Since the end of November, Médecins Sans Frontières/Doctors Without Borders (MSF) teams in the Yida refugee camp, in South Sudan’s Unity State, have been responding to a spike in measles cases that is primarily affecting the young. Many of the sick children recently arrived in Yida after fleeing with their families from Sudan’s Nuba Mountain region, where bombardments and fighting between rebels and the Sudanese government forces have intensified of late.
MSF has been working in Yida since 2011, and the area is now “home” to some 70,000 Sudanese refugees. The crowded living conditions make the refugees more susceptible to the measles virus, which spreads via fluid from the mouth or nose of infected persons. Children under five and pregnant women are most at risk due to their weaker immune systems.
“In a refugee setting, one single case of measles is considered an outbreak,” says Ahmed Mohama Mahat, MSF’s vaccination coordinator in Yida. “And these people arriving in Yida from the Nuba Mountains are in very bad conditions; they have not been vaccinated for a long time.”
Wide vaccination coverage will protect more people
In response to the latest crisis, MSF teams have admitted 93 patients with measles and launched a mass vaccination campaign in collaboration with the International Rescue Committee (IRC) and the United Nations High Commission for Refugees (UNHCR). The goal is to vaccinate 90 per cent of the children in the camps and the nearby host communities between the ages of 6 months and 15 years — an estimated 35,000 children in all — over a period of five days. This would both increase the immunization coverage in the area as well as protect people from future outbreaks.
“Mass vaccination campaigns in emergency situations during outbreaks or for displaced populations often target at large number of people,” says Mahat. “The challenge is to be able to achieve this rapidly in order to control an epidemic or the risk of epidemic.”
'In a refugee setting, one single case of measles is considered an outbreak'
More than 100 people have been recruited from the camp’s population to assist with the campaign, bringing the total number of staff working on the program to around 140. Nine vaccination sites have been set up throughout Yida, each managed by teams of 12 that consist of a supervisor, vaccinators, preparers, watchmen, crowd controllers, and mobilizers. The mobilizers are community health workers who usually help MSF with health promotion, outbreak detection, referrals to the open patient department in the hospital, and tracing of tuberculosis treatment defaulters.
“The community health workers are very important for our work here and especially for the success of a mass vaccination campaign like this,” says Mahat. “They are the eyes and ears of MSF in the community, and the link between the hospital and the community. They are well respected, so they are the force behind the community’s awareness of our facilities and of the vaccination campaign.”
'I recognized the symptoms'
Faisa Said is just the sort of person the campaign is designed to aid. She recently brought her two-year-old daughter, Nana Wii Said Kuku, to the MSF hospital in Yida with a high fever and the dry, wheezing cough typical of measles. The infant had also developed a secondary pneumonia and a rash was starting to spread over her little body. A machine supplied concentrated oxygen through a tube in her nose to help her breath.
“I took my daughter to the hospital when her temperature went up and she started to cough,” says her mother. “I recognized the symptoms of measles since my sister had it some weeks ago. She was treated and recovered in this hospital.”
Faisa hopes the outcome is the same for her daughter. But she knows measles is just one of many challenges her family must contend with. They first fled the violence in the Nuba Mountains in 2012 but went back home a year later, hoping it was safe. When the fighting and bombing worsened once again, they were forced back to Yida. Faisa Said can get treatment for her daughter, for which she is grateful, but she doesn’t yet know if or when she can return home.
MSF is one of the healthcare providers in Yida refugee camp. The MSF facility in Yida, featuring outpatient and inpatient wards, began operating in 2011. More than 100,000 consultations have been performed, along with close to 2,600 hospitalizations last year.