From the field

Click on the images above to read first-hand accounts from our staff and patients in South Sudan. You'll find personal reflections on this unstable region, its medical needs and our vast response - including maternal and child health, malnutrition, disease and violence.

Treating victims of violence

War has ravaged Sudan for more than 50 years as the North and South fought for control. This devastating conflict has left more than two million people dead and more than four million people displaced.

The two sides signed a peace agreement in 2005, and the people of South Sudan voted for secession from Sudan in January 2011. South Sudan is now expected to declare its independence in July 2011.

Despite this, violence and insecurity continues to plague the country. Terri Morris is Head of Mission for our projects in Yambio and Raja. It's a region that remains vulnerable to outbreaks of civil unrest.

Terri describes the challenges involved in delivering medical assistance to people in the face of ongoing violence.

MSFHead of Mission, Terri Morris meets with South Sudanese who fled from attacks in their village.

"Médecins Sans Frontières' longstanding experience with conflict victims is that one of the most significant issues is trauma. The subsequent impact this trauma has on mental health, and the ability to lead a relatively normal life, is enormous.

"We have dedicated teams who work with internally displaced people and refugees, victims of violence, children who have been abducted, and survivors of sexual violence to help them improve their coping mechanisms. Through group and individual counselling sessions, they assist in giving them an outlet for their fears, and strive to improve their prospects for the future."

Naturally, Terri says, "an integral part of our activities is preparing for the consequences of violence, including mass casualties. If we are serious about preparing for potential violence, we have to be prepared to be able to increase resources and respond effectively.

MSFA patient recovers from a gunshot wound to the leg.

"This means a fully resourced mass casualty plan, including an increase in surgical capacity, human resources, training, and a dedicated area in hospitals where we can triage and treat more patients."

Insecurity remains a constant challenge. "One of the things that I have learned is that predictions are dangerous, and preparation is the key. There are a number of different scenarios and variables over which nobody has control or a complete overview.

"In a country where humanitarian needs are already enormous, it is responsible for Médecins Sans Frontières to prepare to respond to any eventuality or increase in needs."

Maternal and child healthcare

Mothers and babies are more likely to die in South Sudan than almost anywhere else in the world. One in seven women here die as a result of pregnancy-related complications, while one in seven children do not live to see their fifth birthdays.

For this reason, a major focus of Médecins Sans Frontières' work in South Sudan is maternal and child health.

It's an area in which we are often the only provider of medical care to thousands of people.

Our work in Aweil Civic Hospital, for example, services a population of 750,000, providing a range of medical services including obstetric and paediatric care. If Médecins Sans Frontières wasn't there, thousands of women like Maria and her newborn baby would have no access to the life-saving care they need.

MSFA Médecins Sans Frontières midwife treats a young child

Maria was 22 years old and eight months pregnant when she came to our hospital. She had given birth at home twice before – both babies had been stillborn. This time, she was determined to access medical care for the birth.

As Maria explained, "I decided to come to the hospital because of the conditions at home. It is safer here. I will wait here until the baby can be delivered safely. I will be happy if this child survives, I was sad when my other two children died, and I want this one to live."

With access to the prenatal and obstetric care that we provide, Maria gave birth by caesarean section.

"Maria has quite a severe spinal deformity, and her pelvis and spine would probably not have coped with a normal delivery, especially if she was at home," explained Médecins Sans Frontières midwife, Janet Fields. "The decision to provide her with the c-section was essential. The great news is that both she and her new baby are happy and healthy."

Through community education in Aweil and the surrounding areas, more and more women like Maria are coming to the hospital to give birth. In the paediatric and maternity units of the hospital, Médecins Sans Frontières medical teams provide pregnant women and children under 15 with free, quality healthcare. Last year more than 3,500 children were admitted to the hospital.

Names have been changed to protect patient identities.

The situation – an overview

Laurent Ligozat, our Deputy Director of Operations, recently returned from Abyei and Agok in South Sudan. Here, he offers his perspective on some of the key issues facing South Sudan and our work in the region.

How would you assess the humanitarian and medical situation in South Sudan?

"For years, South Sudan has been confronting a medical-humanitarian crisis characterised by lack of access to healthcare, chronic malnutrition, regular epidemics, avoidable epidemics, and insecurity that has led to displacement.

"In this healthcare desert, people are dying of malaria, respiratory infections, or simply diarrhoea – all diseases that are easily cured if access to care wasn't so difficult.

"The return of tens of thousands of people to South Sudan who were refugees is also of concern. These people are going to be exposed to diseases that are endemic to South Sudan. Managing the return of these displaced people will be an additional challenge for this region, where resources are already very limited.

MSFWard rounds at the Médecins Sans Frontières hospital in Agok.

"Finally, we can't forget insecurity, which is omnipresent. In 2010 the violence led to more than 900 deaths and 215,000 people being displaced."

What types of care do Médecins Sans Frontières medical teams provide there?

"We offer essential care for free, because healthcare in the Abyei region is limited and uncertain. As is often the case, women and children are the first to be affected.

"Médecins Sans Frontières brought trained staff, quality medicines, and free primary and secondary care, and had an impact on the most vulnerable groups. In Abyei and Agok, we provide maternity services, paediatric care, and general medicine. We also treat malnourished children under five.

MSFAustralian nurse Sam Bartlett examines a child at a mobile clinic.

"Abyei is an area contested by the North and South, and the population is on the front lines. Emergency preparedness plans are currently being implemented by our teams to respond to both the flood of wounded and population displacements.

"Given this situation, Médecins Sans Frontières' role is crucial: to provide aid and medical care to people in need, and to promote independent humanitarian action. It is essential we maintain our independence toward all parties in order to have access to the most vulnerable civilian populations no matter what their origin, gender, or religion."

Australian nurse writes home

Victoria Mowat, a nurse from Brisbane, worked as a supervisor at Médecins Sans Frontières' therapeutic feeding centre at Leer Hospital, South Sudan last year. She describes her experiences treating malnourished children there.

"Leer is a small town in the Unity State, where access to healthcare is generally very poor. People often have to travel long distances to reach a health facility, many of which are incapable of delivering adequate care.


Australian nurse Victoria Mowat at Leer Hospital.

"My role was extremely rewarding. In most cases the children improved quickly once they were given appropriate treatment. I remember Mayom, a two-year-old boy who was in a critical condition when his mother brought him to the centre. He was severely emaciated and anaemic and had lost his appetite completely.

"We were able to give Mayom a blood transfusion and feed him essential nutrients via a nasogastric tube. Gradually, he regained his strength, and we were able to remove the tube. One of the last memories I have from my time in Leer is seeing this little boy running towards me with a smile on his face to say goodbye.

MSFLoading a cargo plane in Leer, Unity State.

"Médecins Sans Frontières is playing an important role in working towards improving access to healthcare in the region. Overall my experience in Leer was rewarding and enlightening. I'm sure I learnt something new every day I was there. The intense teamwork that is part of life in the field has given me friendships that I will treasure for the rest of my life."

Names have been changed to protect patient identities.

One family's fight

Last year saw South Sudan struck by the biggest outbreak of the parasitic disease kala azar in nearly a decade.

Yar, a mother of four from South Sudan's Upper Nile State, came perilously close to seeing how deadly kala azar can be when her youngest son, two-year-old Malith, fell ill last September.

"He became very sick, with a very high fever that lasted many weeks," Yar said. "He was vomiting, had diarrhoea, and became very thin. We went to Malakal Hospital, where Médecins Sans Frontières had a kala azar treatment centre, and they began treatment."

But just as Malith began to recover, Yar's seven-year-old son Mayen and five-year-old son Litiong both began exhibiting the disease's telltale symptoms.

MSFDoctor Maria Ilva Tente examines a patient with kala azar.

"Mayen had a very high fever, a dry cough, and no appetite. Litiong began vomiting, had diarrhoea, and also had a cough and no appetite. They both lost a lot of weight. They were tested for kala azar and found to be positive. So they began receiving treatment too."

As well as producing side effects such as jaundice, kala azar treatment is long and painful, requiring injections into the muscles for around 30 days. This is agonising for patients – and heartbreaking to watch for mothers like Yar.

"Each day, we had to beg the children to accept the injections. They kept saying, 'No, it hurts, I don't want it.' So I had to take them each day and hold them while they cried."

MSFResponding to an outbreak of kala azar in Malakal, Upper Nile State.

Thankfully, all three of Yar's children have now fully recovered from the disease and are back at home. "We are facing many difficulties. But we are very thankful that our children are all healthy and we are together again in our village."

Since the outbreak began, Médecins Sans Frontières has treated more than 2,300 patients with a regime of injections.

With hundreds of thousands of South Sudanese now returning to areas where the disease is endemic, another outbreak appears imminent.

"They have no immunity against the parasite, and they are arriving during the active transmission season," said Médecins Sans Frontières' Emergency Coordinator, Moses Chol Maper. "My concern is that the next season will be a big challenge, with numbers much worse than 2010."

Names have been changed to protect patient identities.