Aweil, South Sudan: Seasonal Emergencies and Reproductive Health
Sudan / 21.11.2008
© James Nichols/MSF
Doing the round in the paediatric ward, Aweil Civil Hospital.
The Médecins Sans Frontières project in Aweil in Southern Sudan’s Northern Bahr el Ghazal (NBEG) state is a comprehensive emergency response to a confluence humanitarian crises including access to healthcare for the population, and the ongoing emergencies of nutrition and reproductive health.
Based in Aweil, the main town of NBEG with a population of 100,000, Médecins Sans Frontières' work in the Aweil Civil Hospital, one of only three hospitals in all of Southern Sudan and covering a population of 1.7 million inhabitants, is the only referral structure providing secondary health care services for all of the state. The access to the hospital from other places in NBEG remains limited. Needless to say, the health needs of the population in South Sudan are huge where indicators such as infant mortality (150 per 1000 live births) and maternal mortality (2054 per 100,000), and crude mortality (22 per 1000) rate as some of the most desperate in the world.
Médecins Sans Frontières is based in the Inpatient and Outpatient departments, for paediatric, maternity wards and an operating theatre where much needed obstetric and gynaecological services are beginning to be properly performed and soon antenatal clinics will also begin. So far in 2008, Médecins Sans Frontières performed 92 surgical interventions (92 interventions in Gynaecological surgery between January and May) and treated 5,310 children during the seasonal peak of malnutrition from February to September (2,745 of them for severe acute malnutrition). Today there are 248 children in the OTP and 15 children in the Therapeutic Feeding Centre. Every week 35 children are also admitted, treated and cared for in the paediatric ward, treating common but deadly illnesses such as respiratory infections (such as pneumonia), malaria, diarrhoea etc. So far, since the maternity activity began just a month ago, 20 to 30 normal deliveries and three caesarean sections are performed each week at Aweil Civil Hospital.
In 2008 Médecins Sans Frontières' base in Aweil was called upon to respond to several emergencies such as a cholera outbreak after floods in and around Aweil in August and October (6,298 patients treated for cholera (450 for severe cholera) and Ministry of Health Cholera Treatment Centres supported).
In the malaria season (from June to September) Médecins Sans Frontières treated 4,244 children and additionally vaccinated 16,971 children from measles. During this period Médecins Sans Frontières also provided non-food-items to 15,881 internally displaced population (IDPs) and supplied water to a further 10,000 people in Maper Akot, an area on the edge of Aweil town where several thousand IDPs and refugees have returned since the end of the war.
Their work also confronts the crisis of human resources in this semi-autonomous region. Following 25 years of civil war between the Sudanese government of the north, and the Sudanese People’s Liberation Army/Movement (SPLA), and four million deaths, what is left of the south in terms of health, education and infrastructure amounts to almost nothing. The signing of the Comprehensive Peace Agreement (CPA) in 2005 while ended a brutal conflict, also signalled the long and arduous task of rehabilitation, disarmament, construction and education. Combined with endemic and seasonal humanitarian emergencies such as epidemics, malnutrition and natural disasters to name a few – the challenge of operating in this context is unquestionable. Therefore one of Médecins Sans Frontières' tasks in Aweil is to train the local Sudanese staff, including nurse and medical assistants (MA). There are very few Southern Sudanese doctors in fact, many have only reached the level of MA because their training has been interrupted by war and a lack of opportunities for scholarships and training in other countries. Critically there are no trained midwives in the south contributing to the deplorable maternal mortality rate from complicated births.
There also remains in Northern Bahr el Ghazal and the other 11 states that make up Southern Sudan, the issue of refugee and IDP resettlement – some 2 million people have returned from the north or bordering countries since 2005. Many of these people require some form of assistance however the obvious effect is a strain on resources and food, as evidenced this year during the hunger gap, when many children suffered from malnutrition. While it is an annual phenomenon due to crop production and poor availability, it also highlighted the difficulties to provide or guarantee the necessary food stocks, particularly in therapeutic food such as Plumpy nut. Therefore organisations like Médecins Sans Frontières purchased large amounts of food (Plumpy ‘nut, CSB, Unimix etc) for next year’s hunger gap which is predicted to begin earlier (in December/January), the necessary infrastructure, food and tools are in place ready to respond.