Nairobi - The south Sudanese state of Beih, in south-eastern Upper Nile on the border with Ethiopia, is being struck by several severe health and nutritional problems at once.

The area, about the size of Belgium, is currently experiencing an exceptionally bad hunger period, exacerbated by a meningitis epidmic, outbreaks of shigella and a lack of health services.

Continued insecurity and fighting between the various political factions in the region has led to population displacements, looting and cattle-raids, worsening the already tenuous situation.

The population of Bieh state, estimated at around 200,000, is without clean water or health services - except in Akobo and Wanding districts, where the medical organisation, Medecins Sans Frontieres (MSF), supports several health structures.

The next harvest is not until August/September, yet the earliest that the United Nations World Food Program expect their pipeline for corn-soya-blend to be on-line to the region is at the end of July or the beginning of August. The success of the MSF intervention depends to a large degree on the capacity of the WFP to conduct general food distributions in the region.

"Since we've just entered the traditional hunger gap period, we expect the situation to get much worse. Immediate intervention is needed if we want to avoid an even bigger crisis than now," said Gareth Barrett, MSF's Head of Mission for the region.

MSF responded to the meningitis epidemic earlier this year, although diarrhoeal diseases and malaria are continuing to weaken the population. A recent MSF nutritional survey in Akobo showed that there are global malnutrition rates of 33.8% and severe malnutrition rates of 7.7% amongst children. The MSF primary health care centre in Akobo is overloaded, with malnutrition, diarrhoea and malaria being the most frequently seen diseases.

"But we expect the nutritional and health situation to be worse in the other districts of Beih state," said Barrett, "since there is more insecurity and there are no health services whatsoever in the area. Access to the civilian population is also hampered by increased insecurity."

MSF's emergency team this week opened a therapeutic feeding centre in Akobo (capacity: 250 children) and supplementary feeding centres in Akobo, Birmath and Wanding; and is now starting a massive measles vaccination campaign, combined with nutritional screening and medical assistance, with a target population of about 60,000 people.

MSF is reviewing the possibility of starting additional supplementary feeding programmes in other locations than those already mentioned.

Erwin van der Borght, MSF's operational officer emphasises the wider context: "Other areas like Western Upper Nile or Blue Nile have little or no assistance either. The essence of the problem is not so much drought as it is in the rest of the Horn of Africa, but a lack of health structures, a lack of access to the population, an increased insecurity and medical problems like measles, meningitis and shigella."

MSF's emergency health and nutritional intervention is expected to continue at least until the end of November 2000.