Médecins Sans Frontières (MSF) employs more than 3,054  South Sudanese staff and 284 international staff to respond to a wide range of medical emergencies and provide free and high quality healthcare to people in need. MSF currently runs 18 projects in 7 out of 10 states in the country and in the Abyei Special Administrative Area.

MSF is particularly concerned about the precarious health situation inside UN Protection of Civilians (PoC) camps in Bentiu and Malakal, where tens of thousands of new residents have arrived in recent months. In both the PoCs, humanitarian resources are under strain and MSF teams are treating spikes in disease, including malaria, diarrhoea, respiratory tract infections and malnutrition. In Bentiu, MSF is concerned by the possibility of a serious outbreak of hepatitis E following a sustained increase in jaundice cases in the camp over the last two months.

Malaria in western South Sudan In the West of the country, MSF is seeing disturbing indications that this malaria-prevalent region of South Sudan is being hit by another exceptionally severe season. So far this malaria season, the number of patients being treated and admitted in MSF facilities is on par with the devastating malaria season of 2014. In response, MSF is scaling up its activities and calling on health actors to be prepared for the possibility of another extreme year for malaria in case the trend continues, including by ensuring adequate supplies of essential medicines.

Cholera in Juba Country and Jonglei

Since the Ministry of Health declared an outbreak of cholera on June 23, MSF has been responding in coordination with the Cholera Task Force with a targeted vaccination campaign in Juba County, cholera treatment in Munuki and support to the state hospital in Bor.

Increasing medical needs inside UN Protection of Civilian Camps in Unity and Upper Nile State

Key elements:

• Sustained new influx into PoC camps
• Diseases increasing
• Concerns about water-borne diseases
• Increase of sexual violence-related injuries

Bentiu Due to a sustained influx of displaced people fleeing conflict and violence seeking protection in the UN Protection of Civilians (PoC) Camp in Bentiu, the camp population has now surpassed 100,000 people. Existing resources in the camp are under strain and the health situation is precarious in the camp overall. In July alone, MSF teams treated over 2,000 patients for malaria, of which 150 required hospitalization. MSF also hospitalized more than 100 children for severe malnutrition in the same period.

Cases of hepatitis E, a potentially fatal water-borne disease, have been confirmed using rapid diagnostic tests and the prevalence of jaundice has increased quickly and significantly. High hospitalization and fatality rates are increasing MSF’s concern for the potential for a serious outbreak. In response, MSF is reinforcing its medical teams, expanding outreach activities and supporting three emergency clinics for children under five years old. MSF has increased camp surveillance and active case-finding for jaundice and suspected hepatitis E cases, and created a designated isolation area for triage and care of suspected cases.

MSF is also deeply concerned by the number of women seeking treatment for sexual violence. Inside the Bentiu PoC, MSF has treated 30 patients for injuries related to sexual violence in the last two months, of which three quarters reported being assaulted either while travelling to the PoC or while outside the perimeter of the camp. The remainder report being raped inside the camp itself.

Malakal

In the Malakal PoC camp, in Upper Nile State, the health situation is also precarious.  With 19,000 new arrivals since the beginning of July, the total population of the camp now exceeds 50,000 people and humanitarian resources are under strain here as well. The new arrivals to the camp are predominantly women and children, most of whom have endured a difficult and dangerous journey to arrive in the camp. On arrival, new camp residents have no choice but to sleep in roads and pathways, putting their health in jeopardy. Inside the camp, the number of patients treated for malaria, diarrhoea and respiratory tract infections has more than doubled since June.  In July, MSF increased its hospitalization bed capacity from 40 to 60 beds, but its facilities have been operating at full capacity for almost the entire month. As a temporary, emergency measure, MSF is distributing plastic sheeting and mosquito nets to new arrivals, but access to safe, sanitary living space must be improved quickly to avoid outbreaks of disease.

South Sudan on track for second, exceptionally severe malaria season

MSF is warning health actors to prepare for the possibility of a critically serious case-load of malaria patients as data from MSF projects in the western half of the country suggest the region is on track for a second, exceptionally severe season.  In this year’s malaria season so far, MSF projects in Warrap State, Northern Bahr Al Ghazal and the Abyei Special Administrative Area are treating and admitting as many patients as they did during the exceptionally severe malaria season of 2014, when the number of cases treated in some MSF projects was as much as three times higher than in previous years.

MSF is scaling up its malaria capacity in response to this concerning trend. In Aweil, MSF has increased its existing hospitalization capacity of over 160 beds with an additional 40 in-patient beds. In Gogrial, MSF is setting up a dedicated malaria treatment service and supporting other health centres in the area to increase malaria response capacity. In Agok, MSF has scaled up by training a network of community healthcare workers to test and treat simple cases earlier, helping to decrease the risk of patients developing severe malaria.

MSF cholera intervention

In collaboration with the Cholera Task Force led by the South Sudan Ministry of Health, MSF is responding to the outbreak of cholera in Juba. Beginning in late July, MSF helped conduct a targeted cholera vaccination campaign that has provided an additional level of protection to populations living in transmission hotspots in Juba County. The eight-day campaign reached over 135,000 people who were considered most vulnerable to the disease. Vaccination activities are continuing into August to help bring an end to the outbreak as soon as possible using a targeted vaccination strategy designed to protect people immediately surrounding new cholera cases.

Also in Juba, MSF has been operating a cholera treatment centre in Munuki, Block A, providing high-quality medical care to patients in Juba County. In Jonglei State, MSF is providing technical and curative cholera support to the State Hospital in Bor.

In a separate outbreak of cholera in 2014, MSF treated over 3,300 patients representing more than 50 percent of confirmed cases across the country that year.