Médecins Sans Frontières (MSF) is establishing a project in the town of Ulang, close to the Ethiopian border, in South Sudan’s northeastern Upper Nile region, to address the needs of people living in a remote and neglected area who have been affected by years of war and frequent bouts of intercommunal violence and who struggle to access medical care.
We have already set up a 30-bed hospital in town, providing the only secondary healthcare for the 100,000 or so people living in Ulang and in villages scattered along the Sobat river.
Due to the conflict, many people living in this area between frontlines have been forced to move, often several times. Many have been displaced to Ethiopia and remain there in refugee camps; others have come back to find there are no longer services or livelihoods.Abdalla Hussein, MSF’s head of mission in South Sudan
In July 2018, MSF launched a short-term emergency response, running mobile clinics in Ulang and the surrounding area. In October, we opened the new hospital, and in April we took the decision to run it as a stable project.
“Our aim is to provide secondary healthcare to very vulnerable people affected by recurrent outbreaks of different kinds of violence, living in a dire situation and with little access to basic services, meaning that sometimes people have to walk for hours and even days to reach much-needed healthcare,” says Hussein.
Between October 2018 and April 2019, MSF’s team in Ulang provided 3,200 consultations, helped 81 women to give birth and admitted 719 inpatients, including 287 children in the pediatric ward.
We see a lot of mothers and children coming to the hospital. They have usually come a long way, often arriving in a critical condition because they have had to wait so long to reach a health facility.Madeleine Walder, MSF’s field coordinator in Ulang
"As well as dealing with complicated pregnancies, we treat people for severe malaria and for gunshot wounds because of the ongoing intercommunal violence.
We also very often treat quite complicated cases of patients co-infected with TB and HIV, who may have had symptoms for a year or more but have never been diagnosed or treated.”, says Madeleine Walder, MSF’s field coordinator in Ulang.
MSF teams are engaging with local communities to explain the main diseases that people should be aware of and when to seek treatment.
We have put in place a referral system, with patients mainly transported by speedboat along the Sobat river from outlying health centres to Ulang hospital. Some victims of violence and patients with conditions that need surgery or other specialist care are transferred either to Malakal, which is about eight hours away by speedboat, or by plane to the capital, Juba.
“The Greater Ulang area presents logistical challenges, for us and for our patients,” says Walder. “During the rainy season, which lasts eight months a year, it is very swampy and the only means of transport is by boat, as most planes can’t land. During the dry season, access is a bit easier and people can move around, but the distances to reach health services are still very long.”
Displaced by cyclical violence – Nyayual’s story
Nyayual has nine children, aged one to 18. An outbreak of intercommunal violence drove her and her family from their home in Doma. They sought refuge in the village of Ying, where several hundred displaced people are staying.
“Our men go to the river and, if they catch some fish, the children will have something to eat. The children are not doing well – they suffer from vomiting and diarrhoea because of eating badly.
The violence in Doma left many people dead. The attackers arrived at night, at 4 am. They went through the village and started shooting at men, children, women, animals. We had been sleeping, so everyone ran away without being able to take many belongings. We lost most of our cattle.
Everyone fled in different directions. We walked for four hours until we arrived at Ying at sunrise. The locals welcomed us. They allowed us to stay in the school and under the trees. Some others who hid in the bush have gathered here too over recent days. All of my relatives are here. These attacks happen from time to time. Before they only took our cows, but now they also kill people.
Although we lack basic things these days, we are safe. We can’t go back to Doma any time soon as there is a risk of more attacks.”
‘First’ and ‘second’ – Yakong’s story
Yakong is a 36-year-old mother of seven. Her twins Both and Duoth – ‘first’ and ‘second’ in Nuer – were born in late March at MSF’s hospital in Ulang.
“I am from Wachjak, a small village on the Sobat river, two hours’ walk from Ulang. There are not many jobs there. People are often hungry. We grow some fruit and maize, but the main source of food is from fishing. My eldest child is 15 and bringing up my children has been a challenge.
Some of my relatives, including two of my brothers, died in the conflict, and my uncle lost three of his boys. It is very sad. I think peace will change things for the better.
“This is the first time I’ve given birth in a hospital. My other children were all delivered at home. I had no idea I was going to have twins, but now I am very happy. I have named them Both and Duoth, which mean ‘first’ and ‘second’ in the Nuer language. The bigger twin has been a bit sick with diarrhoea, vomiting and fever.
When I was pregnant I was not comfortable. I felt dizzy, had abdominal pains and was losing fluids. I knew I wasn’t ready to give birth, but it was causing me pain. I had heard in the community that MSF had opened a hospital in Ulang. If I hadn’t come here, it could have been bad. In the end I had a normal delivery and it didn’t last long. We feel safer with MSF’s presence. I hope they don’t leave.”
Daily struggle to meet basic needs – Nyamach’s story
Nyamach is a 20-year-old mother of three from Ulang. Her youngest child, a five-year-old girl, was admitted to MSF’s hospital in late March with convulsions and fever, and was diagnosed with cerebral malaria. The child also had a wound which had led to a tetanus infection. Vaccination coverage among the local population is low.
"... - like people injured in shootings or suffering severe diseases. To get medical treatment in the past, we sometimes had to go to Ethiopia.
We earn our living by fishing, and we raise cattle and grow maize, sorghum and green leaves. In the rainy season we put seeds in the ground and they grow, so we have more food. However, we lack basics like cooking utensils and proper sleeping materials. Because of the fighting, we have faced a lot of hardship. The war has left us without anything – not even seeds.
For three years I took refuge in Ethiopia and lived at Kule refugee camp. We decided to leave here because there were no schools or healthcare and the violence was affecting us. I was scared. I came back to South Sudan in January 2018 with nine relatives. Other people have decided to come back to Ulang after hearing that MSF is now here. We came back by car – it took three days. I hope the situation stays calm. At least in the rainy season [between May and December] people stay at home and don’t run after each other.”