Sudan's White-Nile State becomes a haven for those fleeing South Sudan's war

Essential emergency medical care provided by MSF to refugees

Over the last three years, the oil-rich state of the Upper Nile in South Sudan has seen continuous conflict between government and opposition forces. This has forced many families to make a drastic decision – stay and risk being killed, or leave and maybe have your property stolen.     

Across the border to the north lies Sudan’s more peaceful White Nile state which many South Sudanese have decided to flee to and escape the violence. Currently, six refugee camps host 83,000 people and many more live outside these designated zones.

Earlier in the year, the rainy season brought a brief lull to the fighting in the South, but now they have gone and there is a return of hostilities between the warring sides. Families have resumed their migration to find safety across the border.

MSF currently runs a 40-bed hospital in White Nile state. It is based just outside Al Kashafa camp where over 17,000 refugees have been allowed to settle. A wide range of services are provided in the inpatient and outpatient departments, the most common concerns relate to reproductive health issues, respiratory throat infections and malnutrition.

Mary, a refugee from Kaka in South Sudan’s Upper Nile state, explained, “When the armed men came to Kaka they showed no mercy. Neither the young nor the old were spared. As soon as we heard that the killing had started we didn’t stop to think, we just ran from the village taking what we could carry, embarking on our frightening journey.”

“To pass through some of the military checkpoints we had to lie about the tribe we belonged to, otherwise we would have been stopped and the worst would have happened. We feel very lucky, as miraculously nobody was hurt.”

While some arrive worn out from their ordeal, suffering from malnutrition and malaria, the majority endure the journey well enough, walking up to eight days to get here.

Mary’s four-year-old daughter is a patient in the MSF hospital because she arrived malnourished. “She became sick on the journey and stopped eating, had diarrhoea and started coughing,” explains Mary. “When we got here the doctor told me that she needed help and put her on the special nutrition program run by MSF. I hope that this will make her strong again.”

According to Mohamed, the project coordinator, “By far our biggest cause for concern is the sanitation and hygiene in the camp. People are living so closely together and there aren’t enough toilets and latrines. They are openly defecating near their shelters and their neighbours.”

“There is a huge risk of multiple cases of measles or acute watery diahorea spreading throughout the community. Young children are particularly at risk as they play in these unsanitary conditions with their friends. The hospital is always ready to deal with an outbreak despite our limited capacity. The only solution is an upgrading of the sanitation facilities.”

MSF is contributing to the upgrading of the sanitation standards with the construction of latrines in two camps (Al Kashafa and Joury). Community health promotion activities are also part of the package offered by MSF, with the aim of increasing the awareness on health behaviour.

The hospital also works as a referral point for other camps and it is the only nutritional stabilisation centre in the area. The most serious cases are referred to Kosti Hospital which is 80 km away on a sandy and difficult to drive road.

The MSF medical facility is not just being used by the new arrivals. Nearly half of all consultations are with local people living outside Al Kashafa camp, which includes the host Sudanese community and refugees from the other five camps.  

Before MSF arrived, the local community had very few alternatives when it came to medical care and MSF Hospital became a point of reference for the local population as well.

The needs of the local community are evident. Elizabeth, from the local village of Alseror, explains why she came to the MSF hospital, “For weeks I was suffering from a very bad headache and a sore throat. My family wanted me to try some traditional medicine. It’s all they could suggest, but I knew it wouldn’t work. So I came to the MSF hospital where the treatment is free and the doctors know what they are doing.”

Many of the refugees living in the camps find themselves in a unique circumstance. Not long ago Sudan and South Sudan were one country, and until recently the authorities in Khartoum gave those raised in the South the rights of Sudanese citizens. As many have family in Sudan (North), understand the northern culture and speak Arabic they may choose to move on to one of the larger towns in White Nile state. Those with money and family connections might even go as far as Khartoum where they can start a new life.

Those without connections will stay in the camp, hoping for the situation to improve. Life in the camps remains hard; while international NGOs are providing a basic education for children, for the adults there is little to do.

Some try to eke out a small income by selling fish or trading in the local market. Others find work labouring on local farms. This enables their families to supplement their food rations and maybe save a little for a better life.

The final outcome for these South Sudanese refugees will no doubt rely on the fighting at home. If things improve then many may go home. For now, this is only wishful thinking.

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