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Under the shadow of a tree, a group is gathering, exchanging greetings. Peter, a mental health counsellor for Médecins Sans Frontières (MSF) and Margaret Abuk, MSF health promoter, are conducting an awareness and educational session for a group of overfifty people. A woman in the background is carrying a jerrycan of water on her head, walking slowly to go back to her shelter. In the distance, two children are standing hand in hand the older taking care of the younger. It is a normal day in Gomgoi camp, South Sudan, where 10,000 internally displace people have settled after fleeing the city of Agok, located a few dozen kilometres north, in February 2022, due to violence.
In this region of Warrap State, which lacks food, water and healthcare services, and faces recurrent outbreaks of diseases, the displaced families are encountering a strained situation in Twic County. On top of that, the floods that affected the west side of the county worsened an already dire situation. The floodwater destroyed the crops and made it impossible to harvest more, creating a food shortage over the course of many long months. The displaced families have lived for over a year in makeshift camps made of wooden sticks, and pieces of fabrics or plastic sheeting. For these people, the normality they have settled into is far from being normal, more than one year on.
Fleeing the violence and settling in the camps
Margaret Abuk, MSF community health worker, is one of the people who fled south into Twic County. She has been living in a shelter with her three daughters, in Majak Aher camp, next to Turalei town.
“Because of the conflict, because we were afraid, because people were killing us and our children, we had to run,” she explains. “I decided to come to Turalei because I knew there is public administration and protection as well as non-governmental organisations that would help us in the camp.”
Following the displaced population, MSF moved its activities from Agok—where the organisation had been running a hospital for eight years—to respond to the urgent needs of the newly displaced people. From March 2022, MSF teams started to offer humanitarian and medical assistance to displaced people within the Twic County. As well as running the mobile clinics, MSF distributed food, plastic sheeting, and other relief items and constructed latrines and water points in six of the seven makeshift camps.
“MSF was the only organisation providing assistance to us. For example, the blanket I have in my shelter and on which my children sleep every night is the one I’ve received from MSF last June,” Margaret adds.
Today, 30,000 persons are still living in dire conditions in the displaced camps, and the medical team witnesses the consequences of violence and displacement on the patients they treat. Amou Lang Deng is the mother of Adhar Deng, a 16-month-old girl, who suffers from severe acute malnutrition. She was admitted to the MSF-supported clinic of Mayen-Abun for fever and diarrhoea. The baby is anaemic and needs regular blood transfusion while still being fed through a nasogastric tube. Amou Lang Deng delivered her in MSF’s Agok hospital. In February, when violence erupted in Agok, she moved with her three young children and newborn baby to Abindau displaced camp, and still lives there with them. She does not remember any detail about her fleeing.
“Life in the camp is very difficult as there is no food,” tells Amou Lang Deng. “There are some organisations, but delays between distributions are important, and the quantities are insufficient. It’s been seven days since I’m in the hospital. I’m sure the food is finished since long time and my three other children are too young to look for food. When you look at my children, you can tell that food is missing, because they are very skinny.”
Focusing on comprehensive care to address urgent needs
From August 2022, MSF’s work shifted from an emergency response to a comprehensive and decentralised offer of medical care through the support of an 86-bed hospital in Mayen-Abun, two health posts in Gomgoi and Nyin Deng Ayuel, as well as in four community sites in the camps (Aweng, Majak Aher, Majok Noon and Abindau).
At the MSF-supported clinic in Mayen-Abun, MSF works hand in hand with the Ministry of Health to provide comprehensive care from outpatient consultations to emergency care and maternity, and hospital. A chronic care unit was also opened, as there are very few options for patients suffering from HIV or tuberculosis for instance. The MSF teams also offer psychological support to the individuals traumatised by violence and difficult life in the camps. Many patients seek care in this location. To reduce the number of patients in the MSF-supported clinic in Mayen-Abun, MSF has started providing consultations in accessible locations inside the camps, or nearby health posts.
Challenges and gaps
The volume of patients received in the MSF supported healthcare facilities reflect the alarming extent of healthcare needs for people in the host communities and those who have been displaced.
“We receive many children with moderate or severe acute malnutrition,” explains James Tikuei Nyibango Okoth, MSF medical activity manager in Twic County. “They come mainly from the displaced camps, but also from the host community, because food is missing all over the region. We face am influx of patients suffering from malaria during the rainy season and high number of malnourished children during the dry period. Our teams are stretched to capacity, and the needs are immense.”
Staff in all wards of the facility are busy. One place is quieter: the neonatal unit, where the newborns and their mothers rest. But one mother, Akon Garan and her son Athan Mariak Muorwel, 8 days old, are preparing to leave early the day after the baby is born. The baby needs an urgent surgery because of a malformation. But there are no surgical capacities in the whole Twic County, so they will be referred to Aweil, Northern Bahr el Ghazal State. Road access is limited and long, and the baby is very small and fragile for the six-hour drive. The absence of an operation theatre puts many lives at risk.
“If a patient is bleeding, or a pregnant woman has an obstructed labour it is very difficult”, says James Tikuei Nyibango Okoth. “We have also lost patients on the way due to the long distance.”
MSF is rehabilitating an operating theatre in a hospital in Turalei, one-hour drive from Mayen-Abun in dry season. Another challenge is the climate situation, as the recurrent flood that occurred in the region for three past years, not only make many areas inaccessible but also result in high peaks of waterborne diseases such as malaria.
More support needed for the population
“The situation is still very severe”, declares Beatriz Martinez de la Fuente, MSF project coordinator in Twic. “Because the conflict is still ongoing and considering that this area is likely to get flooded during the rainy season, this situation could become even more difficult for people here.”
Anticipating the rainy season that will worsen the living condition as well as increase the health needs, more support is needed from other medical and humanitarian actors.
“We continue to run our medical programmes, but there are acute needs for food, water supply, sanitation, shelter and protection, “she concludes.
While this region, along with other parts of South Sudan suffer from soaring needs, cuts to funding or reduced humanitarian assistance put lives of many in danger.