Sudan: Improving treatment of sleeping sickness and malaria amid civil war

Areas of particular concern are in the conflict zones: Kordofan, Unity/Western Upper Nile, Blue Nile and the Nuba mountains. Humanitarian access to these areas is difficult if not impossible. Drought in Northern Darfur and Northern Kordofan has also led to significant population displacements.

MSF has been working in Sudan since the 1970s in activities largely responding to the ongoing civil war. Current activities include mother-and-child health care, surgical intervention, nutrition support at feeding centers, vaccinations, primary health care, water supply, hospital support and programs to fight diseases such as sleeping sickness, tuberculosis (TB), river blindness and kala azar (visceral leishmaniasis). MSF projects are located across the country: from Khartoum and Gedaref in the north and Bahr el Ghazal in the west, to the Lakes Region and Western and Eastern Equatoria in the south.

Western Upper Nile

In April 2002, MSF brought attention to the miserable conditions of civilians in Western Upper Nile in the report "Violence, Health and Access to Aid in Unity State/Western Upper Nile, Sudan." MSF provides aid in several locations in the disputed province, offering basic health care, inpatient and outpatient care, therapeutic feeding, and tuberculosis and kala azar treatment. Based on 14 years of work in Western Upper Nile, the report shows that repeated displacement and continued fighting, coupled with lack of access to health care and humanitarian aid, are slowly killing off the region's people. (See page 30 for excerpts from the report.)

Disruption of aid activities - only one element of the fatal consequences of Sudan's long-running conflict on Sudanese civilians - is all too common in Sudan. In an attack on the village of Nimne in Western Upper Nile in February 2002, an MSF compound was looted. Days later a local MSF health worker was killed when three bombs were dropped on the village. MSF was forced to suspend its program in Nimne. A health clinic in Bieh also suffered disruption following a helicopter gunship attack.

In March, another MSF team in the area was evacuated due to shooting. The attack on Nimne came in the same days that government planes bombed Akuem in the southern state of Bahr el Ghazal, where MSF runs a primary healthcare program and a feeding center.

New treatment achieving positive results

Until September 2001 MSF teams had to treat patients suffering from second-stage sleeping sickness, a tropical disease endemic in southern Sudan, with the toxic and sometimes deadly arsenic-derivative melarsoprol, because no other drug was available. After years of lobbying by the World Health Organization and MSF a much safer drug, eflornithine, has now become available. MSF's first program to document the effects of eflornithine in the field, the Ibba sleeping sickness project in Western Equatoria, is showing positive results.

The number of patients seeking treatment has tripled in recent months and drug-related fatalities are now rare. MSF also treats the disease in Kajo Keji, in Eastern Equatoria. Also in Kajo Keji, an MSF study showed that area malaria strains were resistant to common malaria treatments; in June 2002, MSF introduced artemisinin-based combination therapy (ACT), allowing for better treatment of malaria cases. (See page 10 for more on the fight for better malaria treatments in Africa.)

In March 2002, after years of donating drugs and medical
material, MSF established a health center and eight health units in Nagorba in the Nuba mountains. For the past ten years the government had refused to allow humanitarian access to the region.

In December 2001, after a year of trying to get access to the area, MSF began a kala azar program in Malakal, in Western Upper Nile, with pediatrics and tuberculosis support planned to begin by mid-2002.

In northern Sudan, MSF phased out clinics in three camps for displaced people on the outskirts of Khartoum and in a hospital in Meiram, because other health facilities were available and the needs no longer acute. MSF continues to support a therapeutic feeding center in Mayo camp.

International staff: 93
National staff: 1,293