Throughout 2014, Médecins Sans Frontiéres (MSF) responded to emergency medical needs arising from conflict while striving to maintain its pre-existing, essential healthcare programmes in South Sudan.
When fighting broke out in the capital Juba at the end of 2013 and rapidly spread throughout the country, MSF started dispatching medical supplies and staff to critically affected locations. The number of projects had soon increased from 13 to more than 20 across nine states. Many people fled their homes and thousands hid in the bush. An estimated 1.5 million people remained internally displaced by the end of 2014.
Since the beginning of the crisis in South Sudan, MSF has called on all parties to respect the integrity of medical facilities, and to allow aid organisations to access affected communities. In January 2014, there was heavy fighting in the town of Leer, southern Unity state, and the MSF-supported hospital was looted and set alight. The provision of outpatient and inpatient care for children and adults, surgery, maternity services, treatment for HIV and tuberculosis (TB) and intensive care was interrupted for several months.
Medical care has come under attack time and again in South Sudan, with patients shot in their beds, wards burned to the ground and medical equipment stolen. Hundreds of thousands of people have been denied lifesaving assistance because of these acts. MSF staff witnessed the gruesome aftermath of armed attacks and clashes in Malakal in Upper Nile state, when they discovered patients murdered inside the town’s teaching hospital. After fighting in Bentiu in April, people who had been seeking shelter inside the hospital were killed on the grounds.
To escape the violence in Juba, tens of thousands of people sought refuge in UN compounds, where Protection of Civilians (PoC) sites were designated. MSF set up medical facilities in the Tomping and Juba House PoC sites, but spoke out about the deplorable living conditions there, and in other PoC sites in the country, throughout the year. With the gradual stabilisation of medical needs, and as other organisations increased their activities, MSF’s medical projects in the Juba PoC sites were handed over to the International Medical Corps, South Sudan Red Cross and Health Link South Sudan in August.
The rapidly worsening security situation in January forced the evacuation of international staff from Bentiu. In April, MSF was forced to stop providing TB and HIV care in the hospital because of increased violence. The town’s residents fled to the nearby UN compound, where the population swelled from 6,000 people to more than 22,000 in a matter of days. By the end of the year, the number had increased to 40,000. At the PoC site, MSF maintained a 24-hour emergency room and provided more than 10,000 outpatient consultations, treated nearly 1,000 children for severe malnutrition and performed 300 emergency surgical interventions, 83 per cent of which were conflict-related – mostly gunshot wounds. Tens of thousands of children were vaccinated against measles inside and outside the PoC. MSF ran mobile clinics and set up both a general and an antenatal clinic for people outside the site. Another team maintained a programme of comprehensive medical services for some 70,000 Sudanese refugees at Yida camp, and undertook a pneumococcal vaccination campaign – the first ever in a refugee setting. Some 10,000 children under the age of two were vaccinated.
In Leer, the international MSF team was evacuated in January due to increased insecurity. Shortly afterwards, 240 South Sudanese MSF hospital staff were forced to escape into the bush with their families and some of the most severely injured patients. By mid-April, the local population had begun to return to the town and in May medical activities resumed. By this time malnutrition in the area had reached crisis levels, and during May and June MSF treated more patients for malnutrition than in all of 2013.
Some 70,000 people fled the town of Bor as a result of violence and the state hospital was ransacked. In April, an MSF team helped the health ministry repair the hospital and resume basic medical activities. A team also treated people wounded during an attack at Bor airport. MSF had long supported Lankien hospital, and in 2014 began emergency surgery to treat the increasing number of war wounded. Of the 910 major surgical interventions performed at the hospital, 76 per cent were violence-related. There was also a massive outbreak of kala azar (visceral leishmaniasis) and more than 6,000 patients were treated.
Insecurity in Pibor in 2013 caused MSF to withdraw from a fixed health centre and operate instead through mobile clinics. By July 2014, the situation had stabilised and MSF resumed activities in Pibor town, including basic health consultations, inpatient services and maternity care. Teams also offered healthcare in nearby Gumuruk, Lekwongole and Old Fangak, areas regularly affected by the war.
Upper Nile state
In a pre-existing project at Nasir hospital, a monthly average of 4,100 consultations were carried out until heavy fighting broke out nearby. The town’s population fled and the hospital was evacuated in May. MSF staff visiting in June found the hospital completely looted and the town deserted. They had no way of knowing the whereabouts or the health status of those who had fled.
Due to mounting insecurity, MSF had to stop working in the Malakal public hospital in April and rapidly opened a clinic in the PoC where 20,000 people were sheltering. In Melut, teams provided medical care to those people displaced by violence, which included treating them for kala azar and TB. As the health situation in the refugee camps stabilised over the year, MSF reduced its number of outpatient clinics.
MSF provided basic and specialist healthcare, including vaccinations, in Minkamman camp, Awerial.
Around 95,000 displaced people live in the camp, and more have settled in the surrounding areas. Teams carried out more than 52,000 outpatient consultations and 2,700 mental health consultations and also launched vaccination campaigns against measles, polio, cholera and meningitis.
Following a measles outbreak in Cueibet county in late March, MSF provided support to the health ministry and organised a vaccination campaign against measles and polio which reached 32,700 children under five.
Northern Bahr El Ghazal state
In Pamat, close to the border with Sudan, MSF continued to offer basic and specialist medical care to people displaced by conflict. Staff distributed relief items and provided health consultations to new arrivals in December. Since 2008, MSF has supported Aweil civil hospital, with around-the-clock paediatric and maternity services, including high-risk and emergency obstetric care – more than 7,100 women were admitted to the maternity ward and over 1,500 complicated deliveries were assisted during the year. In addition, MSF treated more than 30,000 people for malaria in 2014 – three times as many as the previous year.
MSF has also supported Yambio state hospital in Western Equatoria state since 2008, with specialist paediatric and antenatal care, surgery and treatment for HIV. There are more than 3,000 patients in the treatment programme. In Warrap state, MSF runs a small hospital in Gogrial town providing basic and specialist care, including an operating theatre for emergency surgery.
MSF continued to work in Agok, 40 kilometres south of Abyei, an area contested by Sudan and South Sudan. In the only hospital providing specialist services in the region, teams offered inpatient care, emergency surgery, maternity services and an inpatient therapeutic feeding centre. Early in the year a triage area and emergency room were also opened. Over 1,550 deliveries were assisted and 6,600 people were admitted to hospital. In February, the mobile clinics run by MSF ceased due to security concerns, and in March outpatient services were handed over to the NGO GOAL.
Cholera emergency response
On 15 May, the health ministry declared a cholera outbreak in Juba. MSF opened and ran five cholera treatment centres and three oral rehydration points, and provided technical assistance at Juba teaching hospital. MSF also responded to small outbreaks in Torit, Eastern Equatoria state, and in Malakal and Wau Shilluk, Upper Nile state.