'We remain vigilant about disease outbreaks — the crowded camp environment poses risks to young children, especially for communicable diseases such as measles'

Vanessa CrammondEmergency Manager, Médecins Sans Frontières/Doctors Without Borders (MSF)
September 26, 2014

In August, Médecins Sans Frontières/Doctors Without Borders (MSF) released a statement deploring the conditions in a Protection of Civilians camp manged by the the United Nation's mission in South Sudan (UNMISS) near Bentiu, a town in Unity State, South Sudan. The camp is one of several that were set up in spontaneous response to the violence that swept across South Sudan last December, and MSF teams are providing healthcare to 40,000 people sheltering at the Bentiu site, running a hospital with an emergency department, surgical care, and maternity, pediatric and tuberculosis wards.

The Bentiu camp is located in one of the world’s largest swamps, and by last August people inside were living knee-deep in floodwater contaminated by raw sewage. Many slept standing up, with their children in their arms. Those venturing outside the confines of the camp and into the conflict zone risked violence and rape at the hands of armed men. In its account of the conditions in Bentiu, MSF called them an "affront to human dignity."

Vanessa Cramond, MSF’s emergency manager in South Sudan, describes below the current situation now that the floodwaters are receding.


Life in Bentiu has improved, but an uncertain future remains

Within the UN protection of civilians site, we’ve seen a significant reduction in water levels after a two-kilometre drainage canal was completed and drainage systems were improved. There are still flooded areas, but most people’s shelters are now dry. Road access within the camp has also vastly improved and people are pleased.

Behind the barbed wire, daily life goes on. People are busy trying to secure their shelters by building mud walls and small ditches. Soil was selling for five South Sudanese pounds (around US$ 1) a wheelbarrow to people wanting to raise the floor in their shelter, but now it has been made freely available by UNMISS troops as a by-product of the excavation.


More 'firewood patrols' and greater mobility

In general, there seems to be less harassment of women and children who venture outside the protected area in search of charcoal or firewood to cook their daily ration of lentils or sorghum. In addition to guarding the camp itself, UNMISS troops are now running “firewood patrols” three times a day along the main route from the camp into town about five kilometres away. Some women have set up little businesses inside the camp selling the extra wood to others who are too scared to venture out. This has allowed them to generate some income. However, MSF still has some concerns about the safety of women and children beyond the walls of the protected area and continues to monitor the situation closely.



Recently we’ve seen people return to the camp with fresh guavas, papayas, lemons and okra that they’ve collected from the gardens of abandoned huts around Bentiu town. On occasion, there has even been some fish available that has been caught somewhere on the outside. Despite this, the surrounding area remains heavily militarized and the situation is tense. In the town itself, abandoned NGO offices have been taken over by armed men, most shops and markets are closed, schools have been turned into brothels or breweries. Boy children in oversized uniforms, armed with shiny new assault rifles, are a common sight.


Concerns about disease outbreaks and the safety of women and children

We’re concerned about civilians who live outside the camp and cannot access our services. To this end we recently set up an outreach clinic in Bentiu town itself. From now on, MSF teams have a regular presence in the looted former hospital building in an attempt to reach any women and children remaining in the villages immediately surrounding the town, and to provide them with primary healthcare services.



We remain vigilant about disease outbreaks — the crowded camp environment poses risks to young children, especially for communicable diseases such as measles. Over the last few months, several children have died from complications related to measles infections, so last week MSF, with the support of other health actors, carried out a vaccination campaign and immunized more than 14,200 children both inside and outside the camp. We screened for malnutrition and observed positive signs of improvement among the children we encountered.



Cautious optimism over improvements in nutrition

Six weeks ago, seven per cent of the children we screened (by measuring their mid-upper arm circumference, or MUAC) were severely malnourished. That’s now reduced to 1.3 per cent. We believe the improvement is down to the provision of clean drinking water and improved healthcare and nutrition services within the camp, together with the regular general food distributions. It’s encouraging that over the last three weeks we have not had any deaths in the MSF hospital attributed to malnutrition.

But for all the improvements, we remain cautious. We’re still in the rainy season and, with the next heavy downpour, the flood water may return. This low-lying area is really not sustainable for people to live on. And when the rainy season ends, there could be problems providing clean water to people living in the camp. With no political solution to the crisis in sight, the people here face an uncertain future.



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