Leer Hospital and Thonyor as well as mobile medical and nutritional clinics. The population is this region has been heavily affected by conflict, including long-term displacement, destruction of shelters, and livelihoods. With the return of other humanitarian actors in 2016, MSF is beginning to finally see the number of children admitted in its therapeutic feeding programs decreasing. However, the population remains highly food insecure and dependent on humanitarian assistance for survival. A sustained humanitarian presence is urgently needed to prevent deterioration in the health of this extremely vulnerable population.
Other urgent medical needs MSF is addressing in the region are high levels of acute watery diarrhea, skin and eye infections, and respiratory tract infections; all of which are associated with the deplorable conditions in which people have been living while fleeing from conflict. The rainy season will begin in the coming months, along with accompanying annual outbreaks in life-threatening disease, which will increase the medical needs. MSF has been looted three times in Leer since conflict began. As a result of repeated lootings, MSF’s capacity to provide medical assistance is greatly reduced from the scope and quality of services it was able to provide before the conflict began.
To escape the violence in Juba, tens of thousands of people sought refuge in UN compounds, where Protection of Civilians (PoC) sites were designated. MSF set up medical facilities in the Tomping and Juba House PoC sites, but spoke out about the deplorable living conditions there, and in other PoC sites in the country, throughout the year. With the gradual stabilization of medical needs, and as other organizations increased their activities, MSF’s medical projects in the Juba PoC sites were handed over to the International Medical Corps, South Sudan Red Cross, and Health Link South Sudan in August.
The rapidly worsening security situation in January forced the evacuation of international staff from Bentiu. In April MSF was forced to stop providing TB and HIV care in the hospital because of increased violence. The town’s residents fled to the nearby UN compound, where the population swelled from 6,000 people to more than 22,000 in a matter of days.
By the end of the year, the number had increased to 40,000. At the PoC site, MSF maintained a 24-hour emergency room and provided more than 10,000 outpatient consultations, treated nearly 1,000 children for severe malnutrition, and performed 300 emergency surgical interventions, 83 percent of which were conflict-related—mostly gunshot wounds. Tens of thousands of children were vaccinated against measles inside and outside the PoC. MSF ran mobile clinics and set up both a general and an antenatal clinic for people outside the site. Another team maintained a program of comprehensive medical services for some 70,000 Sudanese refugees at Yida camp, and undertook a pneumococcal vaccination campaign—the first ever in a refugee setting. Some 10,000 children under the age of two were vaccinated. MSF also has various decentralized clinics and malaria points throughout the PoC.
In Leer, the international MSF team was evacuated in January due to increased insecurity. Shortly afterwards, 240 South Sudanese MSF hospital staff were forced to escape into the bush with their families and some of the most severely injured patients. By mid-April, the local population had begun to return to the town and in May medical activities resumed. By this time malnutrition in the area had reached crisis levels, and during May and June MSF treated more patients for malnutrition than in all of 2013. Along with the therapeutic feeding program, MSF also provides primary health care for the violence-affected, displaced population through mobile clinics.
South Sudan | A Hospital Destroyed, A Community Devastated
Some 70,000 people fled the town of Bor as a result of violence and the state hospital was ransacked. In April, an MSF team helped the health ministry repair the hospital and resume basic medical activities. MSF now provides support in the emergency room, pharmacy, pediatric inpatient department, and with vaccinations. A team also treated people wounded during an attack at Bor airport. MSF had long supported Lankien Hospital, and in 2014 began emergency surgery to treat the increasing number of war wounded. Of the 910 major surgical interventions performed at the hospital, 76 percent were violence-related. There was also a massive outbreak of kala azar (visceral leishmaniasis) and more than 6,000 patients were treated.
Insecurity in Pibor in 2013 caused MSF to withdraw from a fixed health center and operate instead through mobile clinics. By July 2014, the situation had stabilized and MSF resumed activities in Pibor town, including basic health consultations, inpatient services, and maternity care. Teams also offered health care in nearby Gumuruk, Lekwongole, and Old Fangak, areas regularly affected by the war. In February 2016, MSF was forced to leave the compound in Pibor due to heavy fighting and shelter in the UN base on the other side of town. The MSF compound was then looted, and medical supplies, therapeutic food, and even patients beds were stolen. Anything that was not taken, including drugs and medical documents, was strewn around the compound. MSF continues to treat patients, particularly young children suffering from malaria and other infections, at the UN compound.
Upper Nile State
In a pre-existing project at Nasir Hospital, a monthly average of 4,100 consultations were carried out until heavy fighting broke out nearby. The town’s population fled and the hospital was evacuated in May. MSF staff visiting in June found the hospital completely looted and the town deserted. They had no way of knowing the whereabouts or the health status of those who had fled.
Due to mounting insecurity, MSF had to stop working in the Malakal Public Hospital in April and rapidly opened a clinic in the PoC where 20,000 people were sheltering. In Melut, teams provided medical care to those people displaced by violence, which included treating them for kala azar and TB. As the health situation in the refugee camps stabilized over the year, MSF reduced its number of outpatient clinics.
MSF provided basic and specialist health care, including vaccinations, in Minkamman camp, Awerial.
Around 95,000 displaced people live in the camp, and more have settled in the surrounding areas. Teams carried out more than 52,000 outpatient consultations and 2,700 mental health consultations and also launched vaccination campaigns against measles, polio, cholera, and meningitis.
Following a measles outbreak in Cueibet county in late March, MSF provided support to the health ministry and organized a vaccination campaign against measles and polio which reached 32,700 children under five.
Northern Bahr El Ghazal State
In Pamat, close to the border with Sudan, MSF continued to offer basic and specialist medical care to people displaced by conflict. Staff distributed relief items and provided health consultations to new arrivals in December. Since 2008, MSF has supported Aweil Civil Hospital, with around-the-clock pediatric and maternity services, including high-risk and emergency obstetric care—more than 7,100 women were admitted to the maternity ward and over 1,500 complicated deliveries were assisted during the year. In addition, MSF treated more than 30,000 people for malaria in 2014—three times as many as the previous year.
MSF has also supported Yambio State Hospital in Western Equatoria state since 2008, with specialist pediatric and antenatal care, surgery, and treatment for HIV. There are more than 3,000 patients in the treatment program. In Warrap state, MSF runs a small hospital in Gogrial town providing basic and specialist care, including an operating theater for emergency surgery.