Health emergency amid violence

I HAVE spent the past five weeks in South Sudan, the world’s youngest nation and one with some of the worst health indicators. This was not my first time in South Sudan. I was in Gogrial in 2013, operating inside an inflatable tent. This time I worked in a camp. Our intervention in what is now Bentiu IDP camp – a former Protection of Civilians camp established in 2014 after an eruption of violence that forced thousands of people to flee to the nearby UN Mission in South Sudan base.

During the first two weeks of my recent mission, I had to operate on victims of violence – especially gunshot wounds – almost every night. Most of the injuries were to limbs, but there were also severe abdominal and chest traumas. Keeping these patients alive is always a challenge, requiring huge efforts from the whole team, and endless time in the operating theatre. And even if the operation succeeds, unfortunately the patients do not always survive due to a lack of post-operative intensive care facilities.

In my last weeks, we also noticed a worrisome trend of waterborne diseases, along with rising case numbers of malaria. Some of the kids are severely affected by it, and it is not always possible for us to reverse their condition.

I will not forget that some days, while walking inside the camp, I saw a nurse or doctor who had found a quiet corner crying because they had lost another of the little ones from their wards.

As I write, our teams are seeing cases of acute watery diarrhoea grow as well as a sharp increase in cases of hepatitis E. This is a cruel virus that particularly affects pregnant or nursing mothers, and we have already lost people in Bentiu.

These deaths are profoundly unnecessary – the virus thrives among

poor water and sanitation. Yet despite DR continuous warnings, UN agencies and donors have actually reduced services and conditions have deteriorated markedly, resulting in an unfolding tragedy. Immediate, urgent action is required to reverse it.

I also saw patients who had to walk for days to reach our facilities. One night our midwife woke me up because a pregnant woman had arrived with heavy bleeding. We did a Caesarean section and saved her life, but unfortunately the baby was already dead.

Healthcare delivery in the country is mainly dependent on humanitarian organisations, and in remote areas international medical actors are usually the only ones ensuring specialised healthcare for the local people.

Referrals of patients with severe conditions in need of surgical care remain a huge challenge for medical actors, implying heavy costs and facing logistical constraints given the lack of proper infrastructure.

I also had to operate on young children who had been bitten by snakes. I remember how challenging these cases were in 2013 as many of the victims had to undergo amputations. But now we do have antivenom to reverse the effects of snakebites. This time, many of my snakebite patients could go back home quickly. However, those who did not reach us swiftly after being bitten faced major and painful operations because there was no facility close to their villages to provide first aid.

Many health structures, including hospitals, have been destroyed or badly damaged over the years of conflict. Among an estimated 2 300 health facilities in the country, more than half are non-functional. Primary health facilities – that are so needed – often lack supplies, drugs, and health staff in quantity and quality.

During my stay, I was confronted with sexual and gender-based violence, which continues to be of grave concern in South Sudan. Survivors of sexual violence often do not come forward for medical care due to potential stigma and there is a need for community engagement about possible medical consequences. It is a difficult step for a survivor to disclose their experience and seek care.

“It changes your feelings. It makes you hate yourself. You feel that you are not a good person anymore for the rest of your life,” says a female South Sudanese refugee quoted in our latest report, reflecting on South Sudan’s 10 years of independence.

Since the camp transitioned to an IDP camp in March this year, people are being encouraged to leave, to return to the areas they fled from. We must ask why so many of them still prefer to continue to live in undignified and congested conditions in Bentiu, with grossly inadequate water and sanitation, and behind barbedwire fences. I posed this question to the community leaders I met before I left the project.

“There are three things that we need, so we can go back and start our lives again: peace, education and health. And none of them exist out there,” I was told.

I flew back to Juba with these words stuck in my mind. I was also carrying all these interactions and experiences, illustrating a hard and unfair life that the people of South Sudan live, back to the authorities I would meet in the capital.

These impressions were underlined to me also by my colleagues, the huge majority of which are South Sudanese, from all our projects – in Aburoc, Agok in Abyei Special Representative Area, Aweil, Boma, Fangak, Kediba, Lankien, Leer, Maban, Malakal, Mayom, Mundri, Pibor, Pieri, Ulang, Yambio, Yei and Yida.

At this 10-year anniversary of the country’s independence I can see little to celebrate but much to reflect on. Amid the government failing to invest in healthcare and aid funding being cut, conditions in Bentiu deteriorate while violence continues and people have to face long journeys to receive care. There is a lot of work to be done.