Malnutrition Rates Are Alarming in Leer, South Sudan

MSF nutrition nurse Charles Mpona Kalinde, from Democratic Republic of Congo, double checks the details taken in the ATFC, including Gatluok’s weight. He is found to weigh just 5.7 kg; just under two-thirds less of what a boy of his age should weigh (14 kg).
Nick Owen/MSF
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Before the conflict that erupted in South Sudan in mid-December 2013, Doctors Without Borders/Médecins Sans Frontières (MSF) would typically have around 200 children in its ambulatory therapeutic feeding center (ATFC) at any one time, said Grace Ayuelu, MSF medical team leader in Leer. Ayuelu has been working in Leer hospital for almost a year.

“But now, we have over 1,800 children,” she said. “That is a big number.”  

During the conflict, many people’s houses in Leer, as well as the MSF hospital, were looted and razed to the ground. People fled into the bush for safety, many of them going months without anything to eat other than wild roots and whatever else could be gathered from the land.

People are now starting to return to Leer, and the partially destroyed MSF hospital is up and running again, although at half its previous capacity. Now, the busiest area of MSF’s Leer hospital is the ATFC, where children under five are seen and their level of nutrition assessed.  

There are over 207 MSF staff from South Sudan and beyond currently working in Leer, providing emergency nutrition and outpatient care to the population. The MSF project in Leer also accounts for two other ambulatory therapeutic feeding centers in southern Unity state, one in Nyal and another in Mayendit.

Before its hospital was destroyed at the end of January, MSF had been working in Leer for the past 25 years, providing both in- and out-patient care for children and adults, surgery, maternity, HIV/TB treatment, and intensive care. The hospital was the only fully functioning secondary facility in all of southern Unity State, serving 270,000 people.

Carrying her son Gatluok , 25-year-old mum Angelina arrives at MSF’s hospital in Leer, Unity state, South Sudan.
Nick Owen/MSF
Gatluok in MSF’s ambulatory therapeutic feeding centre (ATFC) in Leer hospital, Unity state, South Sudan. After walking five hours from her home village, Angelina spends little time waiting to be seen as MSF’s ATFC supervisor, John Yonk Both, recognises that Gatluok’s condition is critical.
MSF/Nick Owen
Gatluok in MSF’s ambulatory therapeutic feeding centre (ATFC) in Leer hospital, Unity state, South Sudan. Before his consultation, Gatluok’s measurements are taken. The suspended baby scale shows that he weighs just 5.7 kg. The weight of a healthy boy his age should be 14 kg.
Nick Owen/MSF
Gatluok in MSF’s ambulatory therapeutic feeding centre (ATFC) in Leer hospital, Unity state, South Sudan. Gently lowered onto a measuring board he finds the situation distressing, like most children who go through this process. His height is recorded at 78 cm.
Nick Owen/MSF
Gatluok in MSF’s ambulatory therapeutic feeding centre (ATFC) in Leer hospital, Unity state, South Sudan. MSF nurtrition nurse Charles Mpona Kalinde tries to comfort him as he, very carefully, carries Gatluok back to his mother after his measurements are taken.
Nick Owen/MSF
Gatluok in the waiting area of MSF’s ambulatory therapeutic feeding centre (ATFC) in Leer hospital, Unity state, South Sudan. He is then given the all-important MUAC test. His MUAC measures just 94 mm, well within the red area, indicating that he has severe acute malnutrition.
Nick Owen/MSF
Twenty-five-year-old mum Angelina holds her two-year-old son Gatluok in MSF’s ambulatory therapeutic feeding centre (ATFC) in Leer hospital, Unity state, South Sudan. Gatluok and his mum are given a moment to recover after the measurements are taken. He reaches for the hand of an MSF clinic officer.
Nick Owen/MSF
Gatluok is then taken for his consultation with MSF nurse Peter Bitoang Machar. Gatluok’s mum tells Peter of their situation at home, how her house was burned and their food stocks were looted, and how they had to flee into the bush. MSF’s ambulatory therapeutic feeding centre (ATFC) in Leer hospital, Unity state, South Sudan.
Nick Owen/MSF
Twenty-five-year-old mum Angelina holds her two-year-old son Gatluok in MSF’s ambulatory therapeutic feeding centre (ATFC) in Leer hospital, Unity state, South Sudan. During the consultation, Peter tests Gatluok’s appetite with some Plumpy’Nut. But, he won’t eat. Peter carries out another test and establishes that Gatulok has malaria and a high fever.
Nick Owen/MSF
Gatluok in MSF’s ambulatory therapeutic feeding centre (ATFC) in Leer hospital, Unity state, South Sudan. Despite being unwilling to eat, he is incredibly thirsty and eagerly drinks a rehydration solution.
Nick Owen/MSF
Twenty-five-year-old mum Angelina with her son Gatluok in Leer hospital, Unity state, South Sudan. Within half an hour of arriving, Gatluok is admitted into MSF’s intensive therapeutic feeding centre. But it will not be easy. His mum has no food and as she is not a patient, MSF cannot provide her with anything to eat. She is also worried about her other child, who she had to leave behind in the care of her brother.
Nick Owen/MSF
Twenty-five-year-old mum Angelina holds her two-year-old son Gatluok in MSF’s ambulatory therapeutic feeding centre (ATFC) in Leer hospital, Unity state, South Sudan. Now, one week after Gatluok was admitted, he has recovered from malaria and he has started eating again. It is hoped that within the coming days Gatluok will be discharged and will be followed up in the ATFC.
MSF/Nick Owen