Hundreds of thousands of people have been effectively denied life-saving assistance.

As towns in South  Sudan suffer devastating attacks, medical care has also come under fire, with patients shot in their beds, wards burned to the ground, medical equipment looted, and an entire hospital destroyed, Médecins Sans Frontières (MSF) announced today. Hundreds of thousands of people have been effectively denied life-saving assistance.
MSF staff witnessed the gruesome aftermath of recent attacks and clashes in Malakal in Upper Nile State, discovering patients murdered inside the town’s Teaching Hospital. In another disturbing violation of medical facilities since conflict erupted in mid-December 2013, an MSF team returned to Leer, in Unity State, and discovered the hospital looted, burned and vandalised. Large parts of the town appear to have been razed to the ground. 
“Assaults on medical facilities and patients are part of a broader backdrop of brutal attacks on towns, markets and public facilities,” said Raphael Gorgeu, MSF head of mission. “These attacks show a com-plete lack of respect for medical care and deprive the most vulnerable of life-saving assistance just when they need it most.”

Scenes of horror in Malakal

On February 22, MSF teams discovered at least 14 dead bodies at the Malakal Teaching Hospital com-pound. Several patients showed signs they had been shot dead while lying in their beds. Many of the hospital wards, including the therapeutic feeding center for malnourished children, had been burned, and looting had clearly taken place throughout the hospital. MSF evacuated several of the most severely ill patients to the United Nations base in Malakal for treatment, 13 of whom were gunshot victims.
“Malakal is deserted, with houses burned throughout and countless dead bodies strewn in the streets,” said Carlos Francisco, MSF’s emergency coordinator in Malakal. “I can find no words to describe the brutality in Malakal, which has left in its wake a ransacked city and a thoroughly traumatized people.”
Some of the patients MSF evacuated to the UN base said that armed groups entered the hospital on February 19 and shot dead people who had no money or mobile phones to hand over. Later that af-ternoon, armed men returned and killed patients in their beds and others who had fled to the operating theatre. They also reportedly raped women and young girls.

Hundreds of thousands deprived of care in Leer

Hundreds of thousands of people have been cut off from lifesaving medical care after Leer Hospital was ransacked and destroyed between the final days of January and early February. 
When MSF staff assessed Leer Hospital following weeks of insecurity, they discovered a horrific scene of equipment and buildings reduced to ash, drug vials smashed and strewn throughout the grounds, and surgical equipment broken and discarded. Drugs, beds, and supplies were looted. Not a single hospital bed remains in the compound.
“The people of Leer and throughout southern Unity State knew they could count upon MSF for critical medical care, and now that assurance is simply gone,” said Gorgeu. “The trust that is essential for us to carry out our work has been shattered, and the ultimate victims are the countless people who will suffer – and likely die – for want of medical care.”
The hospital in Leer, opened 25 years ago, was the only secondary healthcare facility in the region, serv-ing nearly 300,000 people in the surrounding area. In 2013, more than 68,000 medical consultations were carried out, nearly 400 people underwent surgical care and 2,100 children were treated for malnutrition. Since December 15, when fighting erupted in South Sudan, more than 4,000 consultations were carried out and nearly 170 surgeries were performed until the forced closure in late January. 
“Leer is now empty of civilians who have fled continued insecurity and are living in terrible conditions in the bush, too terrified to return home,” said Sarah Maynard, MSF project coordinator for Leer. “But even if they were to come back tomorrow, or a month from now, they would return to ruins of their former home and no healthcare. This is catastrophic for the population.”
MSF’s 240 locally-hired staff remain hidden in the bush, struggling to treat patients with rapidly dwindling supplies. The staff report they are reusing wound dressings and trying desperately to assist the displaced who have no access to clean water or food. MSF is exploring every avenue to provide healthcare to the displaced and resupply its staff.
“We must seriously consider if we can return to work in Leer Hospital,” said Gorgeu. “That will not only require significant investment of resources, but it will depend upon on unconditional respect from all par-ties for our medical facilities, staff, and patients, not only in southern Unity State but everywhere in the country.”

Disturbing pattern of medical care under fire in South Sudan

The atrocities in the hospital in Malakal and the destruction of Leer Hospital take place amidst a disturb-ing pattern of incidents affecting medical staff, patients, and MSF-supported facilities in South Sudan:
  • In mid-January, armed men robbed and threatened staff at the MSF compound in Malakal, lead-ing to a temporary suspension of MSF’s medical activities in the town.
  • In mid January, the MSF compound in Bentiu, capital of Unity State, was looted amidst fighting in the town, which forced MSF staff to vacate Bentiu State Hospital and leave drugs and supplies with patients and their caretakers. Thousands of people had no access to healthcare for weeks in Bentiu town.
  • Patients were reportedly killed in their beds in the hospital in Bor, capital of Jonglei State, during fighting in December 2013. While the hospital is today functional and well supplied, there are few patients in the wards since most of the town is empty.
“Medical care has come under fire in South Sudan,” said Gorgeu. “Rather than safe havens for treatment, hospitals are now targets of attack and brutality. They are places to fear rather than trust, a complete inversion of their purpose and role. Hundreds of thousands of people are in desperate need of shelter, food, water, and healthcare in South Sudan. The question is, how can effective, neutral aid be provided in a climate of utter disrespect and fear?”

MSF in South Sudan

MSF has been working in the region that today constitutes the Republic of South Sudan since 1983, and currently runs 17 projects in nine of the country’s ten states, with regular projects in Agok, Aweil, Bentiu, Gogrial, Maban, Malakal, Nasir, Yambio, Lankien, Yuai, Pamat, and Yida and four additional emergency operations in Juba, Awerial, Malakal, Melut, and Nimule. 
MSF responds to emergencies, including large-scale displacement, refugee influxes, alarming nutrition situations and peaks of disease such as measles, malaria, acute watery diarrhea and kala azar, in addi-tion to providing basic and specialist healthcare services. MSF is also providing medical and humanitarian to refugees from South Sudan in Kenya, Uganda and Ethiopia. 
In the first ten weeks of the current crisis, MSF carried out 103,614 consultations (including 40,925 of children under five), 3,767 hospitalizations (including 2,282 of children under five), treated 1,393 war wounded, performed 755 major surgeries, and 2,157 deliveries. MSF currently has 333 international staff working in its projects alongside 3,330 South Sudanese staff.

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