When heavy fighting broke out and bullets started flying around the Doctors Without Borders/Médecins Sans Frontières (MSF) medical center in Pibor, South Sudan, Dr. Marisel Mendez was treating a two-year-old boy in the pediatric ward, a concrete room with six hospital beds and cheery cartoon drawings on the walls. The young patient had severe malaria, extreme anemia, and relied completely on the oxygen machine and intravenous drip that Marisel was attending to for his survival. As she cared for the boy, Marisel heard the first gunshots in the distance but stayed focused on her patient.
As the sound of gunshots grew closer and closer, Marisel saw through the window that staff and patients were beginning to run towards the designated safe area of the MSF compound. Yet still Marisel stayed, sitting on the floor of the ward beside the child’s mother to stay low while attending to her patient. She remained as long as possible, but eventually it became clear it was getting too dangerous to stay. Marisel also ran to the designated safe area, arriving as the first sounds of bullets whizzing through the air could be heard.
With the increasing sound of heavy weaponry and a real risk of being caught right in the middle of the crossfire, the MSF team moved out to the United Nations (UN) base on the other side of town. As the team left, some patients who managed to make it to the front gate of the medical center were able to jump into the vehicles that whisked them away, but the two-year-old boy Marisel had been treating with was not among them.
A week later, reflecting on the horrifying events of that day, Marisel is haunted by the gut-wrenching knowledge that the team had no choice but to leave patients behind in the middle of the chaos. “For me, that was truly the hardest moment.”
Days of Violence
Fighting continued in Pibor for three days, from February 23 to 25, and as soon as the MSF team arrived in the UN compound they began supporting the treatment of wounded patients. One of them was a six-year-old boy, hit by a bullet in the stomach. Despite the best efforts of the medics who poured their energy into saving him, the wound was too severe and the child died the following day.
The thirty-five other patients wounded in the fighting all survived. But as Marisel and the other MSF nurses, midwives, and logisticians scrambled to provide lifesaving care, the MSF medical center that has served the Pibor community for over 10 years was ransacked and looted to the point of being totally unusable.
Fans were ripped from the ceiling in the patients’ wards, electronic equipment and fuel were taken, and all the therapeutic food used for treating malnourished children was stolen. Anything of value that was not bolted to the floor was carried off, even the hospital bed belonging to the two-year-old child that Marisel was treating when the violence broke out.
When the fighting subsided, MSF teams returned to a scene of chaos and destruction. Bullet casings littered the compound. Lifesaving medicines and essential records were strewn everywhere, while cabinets and shelves were tossed and emptied in a frenzy of theft and disrespect for medical care.
The MSF medics at the UN compound continued working, aware of rumors of looting at the health center, but oblivious to the real extent of the damage. In any case, their priority was the patients in front of them who needed treatment.
In the days immediately following the fighting, a number of pregnant women went into premature labor, and the MSF doctor and midwife treated them to stave off early birth, which can result in complications and even the death of the child. Most of the two thousand people currently seeking shelter in the UN compound are women and children. They have only one latrine for every 350 people, less than 1.5 liters of water per person per day, and receive no food distributions. But people stay here out of fear, and, for some, because they know they have no home to return to.
We strongly condemn the looting of our medical centre in Pibor, South Sudan, which happened during and after heavy fighting from February 23 to 25. The fighting also destroyed large sections of the town. Medical supplies, therapeutic food for malnourished children and even patients’ beds were stolen from our facility during the looting. Bullet casings were found throughout the compound and the few items that were not stolen, such as IV bags, life-saving drugs and medical documents, were damaged and strewn throughout the compound with no regard for the urgent medical needs of the people of Pibor. © Jacob Kuehn/MSF #MSF #DoctorsWithoutBorders #Pibor #SouthSudan #Looting #Destruction #SouthSudanCrisis #hospital #drugs #IVs #food #bulletsera
“All I was able to take with me was one jerry can,” says Mary, sitting in the waiting area of the MSF clinic that was hastily set up to provide a basic medical clinic. She holds her sick two-year-old son David in her arms as she explains that her house was burned and she had to beg for plastic sheeting inside the camp so that her family of six could have any shelter at all. With her house in town destroyed and all her possessions stolen, her family’s future is not clear. “We have nothing to build a new house with,” she says.
Nearby, a woman named Yayo shares a similar predicament. She has brought her two-year-old daughter, Juang, to the clinic to be treated for diarrhea caused by drinking river water out of desperation. Though Yayo’s house is still intact, everything inside was looted, including all of their clothes and their last bag of sorghum, the only food they had.
A Devastated Community and an Uncertain Future
Pibor is a town of about 40,000 people but when the fighting started thousands fled, not only into the UN compound, but also into the bush, where they face even more health risks. Two days ago, a child came to the MSF clinic in the UN protection site with a snake bite on his ankle. The wound was necrotic and MSF doctor Henryk Bonte helped remove the infected flesh to prevent further infection.
The boy had been hiding in the bush for several days since the snake bit him, too afraid to come back to town and look for help. Two other children arrived after hiding in the bush; they had been suffering from severe convulsions for days before their families felt safe enough to bring them in for medical attention. “People in the bush are terrified,” says Bonte. MSF is treating 140 patients in Pibor every day and the medical team is working urgently to resume some level of emergency response capacity in the looted health center. The focus is on immediate, lifesaving care.
The cause of that fear can be seen throughout town. Pibor is now heavily militarized and weapons are everywhere. Large swathes of houses were burned to the ground. A few non-flammable items stand out from the charred foundations like artifacts. Pibor used to be the biggest market town for hundreds of kilometers and many people relied on trade to earn their livelihoods. Now, almost every corrugated steel shop in what used to be the region’s commercial hub is gutted or burned to the ground. Behind one looted shop, the charred, skeletal remains of a person killed in the fighting still lies in the dirt, surrounded by burnt and collapsed structures.
The medical and humanitarian needs in this context are immense. Back in the UN compound, Marisel tends to another child, a one-year-old girl who is recovering from a complicated case of malaria and who is now also severely malnourished as a result. Marisel prescribes the child treatment for malaria as well as antibiotics to prevent infection and 14 sachets of Plumpy’Nut, a peanut-based therapeutic food that helps children regain their weight. The infant’s mother listens attentively as Marisel explains how to feed the child small dabs of the paste, just a little at a time on her finger to prevent the child from vomiting.
In spite of the hardship, there are still moments of celebration. For Marisel, those moments come especially when she is reunited with patients who were under her care at the MSF health care center when the fighting started. Several have already come to the MSF clinic in the UN camp for medical care.
In each case there is a feeling of jubilation, especially with the mothers. “They give me a big hug when they arrive,” says Marisel. “I think for them it makes a difference that they know we stayed and we are still here for their children. For me, it’s just such a relief. I worried for them, and it makes me so happy to know they are safe and that they are alive.”
But Marisel still thinks about the two-year-old boy she stayed with as the fighting started. “I hope he will also come back,” she says.