As Refugee Numbers in South Sudan Grow, MSF Scales Up Emergency Response

MSF continues to supply aid as the registered number of refugees gathering in the tiny village of Doro in South Sudan increases daily.

South Sudan © Jean-Marc Jacobs

A woman uses the pump at the only water point in Doro, where thousands of refugees from Blue Nile State in Sudan are gathering.

Doro, Maban County, South Sudan

The registered number of refugees gathering at the tiny village of Doro, as of December 7, was 21,500 and increasing daily. Anywhere from 500 to 1,000 newcomers are registering every day. The walk from their homelands in Blue Nile State, Sudan, took anywhere from one week to one month. Although the work to set up a properly organized refugee camp is under way, no family groups arriving at the gathering point at Doro have yet been allocated a plot. So the reality for most is still to find a small tree or bush under which to spread the belongings they were able to carry.

The refugees say they have fled war in Blue Nile State in neighboring Sudan. A community elder who recently arrived told Doctors Without Borders/Médecins Sans Frontières (MSF) staff that he believes his entire community of 5,000 has fled to Doro. “We came, all of us,” he said. “No one remains behind.”

He said his community is largely subsistence farmers, cultivating land for food. Their newfound circumstances, which he is worried may last for years, are unsettling. Many of them have been in this situation before, as past refugees in camps in Ethiopia for a decade during the civil war in Sudan. “I feel very bad being here because we see that life will be difficult for us with no food and water,” he said. “My people keep asking me how we are going to survive in this place.”

The limited services in the area are overwhelmed. Near the perimeter of what is being marked out as the refugee camp, a borehole with a hand pump that has been servicing the local villagers is now overcrowded with women and girls who sometimes wait in line with their plastic water containers for up to 12 hours at a stretch. Tensions are rising.

“Many of the patients that we see in our clinic have respiratory diseases,” says MSF clinical officer Robert Mungai Maina. “And there are many patients with diarrheal diseases because for the past weeks there were no latrines and there is not enough water. Today we had four cases of bloody diarrhea and many more cases of watery diarrhea. We are also seeing malnourished children, some with moderate and some with severe malnutrition. We’re here to provide healthcare, but with our water and sanitation team we are also digging latrines, preparing to supply water, trying to meet the immediate needs.”

One 33-year-old man told MSF that he had come to seek safety, but that he was presented now with a new set of problems. “[During our journey] my children would ask me, ‘Where are we going?’ They wanted to go home. I told them we were running away from the war. We needed to get to a safe place. But here there are a lot of problems facing us. We came to a place where we can be secure, but food security is now replacing the other security problem that we ran from.”

What MSF Is Doing in Doro

On November 28, 2011, MSF set up a temporary clinic in Doro. To date MSF has conducted 700 consultations in the temporary clinic, including 100 patients treated for malaria and more than 100 antenatal consultations. Because this is not a good sanitary environment for giving birth, a midwife will shortly join the MSF team, which also includes a doctor, a nurse, two clinical officers, a health promotion officer, and other humanitarian emergency specialists.

Most of the refugees seeking medical attention present with respiratory and diarrheal diseases. This is largely due to people sleeping without shelters in the cold nights and the lack of clean drinking water and accessible sanitation. Malaria is also common.

The clinic is providing vaccines, notably against measles, tuberculosis, and tetanus for specifically vulnerable individuals and young children. Children suffering from malnutrition are receiving ready-to-use therapeutic foods fortified with the proteins and minerals they need to regain their strength.

MSF’s water and sanitation specialists have started digging latrines and are setting up temporary measures to speed up the supply of chlorinated water. These are emergency measures until other nongovernmental organisations can scale up their operations to provide comprehensive water and sanitation services.

In all, MSF has 15 international staff and upwards of 70 locally hired staff working to provide the urgent healthcare and basic water and sanitation requirements in Doro. MSF logisticians have started setting up a dedicated clinic in the heart of what will be Doro refugee camp. The team expects to start mobile clinics or other medical services in other areas of Maban County affected by the sudden influx of refugees.