South Sudan: Notes from an IDP camp

Dr Bhavna Chawla, a surgeon, recently returned from Bentiu, South Sudan, where MSF operates the sole hospital in a camp of over 120,000 internally displaced persons.  

South Sudan became the world’s newest nation in 2011. But the euphoria of independence would prove short-lived, as the country slipped into a civil war amid a power struggle between the president and his deputy in 2013. The resulting violence has taken a huge toll on the people of South Sudan, leaving over a million displaced over three years with little or no access to medical and humanitarian assistance.

Doctors Without Borders / Medecins Sans Frontieres (MSF) is one of the largest providers of neutral, independent, impartial medical humanitarian assistance in South Sudan. The UN Protection of Civilians (PoC) camp in Bentiu to the north of the country is one of the sites MSF works in. The camp is home to over 120,000 people who have fled violence in different parts of the country.

Looking from afar, there’s a spreadsheet-like symmetry to the camp where shelters are arranged neatly inside square-shaped neighbourhoods. However, the picture changes drastically when you are inside; each shelter houses up to a dozen persons. Dr Bhavna Chawla, an MSF surgeon who recently returned from Bentiu, says the PoC site is characterised by a “paucity of every resource you need for a healthy life – whether it is space, water, food or money.”

The dire living conditions and high density of population mean the threat of disease outbreaks is ever-present. In 2015, MSF and UNICEF provided malaria treatment to over 16,000 children under the age of five in a door-to-door treatment campaign. In 2016, a spurt in cases of cholera led to fears of a large-scale outbreak.

The volume of medical needs is enormous and the services available to the vulnerable people are few and far between. The MSF hospital in the Bentiu PoC is the only hospital for people in the camp. The 120-bed facility provides 24-hour emergency room care, intensive care for malnourished children, medical treatment in paediatric and adult wards, and surgical and maternity services.

As part of the surgical team, Bhavna dealt with “cases you would encounter in a surgical setup anywhere in the world – ranging from appendicitis to chronic osteomyelitis (severe infection of bone). But there were a lot of gunshot wounds and axe wounds as well.” Patients in need of surgical treatment at other MSF facilities across South Sudan were also referred to the hospital in Bentiu.

Many of the patients had witnessed or experienced acts of extreme violence on their way to the camp. She remembers a man who’d been shot through the pelvis brought to the hospital. Another patient – a young girl – was shot after a dispute over cattle.

Read testimonies from the Bentiu PoC site

This was Bhavna’s third assignment in South Sudan, but none the easier for it. The atmosphere inside the camp was tense, and the “slightest of events could trigger a domino effect”, she recollects. There were always more patients than beds, and resources were understandably stretched.  

But as in her previous assignments, Bhavna was surprised by how little is needed to make a difference. “When you don’t have the time, you don’t have the investigations, you just have to go in with your clinical instincts and make the best decision possible for the patients. It’s a learning experience every time you do that…it’s like no other high,” she reflects.

“Every time a patient gets discharged, smiling, walking and being able to do something for his family again, it’s a tremendous feeling.”

MSF has been working in the area that is now South Sudan since 1983. Today, we employ more than 3,000 South Sudanese staff and 330 international staff to respond to a wide range of medical emergencies and provide free and high quality health care to people in need.