Since the fighting erupted in Sudan on April 15, around 290,000 people have entered South Sudan—80 percent of them through the Joda border in Upper Nile state. Although formal and informal transit centers in Renk are meant for only temporary shelter, returnees are spending weeks or even months there, with limited access to food, shelter, water and sanitation, and health care.
Many people, especially children, are arriving at the border with alarming health conditions, suffering from deadly diseases like measles or malnutrition that require immediate medical care. To make matters worse, amidst the rainy season, MSF medical facilities in the area are recording a 70 percent positivity rate of malaria, a disease that already kills more people than any other in South Sudan, and is the world's most deadly parasite.
MSF is supporting Renk Civil Hospital’s measles isolation ward, an inpatient therapeutic feeding center, and a pediatric ward. In the wake of an influx of patients, teams have more than doubled the capacity of the wards, from 22 to 45 beds. Since July, MSF has admitted 232 patients for malnutrition and treated 282 cases of measles requiring hospital care.
“Aid is woefully inadequate in Renk compared to the needs, which are growing every day. We are calling on humanitarian and medical groups to do more by strengthening medical and humanitarian activities at the entry point and at transit centers. Basic health care services should be made available at all times for those crossing the border with medical conditions. A systematic vaccination catch-up should be also available 24/7 on the border, given the current low vaccination coverage in Sudan and ongoing outbreak of measles in both countries,” says MSF Head of Mission in South Sudan, Jocelyn Yapi.
Limited food supply and deplorable living conditions
“Malnourished children in particular must be given urgent nutritional support on the border and at once transferred to the medical facilities,” says Yapi. “Relief items such as mosquito nets, plastic sheets, and other essential non-food items should be provided at the border so nobody who is in need misses out.”
Although people there receive a one-off cash distribution of $12 USD per person, considering the high prices—a normal meal on average is sold for $2 USD in Renk—this assistance is hardly enough to afford one meal per day for a week. People are staying weeks and at times months without further cash assistance and there is no regular food distribution by humanitarian organizations or the authorities in the area.
"I am selling my clothes for 2,000 South Sudanese pounds ($2 USD) per piece to buy food. I have sold six of them and left with the remaining two to wear," says Marta Manher, a mother of six living at Zero, one of the unofficial settlements for returnees in Renk.
Limited food and deplorable living conditions are taking a toll on people’s health. In two mobile clinic sites run by MSF at Zero and Abukadra, the teams are recording 300 medical consultations each day and seven out of 10 are malaria patients. Most people there live under the open sky or in temporary shelters made of clothing. In this area, patches of stagnant rainwater provide ideal breeding grounds for mosquitoes, and people have no mosquito nets or other means of protection available to them.
An urgent humanitarian response is needed
In the Renk civil hospital, where MSF supports the measles isolation ward, 90 percent of patients are returnees and unvaccinated. On top of that, some severely sick patients are being transferred without receiving medical care to Malakal, a 48 to 72-hour journey by boat without medical care, water, or food. Deaths have been recorded on the boats and MSF teams are receiving severely sick patients at Bulukat transit center, resulting in a higher mortality rate at facilities in Malakal.
"The community of returnees is too vulnerable. Not only do they have insufficient food and drinking water, they do not have shelter, as they use pieces of cloth to protect themselves from the sun and rain. As we treat malnourished children in the hospital, we see that many mothers are also malnourished," says Abraham Anhieny, an MSF doctor in Renk.
Years of conflict have already caused one of the world’s largest humanitarian crises in South Sudan. As the country already suffers from regular disease outbreaks, flooding, displacement, and high rates of malnutrition, the arrival of returnees is another burden, and the current response is incapable of meeting additional needs. The country requires more attention and support to deal with the ongoing humanitarian crisis and the emergency caused by the conflict in Sudan.