Nikola Morton is a paediatrician from Sydney who recently completed an assignment in Taiz, Yemen, her fourth with Médecins Sans Frontières. Here she describes setting up an intervention to treat scabies – a highly contagious skin infestation – in a camp for people displaced by the conflict.
The protracted war in Yemen has displaced millions of people throughout the country – millions forced from their homes to escape this intense fighting. Some are lucky enough to be able to find alternate housing, either by renting or staying with friends or relatives. But many are not so fortunate and are forced to live in makeshift camps. Some of these camps are located just behind our hospital – I can even see the tents from my window.
But the perspective from my window is so much different than when you are there on the ground. As we drive in, I see the street is littered with rubbish everywhere. It is dusty and it is dirty. As we park the car, I see a little girl squatting in the open, going to the toilet just a few metres from the tents. As she finishes, she uses some nearby rubbish as toilet paper, and then again tosses it to the ground.
Because of the war, public services are absent and people’s living conditions have worsened. Today, many people lack access to clean water and food and struggle to meet their basic needs.
"Because of the war, public services are absent and people’s living conditions have worsened. Today, many people lack access to clean water and food and struggle to meet their basic needs."
Itching and scratching
As we get out of the car, we are swamped by people eager to see what we are doing here and what we might be bringing them. When we explain we are there to plan an intervention for scabies, they all simultaneously lift their shirts, adults and children alike. They are itching and scratching, eagerly showing me their rashes, saying that almost all of them have been afflicted. We are taken around the camp by the elders, and around each corner we find more and more tents filled with more and more families. What started as only a few tents has continued to expand as more people have been forced from their homes. While we cannot change their circumstances, hopefully we can do something to relieve just some of their suffering by ridding them of their scabies infestation.
After much planning and preparation, the day comes for the scabies intervention. This is not as simple as it sounds – it is a week-long program, every detail planned and with a lot of ground work by the logistic staff, including building showers and washing vats, and ‘sensitisation’ by our health educators. In the morning of the first treatment day, the 20+ staff assemble for the briefing, ready to head out to the camp. There is an air of excitement, the team eager to help outside the walls of our hospital.
Joy and excitement
We head off and the team splits up into four different areas of the camps. Within minutes of our arrival, families are queueing up to receive their treatment. We have the medical team screening patients and administering treatment. The people need to apply the scabies treatment and leave it on for a set time (different for infants, children, pregnant women and adults) and then wash it off, but if the skin is infected, we must treat the infection first. While we are seeing all the families, the logistics team is tirelessly washing all the clothes and bedding in boiling water – they need to make sure the water is the right temperature and the clothing stays in the water for the right time to ensure the scabies are killed. While there was definitely an element of chaos to the whole process, there was much joy and excitement in the camp. One of the boys was dancing around the camp after applying his treatment singing “Mafish garub”, meaning “no more scabies!”
Given the general conditions these people are living in, a scabies intervention seems like such a small thing, but at least it is something. These people have suddenly found themselves in very difficult circumstances. They haven’t always lived here - many once had lovely homes which they were forced to flee, unsure if they will ever be able to return, unsure if there is even a home to return to. And scabies is just one of the many health risks of living in such a camp. There is also the risk of other infectious conditions, especially diarrhoeal disease such as cholera, which unfortunately was soon to follow.”