Jennifer Warren

MSF: Facing up to Reality

Health Crisis Deepens as Violence Escalates in Southern Sudan

Médecins Sans Frontières (MSF) provides care to millions of people in six states in Southern Sudan. In 2009, increasing violence and insecurity caused by tribal clashes, as well as heightened tensions around disarmament, has made it more difficult for MSF field teams to reach people in need of aid.

Present in the most rural and neglected regions of Southern Sudan, Médecins Sans Frontières has been active since 1979. Rural villages, home to millions of Southern Sudanese, are completely cut off from the western world and suffering greatly from the most basic of medical needs and emergencies.

Southern Sudan is desperate for the most basic of services – clean water, access to food, education and health care. The deteriorating security situation only adds to this humanitarian emergency where medical needs are critical. Acute malnutrition, malaria, kala azar, and outbreaks of preventable diseases such as meningitis and cholera, are a constant threat to the population, and mortality rates for pregnant women and children are among the highest in the world.

Commissioned by MSF

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Aerial view of Pieri village, Lol Nuer territory in Jonglei State. The Lol Nuer are perpetrators of repeated cattle raids and attacks against the Dinka and Murle tribes, and the Jikany Nuer sub-tribe. Tribal violence overall in Southern Sudan has dramatically increased in 2009, with over 2000 deaths, more people than have been killed in Darfur.
   
A stranded boat along the tributary to the Nanam River in Pibor, Jonglei State. Pibor is one of the largest villages of the Murle people, who are an entirely nomadic community of cattle herders. Violence and displacement in March, along with a non-productive rainy season, has led to food shortages in the market because boats can't travel the river and trucks won't pass on the roads for security reasons. Malnutrition is reaching acute levels in the area and MSF is the only healthcare providing organisation operating in Pibor.
   
An empty market in Pibor, Jonglei State. The only things available are non-food items, sugar, salt and very expensive white flour. 50kg of flour costs 500 SDG, more than the best quality bull in town. Pibor is one of the largest villages of the Murle people, who are an entirely nomadic community of cattle herders. Violence and displacement in March, along with a non-productive rainy season, has led to food shortages in the market because boats can't travel the river and trucks won't pass on the roads for security reasons. Malnutrition is reaching acute levels in the area and MSF is the only healthcare providing organisation operating in Pibor.
     
  
Nyalol Dol, from Torkej, is squatting in a tukul built for cattle while dismantling her tukul to sell the wood and grass for food. Torkej, Jikany Nuer territory, was attacked on 8 May by the larger Lol Nuer tribe, and is vulnerable to repeated cattle raids and attacks because of their placement on the river and proximity to Lol Nuer lands. Nyalol's 5 children were all killed in the nighttime raid, and she is terrified to return home for fear of another violent attack. The Lol Nuer are perpretrators of repeated cattle raids and attacks against the Dinka, Murle, and Jikany Nuer sub-tribe. Tribal violence overall in Southern Sudan has dramatically increased in 2009, with over 2000 deaths, more people than have been killed in Darfur.
   
Following the attack on Likuangole on 8 March 2009, MSF couldn't reopen the PHCU in Likuangole for almost 6 months. Almost the end of the rainy season, and start of the hunger gap in Jonglei State, MSF staff are now running malnutrition programs to assist those still displaced and recently returned. Murle and Nuer tribes repeatedly conduct cattle raids on the other, but the attacks have gotten more and more violent since the start of the year. Women and children are now being targeted and killed, with over 2000 dead since January 2009.
   
Patients are transported by air to the MSF-H Nasir Hospital in Upper Nile. Wiek Muon Mok, 52, (R) is flown from Pieri, Jonglei State, for surgery on a ruptured hernia and necrotic bowel extrusion due to traditional surgery three days prior. Rout Meet Makuach, 27, (L) suffered a gunshot wound and fractured leg in Lankien, Jonglei State, and also needs surgery.
     
  
Dispensary of the MSF Primary Health Care Center (PHCC) serves one of the largest villages of the Murle people, Pibor, who are an entirely nomadic community of cattle herders. MSF is the only healthcare providing organisation operating in Pibor, Jonglei State.
  
Nyayan Nyak feeds her 2 year old son Lam Kuony Plumpy Nut twice a day, part of the Therapeutic Feeding Program for malnourished children at the MSF-H Nasir Hospital. Lam is soon ready to be discharged and monitored on the Home-Based Feeding Program. Food insecurity is prevalent in Southern Sudan this year, after a short rainy season produced low crop yields, and thousands have been displaced by tribal violence. To reach the hospital, Lam's mother Nyayan Nyak walked two days from their village, Kietch.
  
Nurse in the Therapeutic Feeding Program at the MSF-H Nasir Hospital, holds Parwaath Dabwual, 1 year, while her mother washes clothes. Parwaath will be discharged and monitored on the Home-Based Feeding Program at the end of the day. Food insecurity and malnutrition is prevalent in Southern Sudan this year, after a short rainy season produced low crop yields, and thousands have been displaced by tribal violence.
     
  
Ngaminyia Melok, 58, seeks treatment at the MSF Primary Health Care Center (PHCC) in Pibor, Jonglei State. Pibor is one of the largest villages of the Murle people, who are an entirely nomadic community of cattle herders. MSF is the only healthcare providing organisation operating in Pibor.
   
Tonyang Coli brings her 2.5 year old son Lele Bok to the MSF Primary Health Care Center (PHCC) every other day to replace the dressing on his burns. Children are commonly burned by open fire, usually resulting in 3rd degree burns. The PHCC serves one of the largest villages of the Murle people, Pibor, who are an entirely nomadic community of cattle herders. MSF is the only healthcare providing organisation operating in Pibor, Jonglei State.
   
Tonyang Coli brings her 2.5 year old son Lele Bok to the MSF Primary Health Care Center (PHCC) every other day to replace the dressing on his burns. Children are commonly burned by open fire, usually resulting in 3rd degree burns. The PHCC serves one of the largest villages of the Murle people, Pibor, who are an entirely nomadic community of cattle herders. MSF is the only healthcare providing organisation operating in Pibor, Jonglei State.
     
  
   
Mother of a girl suffering from cerebral malaria in the MSF Primary Health Care Center (PHCC) Pediatric Inpatient Ward in Pibor, Jonglei State. Luckily, her daughter survived and was sent home after 4 days. Pibor is one of the largest villages of the Murle people, who are an entirely nomadic community of cattle herders, and MSF is the only healthcare providing organisation operating in the area.
   
Aidok Kenyche holds her 6 month old daughter Ngachiwun, who has pneumonia, as MSF Doctor Olivier Montigny administers oxygen, in the MSF Primary Health Care Center (PHCC) Pediatric Inpatient Ward in Pibor, Jonglei State. Pibor is one of the largest villages of the Murle people, who are an entirely nomadic community of cattle herders, and MSF is the only healthcare providing organisation operating in the area.
     
  
Lelchok Lomithe, 2, is recovering from an abcess on his shoulder, in the MSF Primary Health Care Center (PHCC) Pediatric Inpatient Ward in Pibor, Jonglei State. Pibor is one of the largest villages of the Murle people, who are an entirely nomadic community of cattle herders, and MSF is the only healthcare providing organisation operating in the area.
   
Liman Nyanye, 28, was infected with Kala Azar while on a cattle raid with 80 other young men in Nyirol County, Jonglei State. He is also suffering from a side effect of the disease, oedema of the face and feet. The Murle and Nuer tribes repeatedly conduct cattle raids on the other, and the attacks have gotten more and more violent since the start of the year. Women and children are now being targeted and killed, with over 2000 dead since January 2009. An outbreak of Kala Azar in Nuer land might be the last hope to reduce the attacks, as people are fearful to move to the neighboring areas.
   
Wiek Muon Mok, 52, receives reparative surgery in the MSF-H Nasir Hospital for a ruptured hernia and necrotic bowel extrusion due to traditional surgery three days prior. Gatwech Lual, anaesthesiologist, restrains the patient during surgery.
     
  
Wiek Muon Mok, 52, receives reparative surgery in the MSF-H Nasir Hospital for a ruptured hernia and necrotic bowel extrusion due to traditional surgery three days prior. Paul Biliew Mut moves the patient to Inpatient Ward Three.
  
MSF Nurse Assistant James Mam Kongkong treats a girl suffering from cerebral malaria in the MSF Primary Health Care Center (PHCC) Pediatric Inpatient Ward in Pibor, Jonglei State. Pibor is one of the largest villages of the Murle people, who are an entirely nomadic community of cattle herders, and MSF is the only healthcare providing organisation operating in the area.
   
Kaka Maze holds her daughter Kidich Jiji, 3, who is suffering from cerebral malaria in the MSF Primary Health Care Center (PHCC) Pediatric Inpatient Ward in Pibor, Jonglei State. The girl was transferred from a remote MSF Primary Health Care Unit (PHCU) in Gumuruk, after convulsions and coma. Kidich couldn't arise from the coma, and she later passed away. Pibor is one of the largest villages of the Murle people, who are an entirely nomadic community of cattle herders, and MSF is the only healthcare providing organisation operating in the area.
     
  
Grandmother of Kidich Jiji, 3, who died from cerebral malaria in the MSF Primary Health Care Center (PHCC) Pediatric Inpatient Ward in Pibor, Jonglei State. Kidich was transferred from a remote MSF Primary Health Care Unit (PHCU) in Gumuruk, after convulsions and coma. Pibor is one of the largest villages of the Murle people, who are an entirely nomadic community of cattle herders, and MSF is the only healthcare providing organisation operating in the area.
   
MSF Nurse Assistants wait for the Isolation Ward to be opened to place the body of Kidich Jiji, 3, for the family to bring assistance for burial. The girl died from cerebral malaria in the MSF Primary Health Care Center (PHCC) Pediatric Inpatient Ward in Pibor, Jonglei State. Kidich was transferred from a remote MSF Primary Health Care Unit (PHCU) in Gumuruk, after convulsions and coma. Pibor is one of the largest villages of the Murle people, who are an entirely nomadic community of cattle herders, and MSF is the only healthcare providing organisation operating in the area.
   
Athil Arzen, 26, was infected with Kala Azar while on a cattle raid with 80 other young men in Nyirol County, Jonglei State. The Murle and Nuer tribes repeatedly conduct cattle raids on the other, and the attacks have gotten more and more violent since the start of the year. Women and children are now being targeted and killed, with over 2000 dead since January 2009. An outbreak of Kala Azar in Nuer land might be the last hope to reduce the attacks, as people are fearful to move to the neighboring areas.
     
  
A tributary of the Nanam River in Pibor, Jonglei State. Pibor is one of the largest villages of the Murle people, who are an entirely nomadic community of cattle herders. Violence and displacement in March, along with a non-productive rainy season, has led to food shortages in the market because boats can't travel the river and trucks won't pass on the roads for security reasons. Malnutrition is reaching acute levels in the area and MSF is the only healthcare providing organisation operating in Pibor.
   
MSF Vaccination Campaign in Pibor, Southern Sudan, to vaccinate thousands of women and children against Polio, TT, DPT, and Measles. The campaign also offers the MUAC test for malnutrition in children under 5. Pibor is a remote area of Jonglei State, yet a major town center for the Murle tribe in Southern Sudan.
   
MSF cook prepares dinner for Kala Azar patients and their caregivers in the new CTC outpatient area at the MSF Primary Health Care Center in Pibor, Southern Sudan. 24 young men were infected with Kala Azar while on a cattle raid in Nyirol County, Jonglei State. The Murle and Nuer tribes repeatedly conduct cattle raids on the other, and the attacks have gotten more and more violent since the start of the year. Women and children are now being targeted and killed, with over 2000 dead since January 2009. An outbreak of Kala Azar in Nuer land might be the last hope to reduce the attacks, as people are fearful to move to the neighboring areas.
     
  
MSF Vaccination Campaign in Pibor, Southern Sudan, to vaccinate thousands of women and children against Polio, TT, DPT, and Measles. The campaign also offers the MUAC test for malnutrition in children under 5. Pibor is a remote area of Jonglei State, yet a major town center for the Murle tribe in Southern Sudan.
   
Loden Ngidok, 22, outpatient suffering from Kala Azar at the MSF Primary Health Care Center in Pibor, Southern Sudan. 24 young men were infected with Kala Azar while on a cattle raid in Nyirol County, Jonglei State. The Murle and Nuer tribes repeatedly conduct cattle raids on the other, and the attacks have gotten more and more violent since the start of the year. Women and children are now being targeted and killed, with over 2000 dead since January 2009. An outbreak of Kala Azar in Nuer land might be the last hope to reduce the attacks, as people are fearful to move to the neighboring areas.