Since February 2008, the situation in Aweil, Bahr-el-Ghazal State, has worsened. The combination of: clashes between armed forces and tribal militias along the disputed border of northern and southern Sudan; ongoing political tensions; increased food insecurity due to flooding last year and the return of thousands of Sudanese former refugees; and a lack of functioning medical facilities has prompted MSF to launch an emergency response.
Southern Sudan 2007 © Sven Torfinn
Malnutrition is the first priority, and MSF has set up several feeding centers. Food distributions are much needed, but the World Food Program has switched from a conflict to post-conflict context, which means there are no more general food distributions, only targeted ones which rely on other organizations to conduct the actual distributions. The situation is particularly serious for the 12,000 displaced people who are gathered in three sites to the north of Aweil. MSF teams have distributed 3,000 kits containing essential items like soap and jerry cans for water to the most vulnerable. Medical teams are also concerned about the very high prevalence of malaria well before the “malaria season”. MSF has set up a treatment unit for complicated malaria cases in Aweil hospital.
In other parts of southern Sudan, the security situation remains precarious and outbreaks of fighting are frequent. In Bor hospital, Jonglei State, four out of every ten patients operated on are victims of violent trauma. In November 2007, MSF was forced to temporarily withdraw staff from the hospital when clashes between different tribes in the area led to the deaths of four people within the MSF compound. Since then, MSF has not been able to transfer patients from certain ethnic groups to Bor hospital to receive care.
Trying to meet the needs
Southern Sudan 2007 © Sven Torfinn
An absence of health-care staff and health structures, roads and transportation, other humanitarian aid providers, and investment, means that in many areas of southern Sudan, MSF is one of the only medical organizations present, and it is struggling to meet the substantial needs. MSF teams work in six states, providing medical care ranging from primary health care to treatment of sleeping sickness. In 2007, staff in MSF’s health centers and hospitals in Jonglei, Upper Nile, and Unity states saw more than 350,000 outpatients and performed more than 2,000 surgeries. In Unity State, around 150 of the patients who were operated on had to be airlifted in from remote sites.
Health care for women is of particular concern, as the maternal mortality rate in southern Sudan is one of the highest in the world. Food insecurity, especially during the ‘hunger gap’ of April to July, is also an issue. In many areas where MSF works, staff are seeing levels of acute malnutrition above emergency threshold levels defined by the World Health Organization. In addition to providing assistance in fixed structures, mobile clinics and outreach teams are essential parts of MSF’s work, as they ensure that people living in extremely remote areas, without roads or any transport facilities, can receive medical care.
Responding to emergencies
Southern Sudan 2007 © Sven Torfinn
In a country devastated by more than 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 is crucial.
When meningitis swept through southern Sudan in early 2007, MSF emergency teams were on hand to respond immediately. Between January and April 2007, the Ministry of Health reported 11,447 suspected cases of meningitis, including 632 deaths, in nine out of ten states. MSF teams responded by setting up a surveillance system to monitor cases, supplying health structures with medicines, treating people, and launching mass vaccination campaigns in all nine of the affected states. In total, around 2,113 people were treated, including 255 severe cases, and more than 630,000 people were vaccinated. In July 2007, MSF also supported the Ministry of Health in Wau, Bahr-el-Ghazal State, after an increase in diarrhea cases.
MSF teams responded to several cholera outbreaks throughout 2007 by setting up isolation and treatment centers and reinforcing teams with additional staff. In total, 2,400 people were treated for cholera during the course of the year. MSF teams also ran measles vaccination campaigns, vaccinating 47,500 children. After flooding in September, MSF staff distributed essential survival items, such as cooking sets, to around 3,000 families in Ayod and Pochalla, Jonglei State.
At the end of 2007, MSF reinforced its emergency response capacity by setting a permanent base in Juba focusing on outbreak surveillance, rapid assessment, and immediate response in collaboration with the Ministry of Health and various partners in ten states. By April 2008, this emergency team had intervened in four of the ten states. In Malualkon, Northern Bahr-el-Ghazal State, the team assisted people who had been displaced by heavy fighting; in Kapoeta, Eastern Equatoria State, they evaluated measles, meningitis, and hepatitis E alerts; in Marial Lou, Warrab State, the team was responsible for providing emergency surgery; and in Yei, Central Equatoria State, they responded to a cholera outbreak.
Caught between northern and southern Sudan : the case of Abyei
Located between Bahr-el-Ghazal, Warrab, Unity, and Southern Kordofan states, Abyei* is geographically, ethnically, and politically caught between northern and southern Sudan.
The vacuum in which Abyei sits places the area in a precarious position. Neither the northern nor the southern administration has assumed full responsibility for all sectors of government. As a result, there is no clear channel for the distribution of resources from the federal or state government, nor is there decisive management of the health sector, which results in local services being hugely under-resourced, and both primary and secondary health-care services being poorly covered.
On top of this, tensions between the Dinka and Misseriya tribes during the migration season led to major clashes between the Sudan People’s Liberation Army and the nomadic Misseriya along the border between South Darfur and Northern Bahr-el-Ghazal at the end of 2007. As a result of this fighting, MSF teams have seen a high number of casualties and some displacement.
In Abyei town, MSF supports a 30-bed Ministry of Health hospital with inpatient and outpatient services. MSF provides primary and secondary health care, including: comprehensive obstetric care; tuberculosis treatment; and a therapeutic feeding program. In February 2008, an emergency nutritional program was started, and more than 400 malnourished children are currently receiving treatment.
In addition to supporting the hospital, MSF teams also work with other organizations to monitor and assess the health situation, with particular regard to epidemic outbreaks, through mobile and community activities in the rural areas of Abyei. However, in February 2008, these activities had to be put on standby due to the political tensions and deteriorating security situation.
* MSF takes no position on the determination of Abyei's geographical boundaries.