South Sudan’s conflict began as a political crisis in the capital, Juba, in December 2013 but rapidly spread throughout the country, involving various armed groups and militias. Civilians have also been repeatedly targeted and subjected to extreme levels of violence, including rape, abduction and murder. Unity state, in the central north of the country, is one of the worst affected areas. Almost 600,000 people are displaced in the state, with many seeking safety in the UN Protection of Civilians camp in Bentiu, and others simply hiding in the bush or swamplands. Médecins Sans Frontières provides the only hospital for the 110,000 people in the camp – a 170-bed facility providing everything from maternity care to surgery.
Two Australian field workers who have recently returned from Bentiu share their experiences:
Andrea Atkinson, medical doctor
“People in the camp have all fled villages when they were under attack and often arrive with nothing, not even clothing in some instances. Unfortunately life in the camp has many dangers itself – namely malaria and malnutrition. People often report that they don't have enough food to feed their children, and there is no fuel for cooking so women often have to leave the camp in search of firewood. This is extremely dangerous and we had many reports of women being raped or abducted outside the camp.
What I noticed inside the camp was how many children there were – thousands and thousands of children, who spend their days playing in the streets of the camp, unfortunately being exposed to mosquitoes carrying malaria. During my time we had a massive malaria outbreak and everyday was a struggle to keep unconscious, convulsing and severely anaemic children alive. It must be very hard for the parents, who have fled terrible violence, to then have their children die from disease and hunger in the camp.
"Médecins Sans Frontières is the difference between something and nothing over there."
Yet it was amazing how resilient the children could be, and the lengths their parents took to protect them. People would hide in lakes and rivers for weeks once their villages were attacked. Eventually they would make the journey to the camp, often coming directly to the hospital to have their children treated. It was an incredibly difficult mission. I was not accustomed to seeing children die, and to be honest, many times I felt quite out of my depth as one of only two or three doctors in the hospital. There were very few other organisations providing even primary healthcare. Médecins Sans Frontières is the difference between something and nothing over there. At one point we were seeing over 300 patients a day, and more than 80 per cent were positive for malaria. Without medical treatment, many of them would have died. Although it often felt that what we were doing was the tip of the iceberg, we have to continue to advocate for more healthcare for the people in the camp and for more protection for those outside it.”
Jennifer Duncombe, epidemiologist
“I worked as an epidemiologist in the camp, following a surge in fighting in Unity State that resulted in a considerable influx of people. As a result, the risk of disease outbreaks due to overcrowding, poor water and sanitation conditions, and strained health facilities increased dramatically.
We saw many cases of malnutrition, measles and Hepatitis E, as well as other tropical illnesses such as Kala Azar, however our biggest concern was malaria. During my three month assignment, Médecins Sans Frontières treated more than 40,000 children aged under five for malaria. Indeed, in August, the camp was so overwhelmed by the malaria outbreak that, together with other organisations, we conducted a community-based malaria treatment campaign. In eight days, 250 outreach workers screened 30,000 children aged six months to five years old for malaria and, of those, treated more than 16,000. It was a colossal effort and something I will never forget! In the following weeks when fewer severely sick children were seen at the hospital, and the number of deaths decreased, we all sighed with relief. Although the outbreak was not yet over, we could at least see some improvement and there was a light at the end of the tunnel.
"We also saw many indirect impacts of the conflict, such as children who came in missing limbs because they were playing with grenades that they found."
We had many patients who were directly affected by the war: for instance people with gunshot wounds. We also saw many indirect impacts of the conflict, such as children who came in missing limbs because they were playing with grenades that they found. At one stage, we had three children come to the hospital with shrapnel wounds and missing limbs from a grenade explosion. Unfortunately, within a few days, all had died. A few weeks later, we had two more children injured by grenades. Thankfully, our surgeon worked his magic and this time they both survived.
Life inside Bentiu camp, although relatively peaceful, is difficult. People are reluctant to come to the camp because they fear disease outbreaks, like malaria, but they are fleeing for their lives and can see no other option. Working in Bentiu was also extremely challenging, both physically and emotionally. It was incredibly hot but also very muddy, so we trudged around in gumboots, sweaty and sunburnt and desperately seeking shade. And yet, it was impossible to feel sorry for ourselves when we came face-to-face with such seemingly unnecessary suffering in the camp each day. What is the point of this war? Why are these people killing each other? When will it be over?”