Aweil, South Sudan: Seasonal Emergencies and Reproductive Health

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Médecins Sans Frontières’ project in Aweil in Southern Sudan’s Northern Bahr El Ghazal 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. © James Nichols/MSF

Aweil is the capital of Northern Bahr El Ghazal (NBEG) with a population of 100,000, The access to the hospital from other places in NBEG remains limited. Here, paediatrician Dr. Stratos Roussos from Australia, discusses the condition of a new born baby to its father at Aweil Civil Hospital. © James Nichols/MSF

In 2008 Médecins Sans Frontières’s 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 were treated for cholera and MSF also supported the Ministry of Health’s Cholera Treatment Centres with medical supplies and equipment. © James Nichols/MSF

Médecins Sans Frontières’ work is mainly conducted in the Aweil Civil Hospital, one of only three hospitals in all of Southern Sudan. Covering a population of 1.7 million inhabitants, Aweil’s hospital is the only referral structure providing secondary health care services in the state. This is a road outside Aweil where displaced people have constructed temporary shelters away from flooded areas. © James Nichols/MSF

With a dedicated team of thirteen expatriate field staff (three doctors, one anaesthetist, two nurses, three logisticians, one adminstrator, one pharmacist, one project coordinator an operating theatre nurse) and more than 50 Sudanese staff; their work confronts the crisis of human resources in this semi-autonomous region. © James Nichols/MSF

Following 22 years of civil war between the Sudanese government of the north, and the Sudanese People’s Liberation Army/Movement (SPLA)– and approximately 2 million deaths, what is left in terms of health, education and infrastructure in the south amounts to almost nothing. After floods around Aweil in August and October, the fields provided people with an opportunity to catch small fish in baskets. © James Nichols/MSF

While the signing of the Comprehensive Peace Agreement (CPA) in 2005 ended a brutal conflict, it 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 – the challenge of operating in this context is unquestionable. © James Nichols/MSF

Médecins Sans Frontières is based in the Outpatient department (OPD), and Inpatient departments for paediatric, maternity and runs an operating theatre where much needed obstetric services are performed. In this photo a caesarean section is underway in the operating theatre at the hospital. © James Nichols/MSF

So far, since the maternity activity began just a month ago, 20 to 30 normal deliveries and 5 caesarean sections are performed by Médecins Sans Frontières each week at Aweil Civil Hospital. Health indicators in South Sudan are some of the worst in the world, maternal mortality rate is 590 / 100,000 live births, neonatal mortality 29 / 1000 live births, and the under 5 mortality rate is 89 / 1000 live births. © James Nichols/MSF

In 2008, Médecins Sans Frontières performed 92 surgical interventions between January and May at Aweil Civil Hospital. © James Nichols/MSF

This baby boy was delivered by a caesarean section procedure performed by Médecins Sans Frontières’ Obestrician/Gynecologist in Aweil Civil Hospital. Hours after delivery the baby started to have some respiratory distress for which he was given oxygen and closely monitored in the intensive care section of the paediatric ward. © James Nichols/MSF

Currently, the reproductive health activities of the hospital are undertaken in two inflatable tents installed by Médecins Sans Frontières (MSF) in the absence of clean and operational maternity wards in the hospital structure. MSF has almost completed the rehabilitation of an old ward in the hospital after which all of the expecting mothers and complicated deliveries will be moved into the hospital structure proper. © James Nichols/MSF

Outside the reproductive health section that Médecins Sans Frontières constructed in the grounds of Aweil Civil Hospital. © James Nichols/MSF

Every week 35 children are admitted, treated and cared for in the paediatric ward at Aweil Civil Hospital, treating common but deadly illnesses such as respiratory infections (such as pneumonia), malaria, diarrhoea and severe acute malnutrition. © James Nichols/MSF

Children playing in the paediatric ward in Aweil Civil Hospital. © James Nichols/MSF

An expectant mother outside the paediatric ward, Aweil Civil Hospital. © James Nichols/MSF

Médecins Sans Frontières medical work is supported by a logistics team that ensures the essential medicines are available to staff at Aweil Civil Hospital, to maintain quality care. © James Nichols/MSF

One of Médecins Sans Frontières’ tasks 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 of the war and a lack of opportunities for training in other countries. Critically there are no trained midwives in the south contributing to the deplorable maternal mortality rate from complicated births. © James Nichols/MSF

In Aweil and several locations in Northern Bahr El Ghazal, Médecins Sans Frontières treated 5,310 children during the seasonal peak of malnutrition from February to September (2,745 of them for severe acute malnutrition). © James Nichols/MSF

In October, 2008, there were 250 children in the OPD and 15 children in the Therapeutic Feeding Centre at Aweil Civil Hospital. © James Nichols/MSF

Paediatric patients and their carers at Aweil Civil Hospital. © James Nichols/MSF

Doing the round in the paediatric ward, Aweil Civil Hospital. © James Nichols/MSF

Malnutrition is an endemic problem is South Sudan, particularly for children under five years of age, who are the most affected during the hunger gap each year between February to September. © James Nichols/MSF

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.