Over the past five months, 49,262 people in the Bahr-el-Ghazal province of south Sudan have been treated for malaria by MSF medical teams that are using bicycles to get to areas that have been isolated by recent severe floods. A total of 71,006 people have been treated in the area - including 800 severe cases - when figures from the fixed facilities are included. Heavy floods have followed two years of drought and have created ideal conditions for the proliferation of mosquitoes - the vectors of malaria - and have brought about an increase in malaria cases in the province. The malaria surge has also followed a food crisis in the region.

MSF teams in Akuem, a town in Aweil East in the Bahr-el-Ghazal province, have seen a massive increase in malaria cases since June and expect to be treating a high number of malaria patients until the end of the year. The work with the mobile teams will continue until the flood waters recede. "These bicycle operated clinics are the only way to treat patients in regions that have been cut off by the floods," explained Greg Elder, medical coordinator for MSF. "These clinics prevent the death of children and vulnerable adults who would otherwise remain stranded in their villages."

MSF has recently been involved in a food crisis in the same area. Now facilities that were used to care for the malnourished now care for malaria cases.

Already weakened from malnutrition, children under the age of 5 are even more vulnerable this year. Over 50% of the patients treated by the mobile teams have been children under the age of five. In each village, the teams diagnose, treat and distribute drugs to hundreds of people. An average of 5,000 patients are treated every week in the MSF fixed facilities and mobile clinics.

The floods have made transport by 4x4 ineffective as huge areas have become marshlands that also prevent people from visiting the MSF facilities. Bicycles are more easily transported through heavily flooded areas. A total of 40 bikes were bought by MSF to equip 15 teams - each team is made up of a minimum of one nurse and an assistant. The teams have been active since August 1 this year.

They transport with them the necessary medical equipment to care for approximately 400 patients. Each stop lasts four or five days and there are six mobile clinics that leave from Akuem, four from Madhol and five from Gok Machar.

Explosion in malaria cases

"Malaria is endemic in this region, however there has been a sustained increase in the number of cases this year in comparison to previous years", noted Elder. "In July, the number of consultations and hospitalisations for malaria exploded in Akuem.

We have treated nearly five times as many patients than this time last year." This year the increase in the number of cases also occurred earlier than usual: the peak is usually registered in August. MSF has increased its treatment capacity and extended its activities to Aweil North. The teams are treating patients in four fixed MSF facilities in Akuem, Mangar Angui, Madhol (Aweil East) and Gok Machar (Aweil North).

Mobile clinics on bicycles have also been set up to treat patients in isolated areas: the particularly heavy rains this year have transformed the entire region into marshlands, preventing patients from reaching health facilities.

Malaria follows malnutrition

This increase in the number of cases of malaria follows a serious food crisis that has been affecting the province since April.

MSF, which had been running a Therapeutic Feeding Centre (TFC), opened two more TFCs in Akuem hospital and three Supplementary Feeding Centres (SFC) in Madhol and Gok Machar. Over the past six months, 1,400 severely malnourished patients were treated in the TFCs and a further 12,000 moderately malnourished patients were cared for in the SFCs. The decrease in malnutrition has enabled MSF to transform these feeding centres into malaria treatment facilities.