In the last few months, a combination of bad harvests and growing insecurity has resulted in a huge increase in the rates of malnutrition in southern Sudan. Médecins Sans Frontières emergency teams are responding to the crisis, but more feeding centres, specialized food, and staff are needed to prevent needless deaths of Sudanese children. Moses Chol, emergency coordinator for MSF in southern Sudan, explains how MSF is expanding activities so that more nutritional aid will reach the regions where people desperately need it.

What is the nutritional situation in southern Sudan today?

The situation is extremely worrying, especially in the Upper Nile region. More than 800 children are being treated in MSF’s feeding centres in Unity State alone. The annual hunger gap is not entirely to blame for this, as there was a 200 per cent increase in the number of children treated compared to the same period last year.

Why do you think the situation is so bad this year?

There is a combination of factors, but the main one is the scarcity of food. Basically, we are six or eight weeks away from the harvest and there is very little food to be found in the market. The price of the main staple food, sorghum, has more than doubled since last year, resulting in people having to sell capital assets such as goats and cows to buy basic foodstuffs.  There are significant gaps in basic healthcare, whereby patients have to walk for several hours to receive the most basic of treatments, which contributes to children getting sick and further weight loss. But of course, the violence and insecurity also make things even worse.

What do you mean?

There are some pockets of violence where tribal disputes or more political post-election clashes have happened. Whatever the root of the violence, many families have had to flee their homes and therefore cannot farm their land.  This has had a direct impact on the agricultural output and families’ capacities to feed themselves.

How did MSF react to the upsurge in malnutrition?

As we saw the numbers going up, we first made sure that we could deal with the increasing number of patients in our own clinics and feeding centres. In many places, we’re pretty much the only aid organization providing nutritional support. But we also figured that if the situation was bad where we were, it was probably at least as bad in other areas where there was no health actor providing assistance. When analyzing the origins of our patients in our feeding centre in Leer, we found that 15 per cent of patients were coming from the capital of Unity State, Bentiu, more than 100 kilometres from Leer – this is what led us there.

You were part of the team doing the assessment in Bentiu. What was the situation when you got there?

Bentiu is a big town of about 100,000 inhabitants where 80 per cent of the people are unemployed and rely heavily on humanitarian aid. Ironically, during the war, they could count on regular food distributions, but this has stopped with the peace agreement. Bentiu has a relatively big hospital, but the staff there did not have the capacity to respond to the nutritional emergency. Children are admitted for an array of pediatric conditions, but cannot be treated for malnutrition because the hospital staff have no specialized food for therapeutic feeding. When we visited the hospital for the first time, they had admitted four children suffering from malnutrition, but two had died. The staff there told us the only thing they could provide was counselling to the families of the two others. There was a lack of supplies, human resources and training, which meant that starting to treat malnutrition was not even an option.

That’s when MSF decided to intervene?

As we’re already intervening in many parts of southern Sudan, we tried to encourage the authorities and other organizations to get involved in Bentiu. But there are very few organizations with spare capacity to go beyond their current program areas and in Bentiu there was no one present in a position to react.

What will MSF do to improve the situation?

Our team has opened two feeding centres in Bentiu Hospital. The first one provides intensive care for children who need to be hospitalized and carefully monitored. The second centre provides ambulatory feeding care, which means that mothers can come with their children to be weighed and measured and then receive specialized therapeutic food they can take home to administer, only having to return to the centre after a week or two. Within three days of the feeding centres opening in Bentiu, 28 children were hospitalized and 70 children were enrolled in the ambulatory feeding program. Once we identify where most of the affected kids are coming from, we may open new ambulatory structures in different areas, but keep referring the kids who are worst off to Bentiu for hospitalization. In addition to providing life-saving care to malnourished children in and around Bentiu, the MSF team will focus on training local health staff to treat malnutrition so that the capacity to respond remains even after MSF’s departure.

Can MSF do more?

MSF is already intervening in many parts of southern Sudan, often as the only organization treating malnutrition. We have managed to find some local partners whom we have trained and helped with supplies, but there is a real need for more people to expand their interventions in the country to tackle this acute crisis.

How long will MSF stay in Bentiu?

That’s not an easy question, but we hope that the nutritional situation will improve after the harvest and that the hospital staff will be able to manage the remaining cases.  Our initial plan is to stay for three or four months. We will re-assess the needs at that time and we may well have to stay longer if the needs are there.

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