Juba, 24 January 2012 – In the state of Jonglei in South Sudan, civilians continue to bear the brunt of inter-communal fighting. Wounded patients are still arriving at the Médecins Sans Frontières (MSF) hospital in Pibor, three weeks after the violent attack on the town and outlying villages in Pibor county. Many were injured after having fled into the bush, where thousands have remained, afraid to come out of hiding. MSF medical teams are now treating serious wound infections, some several weeks old. Since relaunching emergency medical activities in Pibor on 7 January, MSF has treated 47 patients with gunshot wounds, including 16 women and 8 children. A further 43 patients have been treated for stab wounds, beatings or wounds sustained while escaping into the bush.

In the wake of the Pibor attack, MSF learned the tragic news that Allan Rumchar, an MSF watchman, and his wife had been killed. Of 156 locally recruited staff, 25 are still unaccounted for three weeks after the attack, and we remain extremely concerned for them.

The violence in Pibor is not isolated. After an 11 January attack on the village of Wek in northern Jonglei state, MSF evacuated by air 13 patients who needed urgent surgery, the majority women and children, to MSF’s hospital in Nasir. In August 2011 scores of villagers were killed during an attack on the town of Pieri and surrounding villages.  In the past six months, 185 seriously wounded patients have sought care from MSF teams in Lankien, Pieri and Yuai. “We are seeing a cycle of attacks and reprisals throughout this area of northern Jonglei,” said MSF head of mission Jose Hulsenbek. “For the civilians in this part of South Sudan, the fear of having to flee their homes or being killed is very real.”

One recurring characteristic of the attacks in Jonglei is their extreme violence. One woman treated for a gunshot wound by MSF in Pibor said she had fled into the bush with her husband, children and 15 other family members. After running for 11 hours, they were found by a group of men who shot at them. “We scattered. They shot me in my thigh, and my baby, who was hanging on my back. I tried to hide in the high grass but they found me because my baby was crying. They started beating my daughter until she kept quiet. They left us behind thinking we were dead.” Her son was also treated by MSF for a bullet wound to the chest, which, remarkably, left him alive.

MSF is extremely concerned for the health and wellbeing of civilians forced to flee, either from fighting or from fear of an attack. These people hide out in the bush, with no or minimal shelter, limited access to food and increased risk of falling ill. Often, they return to find only ashes where their homes used to be.

Lekwongole, a village north of Pibor town where MSF runs a clinic, scarcely exists now. All that remains of the MSF clinic is the concrete floor and walls.  “The people explained to me that during the day they dare to come out of hiding in search for food or to seek medical care, which MSF restarted on January 18,” says Karel Janssens, MSF project coordinator. “But at night they return to their hiding places in the bush, where they are at risk of contracting malaria or respiratory infections.” In Pibor, approximately half the consultations since 7 January have been for malaria, as people remain exposed when sleeping in the open.

A deeply worrying pattern is emerging, where people and their scarce resources are being deliberately targeted by all the armed groups involved in the intercommunal violence. Hospitals, health clinics, water sources have all become targets for armed groups on all sides, suggesting a tactic of depriving people of their basic necessities for life. Of greatest concern for Colette Gadenne, MSF operations coordinator for South Sudan, is the targeting of civilians themselves: “After these attacks many women and children are coming to us shot, stabbed, beaten. They try to keep safe by hiding in the bush, but it seems that even running away is not enough”.

In a December 2009 report, Facing Up to Reality: Health Crisis Deepens as Violence Escalates in Southern Sudan, MSF documented the escalation of intercommunal violence in Jonglei and Upper Nile states, and its increasing impact on civilian populations. MSF treated 392 patients wounded by violence that year, and estimated that 86,000 people were displaced. The situation has not improved. In the past six months, MSF has treated more than 250 patients wounded by violence in Jonglei state, the majority women and children.