Over the last two weeks, South Sudanese from the internally displaced persons camp (IDP) in Aburoc in South Sudan have started moving across the border to Sudan. Many arriving at the border crossing are severely dehydrated and in need of emergency medical care.

As fighting spreads in the former Upper Nile state, over 20,000 South Sudanese have fled the horrendous living conditions and fighting around Aburoc’s IDP camp, for increasingly overcrowded refugee camps in Sudan. While many more of the estimated 18,000 people left behind will take the road north to Sudan, others will stay in Aburoc, hoping that desperately needed clean water, food, and shelter will arrive.

“The reasons why we are leaving are mainly the lack of security and the lack of food and water. We feel a bit better in Sudan because we are receiving support, and now I am with my family,” said one recent refugee who made the journey to Sudan.

Médecins Sans Frontières kept its operations running in Aburoc when fighting started in nearby Kodok two weeks ago; 20,000 people arrived in Aburoc. A field hospital providing primary and secondary care has been open since the outbreak of the nearby fighting, treating a range of conditions including watery diarrhoea.

“Most of the people we see around Aburoc have packed their few belongings and are waiting for space on a truck departing for the north”, says Marcus Bachmann, MSF Head of Mission for South Sudan. “Nearly all of those leaving have been forced to abandon their homes and have moved places several times in the past.”

Many people were originally from Malakal, and then moved for safety to the town of Wau Shilluk. They moved again, fleeing to Aburoc, when it was attacked earlier this year. Other people came to the IDP camp from the nearby town of Kodok after fighting broke out two weeks ago.

“This is just one area in a whole region that is being destabilised. Over the last week, fighting has spread to places like Tonga and Kaka, provoking more people to depart for the north,” added Bachmann. “We may soon see many other communities forced to take the road north. But many of those still in Aburoc would stay if the conditions improved.”

Until very recently the population of 20,000 people gathering around Aburoc were surviving on a maximum of 21,000 litres of water a day from three hand pumps. This is only 1.1 litres per person per day, which is below the daily minimum amount of 2.5 litres per person needed for survival. The purity of the water is also a concern, as both humans and animals openly defecate in the areas around the water pumps.

Food is starting to arrive in Aburoc’s market from Sudan, but it is at inflated prices that few people can afford.

Other humanitarian organisations are starting to arrive in Aburoc, but it is a race against time to help displaced people before the heavy rains come and make the transport of humanitarian aid impossible.

“The border camp of Khor Waral in Sudan already has over 30,000 officially registered refugees, and 20,000 more are waiting to be processed. Overcrowding is already an issue as the planned capacity of the camp was initially only for 18,000 people.”  

Unfortunately, the availability of water is low, and the supply of sanitation, shelters and non-food items (including plastic sheeting, and cooking and cleaning utensils) is still not meeting the demand. This could have consequences on the health of the new arrivals.

“Sadly, there have been reports of deaths amongst some of the people who started to make the 250km journey to Khor Waral by foot last week. Many of those people reaching the border with Sudan are sick and exhausted, suffering from dehydration, diarrhoea, and malnutrition,” says Bachmann.

MSF already manages a hospital in Sudan’s White Nile State; a team of 30 medical staff was dispatched to Khor Waral to work in close collaboration with Sudanese authorities when fighting in the around the town broke out.