“This sharp increase in COVID-19 patients is very worrying. What is even more concerning is that now COVID-19 has started spreading among the population of some of the largest and most congested displaced persons camps in the country.
Tens of thousands of people living in the Protection of Civilian sites in South Sudan, such as Bentiu or Malakal, face a precarious existence in an overcrowded environment, living in dire conditions with flimsy small shelters where up to 12 family members live together, and with poor access to water and soap. Maintaining physical distance and adequate hygiene levels in these settings is nearly impossible.
If we add the fact that many people – not only in the camps but around the country in general – are at a higher risk not only due to poor living conditions, but also potentially due to co-morbidities such as malnutrition, respiratory tract infections, malaria, tuberculosis and HIV, it is easy to see how the spread of COVID-19 could have catastrophic consequences in South Sudan.
The pandemic is having a significant impact on our ability to provide key lifesaving services. Other diseases, as well as conflict and violence, have not been put on hold because of COVID-19. Malaria, measles, pneumonia and acute watery diarrhoea still kill tens of thousands of people, chronic patients continue to need medication, war wounded need surgery and mothers are still delivering babies every day. Just now, a resurgence of violence around Yei, in the south of the country, has caused the displacement of around 12,000 people.
With active transmission of COVID-19 in the area, addressing their needs while keeping our staff safe with the global shortage of surgical masks and other personal protective equipment, becomes very challenging. We fear this kind of situation will become more and more common as the virus spreads across the country.”
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Médecins Sans Frontières has been operating in the area that now constitutes South Sudan for more than 30 years, responding to conflicts, neglected diseases and assisting with healthcare infrastructure.
Healthcare response in rural South Sudan
Medical care is practically non-existent for people living in remote areas of South Sudan, even those spared from much of the violence associated with the war. We run hospitals and clinics and support existing state facilities, with particular focus on maternal, paediatric and neonatal care, and outbreak response. MSF also set up a system in which South Sudanese staff travel with displaced people to provide medical care, including for victims of sexual violence.
Malaria is one of the leading causes of illness and death in South Sudan, especially among children. In cooperation with the Ministry of Health, MSF teams assist in outbreak response, mass vaccination campaigns, and direct treatment. We train community healthcare workers, run outreach and preventive activities such as vaccination campaigns. MSF staff respond to cholera outbreaks, by setting up treatment centres and field hospitals, and support remote communities with decentralised care.
The normal practice in this area is for women to deliver at home with a traditional birth attendant, and this might mean they don't receive proper antenatal care and that complications are not anticipated. We work a lot in the community to encourage women to receive prenatal care and deliver in the hospital, because it is safer for the mother and the baby... It's important to engage with communities in these hard-to-reach areas.
Access to health care is extremely limited in South Sudan, and MSF's hospital in Old Fangak is often the only place people in the region can receive treatment for serious medical conditions. Patients often have to walk for several hours on foot, and travel through harsh weather to reach the hospital from remote villages. The distance and long journey makes it especially difficult for patients with emergency needs, including women with complications during childbirth.
MSF staff carry out emergency nutritional interventions in response to reports of alarming levels of malnutrition, especially in Mayendit and Leer counties. We also treat the parasitic disease visceral leishmaniasis (also known as kala azar), which is transmitted by sandflies and has a 95% mortality rate if left untreated.
MSF continues to provide healthcare to people within United Nations Protection of Civilians (PoC) sites. These sites were set up as a temporary solution for people fleeing violence in December 2013, but in the years since, hundreds of thousands remain trapped in the hostile camps, exposed to poor sanitation and hazardous living conditions.
MSF staff provide medical care, surgical services, and support for victims of sexual and gender-based violence.