"For the next five hours, we treated as many wounded people as we could. At least 25 patients arriving at the hospital had gunshot wounds. Before that day, I had only seen two gunshot wounds during my whole career as an emergency physician."
On February 17, 2016, fighting erupted in the Malakal Protection of Civilians (PoC) site in South Sudan, an enclosed camp where the United Nations has been providing protection to more than 47,000 people who had fled the country’s ongoing violent civil war. At least 19 people were killed, including two South Sudanese members of MSF’s staff. In total, 108 injured people were received in the MSF hospital for treatment, including 46 with gunshot wounds.
Sunita Swaminathan, an emergency doctor from Toronto, describes what happened on this and the following days:
“Wednesday, February 17, was a normal day at the hospital, quite long and exhausting. I was doing paperwork in our base in the evening when I suddenly heard gunfire in the distance. Then I heard a nurse who was doing the night rounds say over the radio, 'We hear shots! Women and children are flooding into the hospital. We are starting to receive people with gunshot wounds.'
A few colleagues and I immediately went to the hospital. We brought along a surgeon, an anesthetist and a gynecologist from the International Medical Corps because we don’t have a surgeon in our program. On the way to the hospital we continued to hear gunfire. When we arrived at around 11:30 p.m., the hospital compound was filled with about 600 people who were seeking shelter from the violence, most of them women and children. For the next five hours, we treated as many wounded people as we could. At least 25 patients arriving at the hospital had gunshot wounds. Before that day, I had only seen two gunshot wounds during my whole career as an emergency physician.
At around 4:30 in the morning, we had stabilized everyone and the team left to get some rest. I later learned that two local MSF staff had been killed in the camp, one while trying to help people reach medical care.
Most of the structures at the UN base in Malakal were destroyed by the recent violence and fighting.
'No time to be scared'
We came back the next morning to assess the critically ill. The gunfire started again, this time close to the hospital. Women and children came running through a hole in the barbed wire fence separating the hospital grounds from the camp area where the displaced population was living. As the fighting got closer to the hospital, people fled into the military area of the UN site. We had patients who pulled out their IVs, packed up their things and ran.
In the early afternoon, there were still a lot of wounded coming in, and we could hear gunfire coming closer and closer. A lot of the time we were face down on the floor, treating wounded patients. I had no time to be scared because I was just focusing on saving lives. Finally we had to leave because it was getting too dangerous for us to work. When we returned a few hours later there were only a few people left in the hospital, mostly those who were too ill to flee.
We saw a huge cloud of smoke over the area where the displaced people had been living. Everything was on fire. We had already seen a few burn patients. When I flew over the camp on my way to Juba a week later I could see that everything was black. Our field coordinator told me that most of the structures away from the UN base had been destroyed, many burned to the ground.
- 'Sickness is spreading': Families and children struggle to survive in a UN protection camp in South Sudan
MSF local staff work day and night to help others
Talking to our local colleagues, I heard many heartbreaking stories. One of the South Sudanese nurses recognized a patient who had been shot and burned and said, “That’s my neighbour. That means that I probably don’t have anything left.” He now only has the clothes on his back and a bed he can sleep in at the hospital.
Our national staff are truly an inspiration. They work day and night and do everything to help the patients, although many of them have lost everything.
A part of the team was evacuated after the second day of fighting but I stayed behind with a skeleton team. Things have calmed down now and we have returned to our regular medical activities such as making sure that malnourished children get the treatment they need.”
MSF operates a 50-bed hospital in Malakal, including a 24-hour emergency room, as well as a separate emergency room inside the United Nations’ PoC site. MSF has been working in the region that today constitutes the Republic of South Sudan since 1983.