MSF in Sudan

Last updated: March 2009

MSF in Darfur

MSF has provided medical-humanitarian aid in the Sudanese region of Darfur since 2003, when government forces and allied militia began fighting rebel groups seeking greater autonomy and resourcing for the arid and impoverished region. By 2006, the political environment became increasingly complex, with the continued fragmentation of armed groups leading to outbreaks of violence and heightened insecurity. Aid organizations, including MSF, were the target of numerous attacks and robberies, at times making delivery of aid extremely difficult. Harassment from armed groups, increased banditry and clashes between nomadic tribes led to new population displacements. The United Nations estimates that up to 300,000 people have died and more than 2.2 million have fled their homes since conflict in Darfur erupted in February 2003.

West Darfur

In February 2008, a military offensive around Seleia, north of El-Genina, capital of West Darfur, caused the displacement of thousands in the area and security problems for MSF. MSF medical teams changed their strategy during 2008 to reach out to the scattered population, including the use of mobile clinics and fixed health posts. Currently, there are two areas of intervention, as the population has re-established itself in two different localities, Seleia and Juruf. Medical teams provide an average of 1,500 medical consultations and an average of 1,000 antenatal consultations per month.

In April 2008 MSF opened a new project in Golo and Killin, home to around 85,000 people, in the mountainous Jebel Mara region. In Golo, an area controlled by the government, MSF teams are working in the town’s hospital, providing primary and secondary health care with both inpatient and outpatient capacity, obstetric care and nutritional care. Nearby in Killin, a rebel controlled area, MSF provides primary health care, including a small emergency room, in the town’s clinic, in addition to an outpatient nutritional program. In-spite of some serious security incidents in Golo, MSF teams are still present in the two localities. In 2008, medical teams performed an average of 3,800 consultations per month. Medical activities continue to focus on women’s health, malaria and malnutrition.

In Niertiti, where the population totals approximately 40,000, including around 30,000 displaced people, MSF provides outpatient and inpatient care in a health clinic. In 2008, MSF teams performed 86,000 consultations and 4,900 hospital admissions. Diarrhea, respiratory infections and malnutrition are the main causes of hospitalization. In the therapeutic feeding center of Niertiti hospital, 1,071 malnourished children were hospitalized for medical complications. In February 2008, following a meningitis outbreak, 35 patients suffering from this disease were admitted to the clinic. In response, MSF launched a mass vaccination campaign, vaccinating over 28,000 people, aged between two and 30 years old, in five days.

In Zalingei, where 130,000 people live, mainly IDPs, MSF works in three departments of Zalingei hospital: supporting pediatric surgery and the emergency room. In 2008, the pediatrics department had 1,849 admissions, mainly for respiratory diseases. MSF teams also work in two camps for displaced people around Zalingei, providing nutritional care and transferring patients with medical complications to the reference hospital. From the beginning of the year up until July 2008, around 1,500 malnourished children had been admitted to the nutritional program. Since February this year, MSF teams have been providing mother and child healthcare in Hassa Hissa camp. In 2008 MSF teams in Hassa Hissa had provided around 13,200 mother and child consultations, predominantly to children under five years.

MSF teams have also distributed supplementary food to thousands of children aged between six and 36 months in and around Zalingei during the hunger gap period. Around 11,000 children, both resident and displaced, received four weekly rations in May and June, but due to government restrictions this program was interrupted and has not yet resumed.

North Darfur

In the town of Kebkabiya, 150km (about 93 miles) west of North Darfur’s capital of El Fasher, MSF supports two dispensaries and one health post, providing basic health care, including vaccination and treatment of malnutrition. MSF also supports the obstetric department of Kebkabiya hospital and provides comprehensive emergency obstetric care. In addition, a team of home-visitors work in Kebkabiya town. They carry out health promotion, ensure that people adhere to specific treatments, and refer patients to other health structures when necessary.

As other organizations, such as UNICEF and the World Health Organization, are giving increased support to the hospital and the health centers, MSF will gradually hand over its activities in Kebkabiya to the health authorities in 2009. MSF teams will continue their support to the women’s clinic and also to treat malnutrition until the end of the hunger gap, next fall, and will keep lobbying the World Food Program (WFP) to ensure regular food distributions. In April, the two outpatient departments and the home visitors activities will be handed over. While decreasing its presence in Kebkabiya, MSF is looking at assessing other areas of North Darfur where civilians are still cut off from medical aid.

In Jebel Si, MSF runs a dispensary in Kaguro and five health posts in the surrounding area. This dispensary and the health posts provide medical care to around 80,000 people who have been cut off from assistance since 2003, when the area was attacked and most villages were burned down. MSF teams in the dispensary provide outpatient and inpatient care, antenatal care, nutritional support and immunization. In the health posts, outpatient and antenatal care are offered. In 2008, an average of 4,500 consultations were provided, more than 40 patients were hospitalized and around 25 severely malnourished children were cared for each month.

As Jebel Si is a rebel-held area, it is extremely difficult to refer patients to health facilities outside the area, such as Kebkabiya hospital. To address this problem, MSF is developing emergency surgical capacity at the Kaguro dispensary. In addition, the Kaguro team plans to improve access to healthcare for people unable to make it to MSF structures, by increasing the number of MSF outreach health posts providing medical aid.

In Serif Umra medical teams provide primary and secondary health care, including vaccination, antenatal and inpatient care and treatment of malnutrition. Each month around 4,000 consultations are carried out, 110 patients are admitted to the dispensary and more than 45 children receive nutritional care. Currently, when security conditions permit, patients in need of surgery or complicated secondary health care are transferred to hospitals in Zalingei or El Geneina. In April, MSF plans to expand its activities in Serif Umra and offer emergency surgical and obstetrical care. MSF teams also plan to reach greater numbers with medical aid by starting outreach activities in three new locations in the surroundings of Serif Umra.

In Shangil Tobaya, 65km (40 miles) south of El Fasher, MSF provides medical care for the approximately 28,000 displaced people that live in the Shangil and Shadat camps and to an additional 5,000 people in the surrounding villages. MSF provides inpatient and outpatient care, a therapeutic feeding program, reproductive health services, treatment for victims of violence. Staff provide around 4,000 outpatient consultations and deliver 15 babies every month. Due to the constantly changing security situation in different areas of Darfur, there is a near constant influx of newly displaced people in these camps. MSF monitors the status of these new arrivals and provides the most urgent cases with additional assistance.

MSF started working in Tawila, 60km (37 miles) west of El Fasher, where close to 35,000 displaced people have gathered in three camps since August 2007. MSF set up mobile clinics in these camps, focusing on nutritional care and mother-and-child health care, and a 25-bed inpatient department in Tawila town. In 2008, MSF expanded its services, not only in Tawila but also in a number of villages in the surrounding area, where many people had lacked access to health care since 2003. The expanded services include outpatient and inpatient care; nutritional care; and vaccination. However a recent security incident forced the international team to be evacuated.

South Darfur

Since March 2008, fighting between two groups in Sania Afundu, around 60km (37 miles) southeast of South Darfur’s capital, Nyala, has displaced around 60,000 people. Although the ongoing insecurity makes it difficult to reach these people, MSF has provided around 10,000 people with non-food-items, such as jerry cans, blankets, and clean water.

Kalma camp, home to around 90,000 people, is one of the largest for displaced people in Darfur. MSF has worked in the camp since May 2004. Six international and 150 Sudanese staff run an outpatient department, which provides an average of 4,500. MSF is also focusing on mother and childcare and running a women's health center with up to 200 consultations per day. The center provides antenatal and postnatal care, as well as delivery assistance for high-risk pregnancies and referrals for obstetric emergencies. Medical treatment is offered to survivors of sexual violence. The MSF team also responds to the emergency needs of new arrivals whenever necessary.

Following hostilities in Kalma Camp at the end of August 2008, more than 65 wounded were admitted to the MSF clinic and 52 of the most severely wounded were evacuated to Nyala Teaching Hospital - over half of whom were women and children. Five of these severely wounded patients subsequently died. Since May 2008, only half-rations of food have been provided in Kalma Camp. While malnutrition has not yet reached alarming figures, this lack of food can have a negative impact on the health status of the population. MSF is very concerned and has urged the WFP to start providing full food rations again.

At the beginning of November last year, the government instructed MSF to stop admitting new patients into the Kalma mental health program which had been providing medical care to people suffering from profound psychological stress and trauma due to tenuous living conditions and the long-running conflict in Darfur. Since the mental health program started in 2006, a total of 1,600 patients have been treated with 84 percent showing improvement or a complete resolution of their symptoms. MSF regrets the fact that we will not be able to continue treating mental health patients and that we were unable to convince the authorities of the vital medical nature of this activity.

Through a 25-bed clinic, MSF provides medical care to around 70,000 people living in and around Muhajariya, a large town in South Darfur. MSF staff offer surgical care and run inpatient and outpatient departments and a laboratory, in addition to providing reproductive health services. Treatment for survivors of sexual violence is also available. In the last year more than 55,000 patients were treated at this site, along with 1,300 in-patients and 440 surgical patients. In April 2008, MSF restarted mobile clinics in the nearby areas of Labado and Um Shegeira to enable better access to healthcare. In 2008, there were 660 malnourished children assisted through the MSF clinics. However, insecurity often prevented MSF teams from visiting these two locations. In January 2009, clashes between two rival rebel groups forced MSF to evacuate most of its medical team, leaving thousands without critical healthcare. The MSF base was completely destroyed by fire, however the clinic was untouched, and following four weeks of forced absence an MSF team was able to return. In February 2009, insecurity surrounding proceedings of the International Criminal Court forced a preventive evacuation of the full medical team.

In the mountains of eastern Jebel Mara, an MSF team in Feina runs a clinic providing outpatient care, antenatal care, and an ambulatory feeding program. There is also an inpatient department for severely malnourished children and emergency cases that require overnight care. The travel distances can be very long in such a mountainous area. For example, travelling from Gulombei to Feina can take up to six hours by donkey. Since May 2008, MSF has run a mobile clinic in Gulombei, with a focus on children under five and pregnant women. This MSF mobile clinic treats children for the most common diseases, like diarrhea and respiratory infections, and provides antenatal care for pregnant women. The Gulombei mobile clinic means that patients from even further away in this mountainous area, where the population is widespread, can access health care. In Feina and Gulombei, MSF sees about 3,000 patients per month and saw almost 8,000 women during their pregnancies. Regrettably, recent insecurity forced MSF to temporarily suspend its presence, as of March 2, 2009.

Ongoing insecurity has meant that people living in and around Adila, in the east of southern Darfur, near Kordofan, have been cut off from significant humanitarian assistance for the last four years. In March 2008, an assessment in Adila found a 14 percent rate of acute malnutrition. MSF teams responded by opening an inpatient feeding center and 10 ambulatory feeding centers in April. By the end of October, more than 4,700 malnourished children had received treatment in the centers.

View the Darfur operational update from December 2008.

Southern Sudan

Published: June, 2009

Doctors Without Borders/Médecins Sans Frontières (MSF) provides care to hundreds of thousands of people in six states in Southern Sudan. In recent months, increasing violence and insecurity caused mostly by fighting between different tribes, as well as heightened tensions around disarmament initiatives, criminality in the regional capital, Juba, and road banditry has made it more difficult for MSF field teams to reach people in need of aid.

The needs in Southern Sudan continue to be immense, with MSF teams stretched to ensure the provision of basic and secondary health care and to respond to emergencies. Currently, MSF has 1,143 national staff and 129 international staff in Southern Sudan.

Working amid ongoing insecurity: treating victims of violence

In early 2009, there was a sharp increase in inter-tribal violence in Jonglei, Upper Nile, Lakes, and Warrap states resulting in hundreds of deaths and the displacement of thousands of people.

In May, an attack on the village of Torkej in Upper Nile State, bordering Jonglei State, resulted in many wounded arriving in nearby Nasir, where MSF runs a hospital providing basic and secondary health care, including inpatient facilities and treatment for malnutrition, maternal health, tuberculosis care, and kala azar, as well as surgical care. A total of 57 victims made it to the hospital. Many patients suffered multiple gunshot wounds and needed follow-up surgery and care. The majority were women and children. Several thousand civilians have been displaced by the ongoing clashes, with around 2,000 people fleeing to the outskirts of Nasir and Jigmir.

Two other brutal clashes occurred in March and April 2009 in Pibor and Akobo counties in Jonglei State. Upwards of 15,000 people fleeing the violence arrived in Akobo, south of Nasir, near to the Ethiopian border. In response, MSF sent a team to assist staff at Akobo hospital. Some 36 wounded patients were treated, mainly for gunshot injuries. Eight patients were flown to Leer Hospital in Unity State, run by MSF, for further surgery. MSF also provided the hospital in Akobo with medical supplies, mosquito nets, and food and blankets for the wounded and their caretakers.

“Nearly all the patients tell us they lost family members in the violence. We heard horrific stories—women and children were attacked and killed in their homes, and children were also kidnapped,” says Dr. Jonathan Novoa, MSF medical coordinator in Akobo County.

“Many patients had multiple gunshot wounds—a 10-year-old boy had three bullet wounds to both his legs. One mother we treated had lost five children and her husband. She managed to escape with only her smallest baby who had been shot in the arm; both survived and made it to the hospital. The wounded and their families are suffering from the trauma of the attacks. Their homes have been burned, along with their food stock. The people who managed to flee have nothing with them—they ran for their lives so they couldn’t bring any clothes or cooking pots. They sleep outside.”

On the other side of Jonglei State, following attacks in Lekwongole, Pibor County, in early March, another MSF team evacuated injured people to Pibor hospital. More than 40 patients were treated for violent trauma wounds resulting from gunshots. The 22 most seriously injured were flown to hospitals in Juba and Boma for urgent surgery.

Dr. Catherine Van Overloop, Medical Coordinator for MSF in Pibor Country explains, "Even up to ten days after the attacks on Lekwongole, wounded people were still arriving in our clinic. They had been hiding in the bush, too afraid to move. Fearing more attacks they didn’t dare seek the medical treatment they urgently needed, so they reached us when their wounds were even more infected. The people are so fearful here. For days after the attacks, the women in Pibor were too afraid to ever leave their children alone, in case there was another sudden clash and the children were killed or taken. They brought them absolutely everywhere with them, even to work, carrying them on their backs, afraid they might have to suddenly flee."

Villages on the border with Congo attacked

Towards the end of 2008, attacks by the Ugandan rebel group, the Lord’s Resistance Army (LRA), near the Congolese border and also in Democratic Republic of the Congo (DRC) itself, caused thousands of Sudanese people to flee their homes and Congolese refugees to cross the border and seek refuge in Sudan. In response, MSF started supporting two primary healthcare clinics in Gangura and Sakura, in Western Equatoria State, close to the border with DRC. By the end of 2008, 7,200 medical consultations had been provided to both the resident and refugee populations in these two areas.

In January 2009, more displaced people arrived in the area, and MSF decided to start an emergency intervention in Western Equatoria State. Mobile teams started working in Ezo, Naandi and Makpandu, supporting primary health care centers; providing mental health counseling; doing nutritional screenings and referrals of patients; training Ministry of Health staff; and providing medical and logistical materials.

In February, MSF teams in neighboring Central Equatorial State also began assisting Congolese refugees in Lasu, approximately 50 km (30 miles) from the Congolese border. Initially, MSF assisted in two temporary camps in Libogo and Nyori where more than 6,000 people had sought refuge. In both locations, the majority of refugees arrived from DRC without any of the essential basics needed for everyday life. MSF teams worked to provide shelter, repair boreholes and build showers and latrines in the camps.

The following month, when the UN High Commissioner for Refugees (UNHCR) created a camp in Nyori, MSF set up a health facility with inpatient capacity and a pharmacy. This facility provides general medical consultations, antenatal care, deliveries and treatment for malnutrition. In the first week, 500 consultations were provided. MSF teams also constructed 39 communal latrines for the camp and drilled two new boreholes. Health promoters were employed to raise awareness of diseases like tuberculosis, malaria, and water-borne diseases. MSF also vaccinated 1,638 children in the camp against measles.

Responding to Outbreaks and Epidemics

Large-scale outbreaks of meningitis, measles, cholera, and malaria are common in Sudan. In the early months of 2009, MSF teams responded to several outbreaks of cholera: in Peth, in Aweil East, northern Bahr-el-Ghazal State; Pibor, in Jonglei State; and Gogrial town, Warrap State. Where possible, MSF worked alongside the Ministry of Health, providing treatment, medical supplies, tents, and staff as necessary.

In Juba County, Central Equatoria State, where there are cholera outbreaks every year MSF has started preventive activities including health promotion and the provision of clean water in communities at risk, such as Kator and Munuki. In order to improve hygiene and reduce the number of deaths from water-borne diseases, MSF is providing clean water by repairing existing boreholes in the community and drilling new boreholes, including in four health centers.

In February, MSF responded to a meningitis outbreak in Kapoeta, Eastern Equatoria State, vaccinating 65,322 people and supporting health structures in treating people infected with the disease. MSF also coordinated with other agencies to respond to meningitis cases in northern Unity State.

Medical care at all levels

MSF’s activities continue in other parts of Sudan. An absence of healthcare staff, structures, roads, transport, other aid agencies, and investment in health care means that in some areas MSF is often the only medical organization present. In Aweil, Bahr-el-Ghazal State, MSF supports a hospital, focusing on providing healthcare to mothers and children and nutritional care. In the disputed areas of Abyei and nearby Agok, in Warrap State, MSF runs outpatient clinics and provides nutritional care in both fixed and mobile clinics. In 2008, 8,950 outpatient consultations were provided and over 1,200 severely malnourished children were treated. In 2009, MSF began a reproductive health program providing antenatal care and safe deliveries in the Abyei region.

In Pieri, Lankien, and Pibor, all in Jonglei State; Nasir, in Upper Nile State; and Leer, in Unity State, medical staff provide all levels of health care, ranging from consultations for respiratory tract infections to lifesaving surgery. In 2008, medical teams provided over 360,000 outpatient consultations, almost 20,000 antenatal consultations, 1,098 surgeries, many of them emergency surgical interventions for gunshot wounds, and admitted about 8,300 people as inpatients. Some 492 people were started on treatment for tuberculosis in 2008. Malaria is a growing concern. In 2007, 4,400 people were treated for malaria in Leer hospital. In 2008, this number rose to 25,500, and in the first four months of 2009 the MSF team had already treated 14,000 patients.

MSF has worked in Sudan since 1979.

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