Since fighting first erupted in northern Ethiopia in early November, hundreds of thousands of people have been displaced from their homes. Some 50,000 people have crossed the border into Sudan as refugees, leaving border towns struggling to provide adequate food and shelter for those fleeing the violence.
MSF teams in the region are providing essential medical care and support to refugees as they cross into Sudan. Australian nurse Kiera Sargeant, former MSF medical coordinator in Sudan, discusses the urgent needs and our current responses to the crisis.
Tell us about the situation on the Ethiopian border.
In early November 2020, refugees from the Tigray region of Ethiopia started crossing into Sudan at two points, Hamdayet and Ludgi. Initially it was only a small number of refugees, but this has increased to more than 1,000 new arrivals a day. More than 55,000 people have now arrived in Sudan from Tigray.
At first most people crossed into Sudan by swimming or wading across the fast-flowing river which marks the border with Ethiopia, while others crossed by boat or land. We hear that it is more challenging now for people to find safe routes to reach the crossing points into Sudan; often people tell us that they had to hide for days at different points until they could continue on their way.
The refugees are staying in Kassala and Gedaref states. In Gedaref, there are two permanent official camps, Um Rakuba and a new camp, Al Tanideba. The transport of the refugees from the border reception and transit camps to the official, permanent camps in Gedaref can take between 10 to 15 hours.
What are the main health concerns for those who are seeking refuge in Sudan?
Initially people’s physical health condition was okay, as they had not travelled long distances. But early December we saw a shift, with new arrivals often exhausted and in a worse health condition due to the journey. In addition, we are particularly concerned about people not having access to required medications for chronic health conditions.
The main medical conditions our teams see are respiratory tract infections and acute watery diarrhoea, as well as people with chronic health conditions, such as diabetes and hypertension. We’ve treated several shrapnel and bullet wounds, and some are expressing mental health related concerns to us. We’ve heard reports of sexual violence and we’re spreading the message within the community that we can provide survivors with medical and psychological care.
The humanitarian situation in the reception area in Hamdayet is poor: there is not enough shelter, food, water or essential relief items for the people there. Services are still being scaled up in the nearby refugee camps, but the response is too slow, as is the movement of people from transit camps to more permanent camps. We are extremely worried refugees are arriving to camps that lack essential services, and that their basic needs will not be met.
MSF has been working in Sudan for many years—how is our response adapting to assist with this sudden increase in refugees?
I arrived in Sudan in September 2020 to help start new activities in Kassala and South Darfur—at that time Sudan was in the process of recovering from severe floods and there were reports of viral haemorrhagic fever in two states, for which MSF provided some support. When the fighting erupted in Ethiopia in early November, we adapted our approach and headed for the Ethiopian border.
We are now scaling up our activities at the border crossing locations and in the two permanent official camps, Um Rakuba and Al Tanideba. In these camps we will be providing primary healthcare, reproductive healthcare, mental healthcare, vaccination, malnutrition treatment and treatment for chronic health conditions, as well as an inpatient care department and provision of water and sanitation facilities. We are also supporting a Ministry of Health clinic in providing free healthcare and water and sanitation facilities to both the Hamdayet community and refugees.
Our teams are working at the points where refugees cross the border providing health checks, including screening for malnutrition. As there are no other organisations at the border crossing points, we often also provide information and guidance to the new arrivals about where they can go next and what services they can reach.
What are the main concerns from the refugees themselves?
Many of the refugees became separated from family members as they fled, so one of their main issues is concern for family and loved ones, due to the limited phone network in the Tigray region. We have seen several unaccompanied children, most of whom were separated from their families as they ran away from their homes. We refer the children to the UN Refugee Agency’s (UNHCR) child protection services.
Other concerns that we hear of include farmers missing the harvest of their crops. Now that they are in Sudan, they are worried about how they will earn a living, and where they can get food and shelter.
Some refugees have talked about their concerns regarding the COVID-19 pandemic, but most tell me they have bigger things to worry about, such as shelter, food and access to water.
What are main challenges in responding to this refugee crisis?
The sudden influx of refugees has put a strain on existing infrastructure and the health services in Sudan. This came on top of existing fuel shortages and steep inflation in Sudan, which have caused logistical and financial difficulties for everyone involved.
For MSF, one of our biggest challenges has been sourcing enough medical supplies. We are seeking emergency importation of medical supplies so that we can respond in a timely manner. The pandemic has also created challenges to bringing in experienced medical staff that are needed as there is already a shortage in the country.
We urgently need to increase assistance to address the needs of the refugees; particularly in advance of the rainy season, which will make this area of Sudan very difficult to access. It is extremely important that the Government of Sudan, the UN, donors and NGOs do everything in their power to scale up this response.
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