South Sudan: Helping displaced and local communities in Abyei region

20 Dec 2023

South Sudan, the youngest country in the world, experienced severe instability throughout 2022 continuing into early 2023. Eight out of its ten states were wracked by violence. This upheaval triggered extensive population displacements, predominantly in the Abyei Special Administrative Area and regions such as Twic County. 

These mass displacements have been aggravated by a historical backdrop of conflict, an increasing climate crisis, economic hardships, and lack of access to lifesaving healthcare. 

 Displaced people in Abyei, South Sudan

Five families have recently arrived in Abyei following a long perilous journey through regions torn apart by conflict in Sudan. The older generation came originally from Warrap state in South Sudan, but the two younger generations were born in Sudan. © Sean Sutton/Panos Pictures

The acute challenges of survival

Most of the people in this internally displaced camp in Abyei are Nuer. Some fled violence in Agok, while others have come from Unity state to escape flooding, particularly around Bentiu.

Akur has seven children. She explains, "The area is very overcrowded, and people are still arriving. It was okay at first, but since April, we have been suffering. New arrivals don't receive ration tokens, and they can't get help with shelter and food. So, we take care of them, even though we don't have enough ourselves. This is additional pressure we can't live with, but people can't eat alone; we should eat together, and we have to share what little we have."

Abdhul Nasir Adam, Hammad, wife, three children, currently in the United Nations transit centre in Abyei

Abdhul Nasir Adam, his wife and three children have fled Sudan and are currently in the United Nations transit centre in Abyei. "There are many, many families who are stuck in dangerous places and are desperate to come here. But the journey is too difficult, too expensive, and too dangerous. There are frequent attacks on people fleeing and a lot of looting. They take everything." © Sean Sutton/Panos Pictures

Amidst the already dire situation in Abyei, a new challenge arose: an influx of South Sudanese returnees and Sudanese refugees fleeing Sudan's war after fighting broke out on15 April. Families who had been displaced from their homes sought refuge in Abyei, looking for safety and a chance to rebuild their lives. 

As at the end of November, over 400,000 individuals have crossed the border, predominantly South Sudanese returnees but also Sudanese refugees. The large number of arrivals, particularly women and children, presents challenges for transit sites. Rising market prices have contributed to worsening food insecurity. In addition to what South Sudan already suffers from, such as regular disease outbreaks, flooding, displacements and high rates of malnutrition. 

Makeshift school at Bok Chop internally displaced people camp in Sudan.

Makeshift school at Bok Chop internally displaced people camp in Sudan. “This is a school for refugees. We have very little and need blackboards, books, pencils. The children have to sit on the floor; we don’t have enough mats.” - Michael Kuol, teacher. © Sean Sutton/Panos Pictures

Medical needs and community engagement

Many remote areas in war-torn Abyei are completely isolated, making it nearly impossible for people to access healthcare facilities. Floods posed a great threat during the rainy seasons, while conflict poses another in the dry season.  

Integrated Community Case Management

The Integrated Community Management team member, Chuol, provides health advice to a village during a visit the MSF health post in Dokura village. © Sean Sutton/Panos Pictures

Around the region, MSF has 17 integrated community case management sites manned by trained local volunteers and in collaboration with local health authorities. MSF’s team travels long distances to the village health posts to bring medicine and support the trained community health workers.

Awa, team leader of integrated community case management, is carrying an unwell child to MSF’s vehicle before transporting him and his mother to the hospital.

"We assist the people and provide advice and information, helping them recognise the signs and understand what to do before it becomes serious. This is particularly important for malaria and diarrhoea, which are common problems. We inform people when they should seek help." says Awa.

"We are not nurses, but we have received training, and being able to help means a lot." 

Ajok Lual is a village volunteer at the aid post.

Ajok Lual is a village volunteer at the aid post. © Sean Sutton/Panos Pictures

Mary Ajok is a village volunteer at the health post. She explains, "I have been an MSF volunteer since 2015. We see 2,500 to 3,000 patients a year, with the biggest problems being malaria and pneumonia. The suffering caused by the flooding is immense. I can conduct malaria tests and check people's temperature. If they test positive for malaria, I can provide treatment. If the case is serious or if I can't determine the issue, I send them to the hospital. We also screen for malnutrition and dehydration, receiving refresher training every three months.”

“I am an elderly woman with a lot of work to do, but this is very important, and I am proud to help the community. Yes, I feel happy and proud. Before MSF came here, the people were suffering much more. We also work with the community to raise awareness of signs of illness. This makes a big difference because people can get help before their condition worsens, especially for malaria and diarrhoea.”

“Life here is hard, and we are displaced by flooding every year. We have to spend months on the side of the road to escape the floods, typically from August to January. It's been like this every year for six years, and every year, the farms are destroyed. The village has 1,500 families, but due to the crisis, 150 families share shelter with another family – we have 150 extra families to look after." 

Supporting emergencies and hospital care

Nur Mawien is a nursing team supervisor at Ameth Bek Hospital, Abyei. Being from the community himself, he explains the key role of the MSF-supported hospital: "Having the hospital means a lot to the community, people feel safe there. Simply having a hospital is not enough, it is having a hospital that is running well that serves everyone that is important. That means that everyone wants to come to this hospital, and they travel far distances to get here. The problem is many patients come to our facilities do not meet the admission criteria. This is a secondary level health care facility and that’s hard for people to understand. Secondary care means we only treat people with serious illnesses—we don’t have the capacity to do more." 

© Sean Sutton/Panos Pictures

A nurse checks little Arop Alore in emergency room of Ameth Bek Hospital in Abyei. © Sean Sutton/Panos Pictures

While MSF’s mobile clinics cater to the immediate healthcare needs of these remote communities, MSF also provides secondary healthcare services at the main hospital in Abyei. The array of services includes round-the-clock emergency room access, inpatient care, surgical care, critical care including the close monitoring unit, comprehensive maternal and neonatal care, treatment for chronic illnesses, and mental health support. Since the start of the year, more than 50,000 patients have sought medical care from the hospital, and more than 15,000 consultations were carried out in the emergency ward.

A baby boy was born via caesarean section at Ameth Bek Hospital in Abyei. Between January and September, medical teams performed 1,504 surgical operations, and assisted around 350 deliveries. 

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