1 November 1998
Crisis in South Sudan By May 1998 it was estimated that 930,000 people in South Sudan were facing a crisis situation due to two successive poor harvests, displacement and years of war. Global malnutrition rates of 30-40% have been established in pockets of Bahr el Ghazal and Western Upper Nile, indicating a serious situation. Teams were running nine feeding centres in early June and had admitted 5,000 children. Another poor harvest is anticipated due to late rains, indicating the need for at least one more year of significant food support. MSF'S activities in South Sudan Panarou, Upper Nile, was the focal point of a kala azar epidemic in the south that killed thousands. A recent assessment with Medair established a need for medical services and relief distributions, but only mobile interventions were considered possible. MSF completed a first distribution of 5,500 mosquito nets while Medair ran a mobile health clinic, but insecurity forced both teams to evacuate. Until April 1998, MSF supervised TB, kala azar, brucellosis and nutritional programmes run by national staff in a health centre in Duar region, Western Upper Nile. As the security situation deteriorated, staff fled and MSF moved further south setting up 13 primary health care units between Ler and Nimne (target pop. 244,000) and conducting nutritional monitoring. In the first month a supplemental feeding programme admitted 751 children, of whom 265 were severely malnourished. Meanwhile, kala azar, TB and referral services continued in Ler during this period. Unfortunately, both teams had to evacuate on 29 June, due to insecurity spreading to Ler town. Although services had been handed over to the national staff, by 30 June the population had fled. Further east, MSF provides kala azar and referral services in Jaibor and Lankien for a target population of approximately 150,000. Teams working in Akobo and Wangding counties (pop. 100,000), where many have suffered severely from the fighting, support Akobo's 68-bed district hospital and provide mobile activities in three primary health care units in Akobo district and two in Wangding. A water and sanitation programme began in January 1998 to drill ten boreholes. The primary health care programme expanded to Kaikuny and Watt districts in April. Two new health care units are being built to cover the basic needs of an estimated 50,000 people. In September 1997, MSF began renovating Kajo Kaji hospital, providing essential equipment, training and relaunching activities in the rebuilt laboratory. Emergency preparedness is also important. Assistance to IDPs in Maridi and Mundri counties focused on endemic disease control, managing a 48-bed rural hospital and TB treatment. This also covers measles vaccinations, training for traditional birth attendants and a primary health care centre in Bari camp, primary health care units in Kuluwe and Lacha camps and emergency preparedness for further IDP influxes. Up to 300,000 people benefited from these programme, which closed in March 1998 as other NGOs are now present and improvements have been made. MSF has been working for four years, on and off, in the rebel-held areas of Bahr el Ghazal. In Tonj county, a team running a rural hospital in Marial Lou serving a population of 150,000 people provides out-patient consultations, including mother-and-child health, surgical, paediatric and maternity services. Mobile clinics offer EPI and out-patient services to the pastoralist community during the dry season, and there is support for five primary health care units. Four teams offer primary health care and assistance in combating endemic diseases in Wau, Gogrial and Aweil East counties. A measles immunisation programme targets all under-fives. MSF monitors health and nutrition among IDPs and local populations and prepares for emergencies. A training project for community health workers in Mapel began in November 1997 and aims to train 15 people in the first year. MSF's activities in the Jonglei region are also managed by the South Sudan mission. The team which supports a health centre and six primary health care units in Panyagor, close to the front-line, has often had to be evacuated. As many of the target population live in the region's swamps for food and security reasons, mobile health staff were recently trained and dispatched there to meet health needs. A 1998 water programme focusing on remote IDP settlements has drilled nine new boreholes and renovated three existing wells since January. The team concentrates on training local staff in basic health, EPI, mother-and-child health and laboratory work. MSF's activities in North Sudan MSF's activities in four official camps housing some of the 1.9 million IDPs around Khartoum cover dispensaries, medical consultations, mother-and-child health, water and sanitation. A therapeutic feeding centre operates in Mayo camp. MSF advocates against forced displacements and helped persuade the authorities relocating 400 families in September 1997 to distribute cards entitling each family to a plot of land and secure access to health care and water. With a dramatic increase in the potentially fatal disease kala azar in Umm Kurra, Gedaref state, since September 1997, the two MSF treatment centres predict a rise in patient numbers from 3,261 patients in 1997 to 10,000 in 1998. MSF provides blood testing, treatment and consultations in support of local health organisations battling the disease in South Sudan. In neighbouring Blue Nile state, an undeclared cholera epidemic that killed hundreds at the beginning of the 1997 rainy season was only discovered in September. MSF donated a cholera kit for future emergency use and a programme began in February 1998 supporting national agencies assisting up to 25,000 IDPs. MSF's mission in North Sudan is also responsible for the administration of the programme In Dilling, South Kordofan, where MSF supports three health centres providing consultations, epidemiological surveillance, training, ante-natal care, distributions of drugs and medical material, and sanitation. A recent hospital programme aims to improve hygiene, sterilisation, water and sanitation. MSF also runs a health centre with some in-patient facilities in Meyram, West Kordofan, focusing on out-patient consultations, vaccinations, growth monitoring, in-patient and emergency care. Supplementary and therapeutic feeding activities are also provided. A sanitation programme runs in the town and three mobile clinics cover surrounding villages. In May 1998, MSF started a programme providing curative services in Wau's civilian hospital, EPI and drugs distributions. Additional services had to be set up following a dramatic rise in the number of people returning to the town after fleeing in January.