MSF PROJECTS IN SOUTH SUDAN – JUNE 2011
July 7, 2011
Médecins Sans Frontières (MSF) is an international humanitarian medical aid organization that provides emergency medical assistance to people suffering from man-made and natural disasters like wars, civil wars, and earthquakes irrespective of race, religion, or political affiliation. Each year, more than 22,000 international and national staff provides emergency medical care to people in more than 70 countries, including Sudan, the Democratic Republic of Congo, Pakistan, Nepal, Haiti, Guatemala, and many others.
Médecins Sans Frontières (MSF) has been working in Sudan since 1978. In 2011 MSF employs more than 2,000 national staff working alongside almost 200 international staff in 13 projects covering 8 States in South Sudan. From January through April 2011, MSF hospitalised 6,422 patients, performed 140,519 outpatient consultations and 29,278 antenatal care consultations for women, delivered 2,681 babies, treated 10,392 malaria cases, admitted 6,109 malnourished children, performed 1,828 major surgeries including c-sections, and treated 1,079 kala azar patients & 2,347 TB cases.
MSF in South Sudan is working in the following current projects:
Northern Bahr-el-Ghazal State
In Aweil Civil Hospital, MSF works together with the Ministry of Health to try and reduce maternal and paediatric mortality, treat malnutrition and respond to emergencies. MSF staff perform minor surgeries and caesareans, and provide gynaecological and obstetric care and mother and child healthcare, including ante- and post-natal consultations and vaccinations. Every month approximately 3,000 ante-natal consultations are provided, more than 240 women deliver their babies and more than 3,000 paediatric consultations are performed. In 2010, MSF hospitalized 3,573 children and admitted 2,689 others children in the inpatient therapeutic feeding centre and ambulatory feeding programme, similar numbers to those treated for malnutrition in the same period the year before.
Western Bahr-el-Ghazal State
MSF began working in Raja County in August 2010, focusing on emergency preparedness and reducing maternal and paediatric morbidity and mortality. In 2010, MSF conducted more than 6,000 outpatient consultations, supported the treatment of 3,000 malaria cases, and admitted almost 1,000 patients.
Western Equatoria State
MSF is providing essential primary and secondary healthcare in Yambio, including emergency medical care, mental healthcare and relief activities, for people affected by violence, many of whom have been injured in attacks carried out by the Uganda-based rebel group, the Lord’s Resistance Army. MSF uses mobile teams in this area to reach people affected by violence and provide primary healthcare. MSF is also supporting Ministry of Health facilities in Makpandu refugee camp, and running mobile clinics where needs arise in and around Yambio.
In May 2010, MSF began supporting the paediatric, surgical, outpatient, inpatient and reproductive health departments of Yambio Civil Hospital, as well as its sleeping sickness program. During 2010, MSF performed more than 30,000 outpatient consultations and treated approximately 12,000 people for malaria in Western Equatoria State. MSF teams admitted 2,288 people to Yambio Civil Hospital and performed more than 400 surgeries.
Apart from a small Ministry of Health facility in Pibor town, MSF is the only primary healthcare provider in this part of Jonglei State, home to around 160,000 people, where villages are often far apart and roads are impassable. MSF runs a primary healthcare clinic providing emergency care, inpatient care, outpatient care and reproductive health services, including antenatal consultations, nutrition, maternity care, treatment for tuberculosis and sexually transmitted infections.
MSF also runs two outreach primary healthcare units in Lekwongole and Gumuruk, providing basic care, such as general consultations, treatment for malnutrition, deliveries, antenatal care and vaccinations, as well as referring more complex cases to Pibor. During the rainy season, which lasts from May to September or October, both these sites are only accessible by boat or plane. Emergency surgical cases are referred to Boma and Juba for operations, and are flown directly by an MSF plane.
Insecurity is a major issue in Jonglei State, due to intercommunal clashes, cattle-raiding, and the presence of militia groups clashing with the SPLA. For instance, following three security incidents in the space of a month in June 2011, the Gumuruk health post was suspended from July 2010 until the end of February 2011, seriously affecting the population’s access to healthcare in the area.
In April 2011, the MSF team in Pibor provided medical assistance to 12 people wounded after heavy fighting during a cattle raid. Nine of these people had to be referred for surgery and further medical treatment outside of Pibor, so MSF flew them to Boma and Juba to ensure they received this care. In addition, MSF carried out a distribution of BP5 emergency nutrition biscuits to 681 households of people displaced by the fighting, before they returned to their homes.
Then, in June 2011, intercommunal violence and cattle raiding near Lekwongole, meant the MSF team In Pibor treated five patients for violent trauma wounds. As insecurity continued, the entire community, including MSF’s Sudanese staff, fled. This effectively shut down the health post for a fortnight, seriously affecting peoples’ access to healthcare. A week later, further intercommunal violence and cattle raiding forced the MSF team to evacuate from the healthcare clinic in Pibor on June 25th, reducing medical activities to life-saving only.
From January 2011 through the end April 2011, MSF provided 12,051 consultations in Pibor, Lekwongole and Gumuruk. The teams also provided 2,396 antenatal consultations and delivered 205 babies. In addition, MSF staff treated 1,266 people with malaria, plus also provided care for 170 people with violence-related injuries. Between January and the end of May, the MSF team treated 588 severely malnourished children.
In the remote northern area of Lankien, MSF runs a busy clinic which serves around 127,000 people. With outreach sites in Pieri and Yuai, MSF teams provide all levels of medical care, ranging from treatment for respiratory tract infections to spear wounds. In the outpatient departments, more than 23,000 patients were seen between January and April 2011. More than 1,600 people were treated for malaria, 93 people began tuberculosis treatment, 620 people were admitted to the hospital, and around 393 children were treated for malnutrition. The clinics in this area are also affected by the ongoing kala azar outbreak, and more than 258 people began treatment for kala azar. Almost 2,000 pregnant women received antenatal care and 118 babies were delivered in the first four months of 2011. This area of Jonglei state also historically sees an increase of wounded as a result of cattle raiding and intercommunal violence.
MSF is one of the few organisations providing medical care in Leer, an area located close to the contested north/south border area and numerous oil fields. MSF teams run a hospital which provides all levels of care including emergency surgery, outpatient health care, as well as surveillance and response to medical emergencies and outbreaks. In the first four months of 2011, MSF teams provided over 30,874 outpatient consultations, treated 3,175 people for malaria, and admitted 1,097 people to the hospital, 215 of whom were operated on.
At the beginning of 2011, several cases of measles were seen and MSF conducted a measles vaccination campaign in the cattle camps were young children are often found during the dry season. In total MSF teams managed to vaccinate 16,702 children in addition to the 2,086 children that were routinely vaccinated in Leer hospital. Furthermore in Leer hospital, from January to the end of April 2011, 158 patients were admitted for tuberculosis treatment and 37 patients started anti-retroviral treatment for HIV/AIDS. More than 3,200 pregnant women received antenatal care while 142 babies were delivered.
Food insecurity in the region is on the rise because of an only moderately successful harvest, insecurity in the area , and the influx of returnees from northern Sudan, resulting in an increase in malnutrition. In the first four months of 2011, MSF teams treated 1,019 children under five years of age for malnutrition.
In July 2010 MSF opened a feeding programme in Bentiu, the capital of Unity State, as teams were seeing increasing numbers of patients coming from there to seek treatment in Leer. The nutritional situation in Unity State is extremely worrying and it seems that the high levels of malnutrition cannot be attributed to the annual hunger gap alone. Factors such as scarcity of food, high prices of staples such as sorghum, violence, insecurity and displacement have had a direct impact on people’s ability to produce food and feed themselves In 2011, MSF has treated 3,067 children for malnutrition.
Upper Nile State
MSF runs a hospital in Nasir offering primary and secondary healthcare. In 2010, MSF teams focussed on the development of medical programmes, including HIV and TB care. In Nasir, MSF teams provided over 16,954 outpatient consultations between January and April 2011. More than 556 people were treated for malaria, 855 children were treated for malnutrition, and 965 people were admitted to the hospital, 95 of whom were operated on. In Nasir, MSF teams work to combat maternal mortality with more than 2,146 pregnant women receiving antenatal care and 212 babies delivered in the first four months of 2011.
The wider Upper Nile region is the epicenter for kala azar in South Sudan. In 2010, the largest outbreak of kala azar in eight years occurred in South Sudan, with MSF teams treating more than eight times as many cases than in the previous year. Parts of Upper Nile and Jonglei States were mainly affected and it is anticipated to spread further in 2011. In 2010, MSF responded to outbreaks in Pagil, Atar, Khorfolus, Adong and Rom by providing treatment and training health staff in these locations. Medical teams also assisted a clinic in Old Fangak and the Ministry of Health in Malakal, Upper Nile State, with technical and material support. MSF has treated approximately 3,400 patients for kala azar since mid-2009, with an expected peak of 5000 more cases in the 2010/2011 season. High levels of malnutrition, population movements due to violence and resulting displacement, and the presence of returnees to South Sudan with little to no natural immunity against kala azar will contribute to increased cases in 2011.
In December 2009, MSF began working in Gogrial West County, Warrap State. Initially, MSF provided basic healthcare on an outpatient basis. There was no hospital in Gogrial West County, so people in need of urgent surgery were forced to travel long distances at great personal expense. In order to meet the medical needs of the approximately 240,000 people living in this area, MSF built a brand new primary healthcare center, with inpatient wards, a pharmacy and laboratory. In 2010, MSF then set up two inflatable clinics to provide maternity, emergency obstetric and surgical care. However, in 2011, MSF began to build more permanent structures for these units that should last for many years.
From January to the end of April 2011, the MSF team in Gogrial provided 20,750 medical consultations, delivered 118 babies, and carried out 281 surgeries. As the hunger gap approaches, MSF has already treated 424 (until end April), 586 (until end May) severely malnourished children, with this number expected to rise significantly due to increasing food prices and insecurity.
In March 2011, MSF also added a new medical element to the project when it began to provide treatment for people with tuberculosis. In the first month, the team provided treatment to 26 people with TB.
As well as running the regular primary and secondary healthcare project, MSF teams responded to several emergencies, including measles outbreaks and violence. In the first days of January 2011, an MSF team vaccinated 13,000 children in Kuajok, following a measles outbreak in the transit camp for people returning from North Sudan, and the host community.
A cattle raid in the Toch area of Gogrial East in the villages of Thiek Thuk, Mangol and Maker resulted in an influx of 18 gunshot wounded people to the MSF project in Gogrial on the 8th and 9th May in need of surgery.
In mid-May heavy clashes and bombing, in and around Abyei, between the northern SAF (Sudanese Armed Forces) and southern SPLA (Sudan People's Liberation Army) caused a massive exodus of an estimated 60,000 people towards the south. Many gathered on the road to Agok, Bahr-El-Ghazal State, or near Mayen-Abun or Turalei in Warrap State. The MSF team in Gogrial carried out a first assessment on May 27th and provided assistance to displaced people in Alek in the form of a mass measles vaccination to 165 children and BP5 emergency biscuit distributions to 315 people.
On June 18 MSF then launched a second emergency team upon discovery of nearly 10,000 people who had also been displaced by the violence in Abyei and who had sought refuge in the villages of Mayen Pajok and Juong Pajok, near Akon in Warrap State. It took many of this group up to 12 days to reach Akon, arriving without access to food, clean water, shelter or healthcare. Exposed to the harsh sun they tried to build basic shelters with twigs and clothing to shield themselves. MSF distributed non-food-item kits to 222 families and will distribute essential items like cooking utensils, blankets, soap and jerry cans. MSF has also conducted a mass vaccination campaign against measles for 3052 children under fifteen years, in addition to providing BP5 emergency nutrition biscuits for more than 1500 households and a peanut-based therapeutic food for 38 malnourished children. MSF also started mobile clinics to provide more regular healthcare to these two pockets of displaced people.
TRANSITIONAL AREA OF ABYEI
MSF has worked in the transitional area of Abyei since 2006. MSF provides primary healthcare and treatment of severe malnutrition of children under 5 years old through an outpatient clinic in Abyei town and has been running mobile clinics in the northern part of the Abyei area. Between January and April 2011, MSF performed 1,359 outpatient consultations in Abyei town.
Following increased violence and hostilities in the Abyei region, MSF was forced to evacuate the Abyei clinic on May 21st, 2011. At least 60,000 people have fled the area to Agok and Turalei in Warrap State and the surrounding areas.
In Agok, 40 kilometers south of Abyei, MSF runs the only secondary healthcare centre in the area, with surgical facilities, out & inpatient care, reproductive healthcare and treatment for severe malnutrition.
Since the end of May, Agok has become a host town to thousands of the displaced from the violence in Abyei. MSF responded quickly by focusing on performing life-saving surgeries, treating malnutrition, providing reproductive healthcare, vaccinating children, and providing access to secondary healthcare. MSF teams are also distributing plastic sheeting and non-food items, such as kitchen sets and soap, to the displaced from Abyei, targeting at least 20,000 people.
MSF mobile medical activities are caring for the wounded and displaced in areas outside Agok, including Mading Jokthiang, Rayan, Awal + Mathiang, Rumkor, Mayom Ngok, Ajak Kuach, and Abeimnom. MSF received 53 wounded in Agok hospital in the first four days and treated at least 2,300 people in the first two weeks of the fighting.
Many of the displaced from Abyei also fled to Turalei, Warrap State, 45 kilometers south of Agok. At the end of May 2011, MSF teams set up an emergency response in Turalei, by establishing a therapeutic feeding centre in the hospital of Comitato Collaborazione Medica (CCM). In addition, MSF emergency teams run mobile clinics in Turalei, Machbong and Mayom Abum, that screen for malnutrition, provide maternal and primary healthcare, distribute food, and refer serious cases to CCM’s Turalei Hospital.