After more than one year, care continues for displaced in previously disputed border region of Sudan

Médecins Sans Frontières (MSF) has been working in Abyei hospital since 2006. Following violence in May last year, an MSF emergency team responded to the needs of the displaced, 20,000 to 30,000 of whom fled south from Abyei town to the village of Agok.

“A few thousand came back to Abyei but most of the displaced don’t dare to stay overnight and are still living scattered around Agok in the bush. People fear that fighting might erupt again in their town,” says Volker Lankow, MSF’s field coordinator in Abyei.

MSF is providing medical care through fixed clinics in Agok and Abyei and is running six mobile clinics in 12 locations near the two towns. There are 117 Sudanese staff along with nine expatriates providing medical consultations to more than 2,300 people a month.

“We are providing primary healthcare and obstetric care to the displaced people and nutritional support, including running an inpatient therapeutic feeding centre. Malnutrition is a big concern,” explains Lankow, “as it’s currently the hunger-gap time of year in Sudan.”

Helle is a nurse overseeing the feeding program for the project. “We are starting to see adults being treated for malnutrition, this is new,” says Helle. “However, children under five are still the most affected by the lack of food. When I began working here we were treating 275 malnourished children, but now, five months later, it has doubled to more than 540 children.”

For over a year now the displaced people have been living in shelters and depending on international aid for their survival. Their medical problems mainly consist of respiratory tract infections, malnutrition, diarrhoea and malaria.

“We just hope that everything will be fine in the coming weeks. The displaced are already living in a precarious situation, I don’t want to think about them having to flee again,” says Lankow.

In 2008, MSF provided 8,950 outpatient consultations at the hospital in Abyei and more than 1,200 severely malnourished children were treated. In 2009, a reproductive health program providing antenatal care and safe deliveries was started in the Abyei region.

MSF activities in Southern Sudan – June 2009

MSF provides care to hundreds of thousands of people in six states in southern Sudan. In recent months, increasing violence and insecurity caused for the most part by fighting between different tribes, heightened tensions from the disarmament initiatives, criminality in Juba and road banditry has made it more difficult for field teams to reach people in need of aid. The needs in southern Sudan continue to be immense, with MSF teams stretched to ensure the provision of basic and secondary health care and to respond to emergencies.

Working amid ongoing insecurity: Treating victims of violence

In early 2009, there was a sharp increase in inter-tribal violence in Jonglei, Upper Nile, Lakes and Warrap States resulting in hundreds of deaths and the displacement of thousands of people.

In May, an attack on the village of Torkej in Upper Nile State, bordering Jonglei State, resulted in many wounded arriving in Nasir, where MSF runs a hospital providing basic and secondary health care including inpatient facilities, nutritional care, maternal health care, tuberculosis care, kala azar treatment and surgical care. A total of 57 victims made it to the hospital. Many patients suffered multiple gunshot wounds and needed follow-up surgery and care. The majority of the victims were women and children. Several thousand civilians have been displaced by the ongoing clashes, with around 2,000 people fleeing to the outskirts of Nasir and Jigmir.

Two other brutal clashes occurred in March and April 2009 in Pibor and Akobo counties, in Jonglei State. Upwards of fifteen thousand people fleeing the violence arrived in Akobo, south of Nasir, near to the Ethiopian border. In response, MSF sent a team to assist staff at Akobo hospital. 36 wounded patients were treated, mainly for gunshot injuries. Eight patients were flown to Leer Hospital in Unity state, run by MSF, for further surgery. MSF also provided the hospital in Akobo with medical supplies, mosquito nets and food and blankets for the wounded and their caretakers.

On the other side of Jonglei State, following attacks in Lekwongole, Pibor County, in early March, another MSF team evacuated injured to Pibor hospital. More than 40 patients were treated for violent trauma wounds resulting from gunshots and 22 of the most seriously injured were flown to hospitals in Juba and Boma for urgent surgery.

Villages on the border with Congo attacked

Towards the end of 2008, attacks by the Ugandan rebel group, the Lord’s Resistance Army (LRA), near the Congolese border and also in the Democratic Republic of Congo itself, caused thousands of Sudanese people to flee their homes and Congolese refugees to cross the border and seek refuge in Sudan. In response, MSF started supporting two primary healthcare clinics in Gangura and Sakura, in Western Equatoria State, close to the border with DRC. By the end of 2008, 7,200 medical consultations had been provided to both the resident and refugee population in these two areas.

In January 2009, as more displaced people arrived in the area, MSF decided to start an emergency intervention in Western Equatoria State. Mobile teams started working in Ezo, Naandi and Makpandu, supporting Primary Health Care Centres; providing mental health counselling; doing nutritional screenings and referral of patients; training Ministry of Health staff; and providing medical and logistical materials.

In February, MSF teams in neighbouring Central Equatorial State also began assisting Congolese refugees in Lasu, approximately 50 kilometres from the Congolese border. Initially, MSF assisted in two temporary camps locations in Libogo and Nyori where more than 6,000 people had sought refuge. In both locations, the majority of refugees arrived from Congo without any of the essential basics needed for everyday life. MSF teams worked to provide shelter, repair boreholes and build showers and latrines in the camps.

The following month, when the United Nations High Commission for Refugees (UNHCR) created a camp in Nyori, MSF set up a health facility with inpatient capacity and a pharmacy. This facility provides general medical consultations, antenatal care, deliveries and treatment for malnutrition. In the first week, 500 consultations were provided. MSF teams also constructed 39 communal latrines for the camp and drilled two new boreholes. Health promoters were employed to raise awareness of diseases like tuberculosis, malaria and water-borne diseases. MSF also vaccinated 1,638 children in the camp against measles.

Responding to outbreaks and epidemics

Large-scale outbreaks of meningitis, measles, cholera, and malaria are common in Sudan. In the early months of 2009, MSF teams responded to several outbreaks of cholera in Peth in Aweil East, northern Bahr-el-Ghazal State, Pibor in Jonglei State and Gogrial town, Warrap State. Where possible, MSF worked alongside the Ministry of Health, providing treatment, medical supplies, tents and staff as necessary.

In Juba County, Central Equatoria State, where there are cholera outbreaks every year, MSF has started preventive activities including health promotion and the provision of clean water in communities at risk, such as Kator and Munuki. In order to improve hygiene and reduce the number of deaths from water-borne diseases, MSF is providing clean water by repairing existing boreholes in the community and drilling new boreholes, including in four health centres.

In February, MSF responded to a meningitis outbreak in Kapoeta, Eastern Equatoria State, vaccinating 65,322 people and supporting health structures in treating people infected with the disease. MSF also coordinated with other agencies to respond to meningitis cases in northern Unity State.

Medical care at all levels

MSF’s activities continue in other parts of Sudan. An absence of healthcare staff, structures, roads, transport, other aid agencies and investment in health care means that in some areas MSF is often the only medical organisation present. In Aweil, Bahr-el-Ghazal State, MSF supports a hospital, focusing on providing healthcare to mothers and children and nutritional care. In the disputed areas of Abyei and nearby Agok, in Warrap State, MSF runs outpatient clinics and provides nutritional care in both fixed and mobile clinics. In 2008, 8,950 outpatient consultations were provided and over 1,200 severely malnourished children were treated. In 2009, a reproductive health programme providing antenatal care and safe deliveries was started in the Abyei region.

In Pieri, Lankien and Pibor in Jonglei State; Nasir in Upper Nile State; and Leer in Unity State, medical staff provide all levels of health care, ranging from consultations for respiratory tract infections to life-saving surgery. In 2008, medical teams provided over 360,000 outpatient consultations, almost 20,000 antenatal consultations, 1,098 surgeries, many of them emergency surgical interventions for gunshot wounds, and admitted about 8,300 people as inpatients. 492 people were started on treatment for tuberculosis in 2008. Malaria is a growing concern. In 2007, 4,400 people were treated for malaria in Leer hospital. In 2008 this number rose to 25,500 and in the first four months of 2009, the MSF team had already treated 14,000 patients.