“We landed in Leer and walked from the airstrip up to the hospital. There was no one else around. Normally there are dozens of local boys playing football under the big trees by the hospital, mothers getting water from the handpump, and people walking to and from the market.

We came to the back gate. For the first few minutes I just stood there. I was in total shock.

The destruction from fire was unbelievable. The medical storage is straight ahead when you come in the gate, but you couldn’t even recognise it. It had been burnt down and the roof had collapsed. The freezers and the fridges where we used to keep the vaccines cold were just melted white blobs.

Targeted, burned, looted

Also burned down was the place where we used to store food for our inpatients and the therapeutic food for malnourished children. I remember thinking, ‘Our supplies have really been targeted’.

The buildings made of metal containers, such as the office, were totally burned out. Other buildings made of bricks and concrete were more intact, but they had been emptied of everything. Not a single hospital bed remained in the compound.

In one of the wards, the nurses’ station had been trashed. There were papers and drugs strewn everywhere and every cupboard had been opened. On the floor were a number of metal trunks which had their padlocks broken.

The emergency room had been gutted by fire. The operating theatres had been thoroughly ransacked and one of them extensively burned, including the operating table. In the sterilisation room, all the surgical instruments had been removed from their sterile packaging and strewn all over the floor.

The therapeutic feeding centre for malnourished children had been burnt and its roof had col-lapsed. The building used to be orange – obviously the temperature had been really high because it had changed colour completely.

We don’t know who was responsible for this. There’s almost no way to tell. The last of our local staff left Leer on 28 January and fled into the bush, and at that stage the hospital was still intact. No MSF staff were present to witness what happened after that.

Hundreds of thousands left without lifesaving care

The hospital in Leer was one of only two secondary healthcare facilities in the whole of Unity state. Now nearly 300,000 people have no access to a hospital, nor any general healthcare, apart from the very basic care that our staff are providing in the bush. Even if people could return to Leer tomorrow, they would come back to a town with absolutely no healthcare. There’s nothing left in the hospital that is useable.

Living off river water and waterliliesThe hospital was one of our longest-standing health facilities in South Sudan, and it had obviously grown massively since MSF first began working in Leer 25 years ago. Some of the buildings could be used again, but there are huge parts of the hospital that will have to be carefully managed to make them safe. And I don’t even know where to start with the melted fridges and twisted metal…

I’ve been able to speak sporadically by phone with some of our 240 local staff who fled into the bush, but there are still two-thirds of our staff I’ve been unable to reach. We’re extremely worried about them and the unknown thousands who are living in horrible conditions in the bush, vulnerable to disease and attack.

The local staff tell me that that people are becoming ill from drinking dirty river water and from eating waterlilies for lack of food. They hide during the day and only feel safe to come out at night. It must be terrifying for them all.

The staff I’ve been able to speak to are doing an amazing job. They are still trying to care for the several dozen most severely ill patients that they brought with them and care for other displaced people who seek out the MSF team in the bush, but they are struggling to treat them with dwindling supplies. They’ve told me that they’ve had to start reusing wound dressings, and that they are afraid some of the patients will need amputations because their wounds are so badly infected.

We desperately want to reach them, but I don’t know how we will do it. It is still very insecure and they won’t come out of the bush for fear of violent attack.

Return to Leer?

It’s not clear if or when ordinary people will return to Leer. Even if they do, we will have to start from scratch and it will take a long time to get back to where we were before. The trust that we need to carry out our work has been shattered. To be able to return, we will need unconditional respect from everyone for our medical facilities, staff and patients. Whether that can happen is impossible to say.”