Dying by the roadside

Alison blogs from Batil refugee camp, where MSF is responding to the needs of people who have fled violence

At the moment we’re functioning as a transit camp, with refugees being moved from the Km 18 camp which has virtually run out of water, through to the new Batil camp, which is about an hour and a half’s drive away by truck or tractor.

MSF Doctors Without Borders South Sudan

People in the flooded transit camp ©Corinne Baker/MSF

I arrived here just over a week ago at the point when this transportation commenced. There have been about 35,000 people on the move, along with the approximately 32,000 who are already here in Jamam camp. For the refugees, this is the second relocation since they fled fighting across the border, and you can see the toll that this is taking. Emotionally, it must be extremely difficult, but physically, it’s taking a huge toll.

On the day I arrived, an old lady just dropped down and died from exhaustion right in front of me. The people here have minimal clothing and they’re living in appalling conditions, with just plastic sheeting to cover families of eight people and more. We’re doing what we can to distribute blankets and other items, but when it rains, it’s very heavy and often horizontal.

The tents in our compound flooded the other night, and when we got out to the main camp it was just a sea of mud. But despite all these difficulties, I’ve been so moved and impressed by the refugees themselves. To witness how resilient they seem to be, and how they’re coping in this incredible situation is astonishing. People come in for a consultation, and you can still get a smile and a laugh from them. I find that remarkable.

We’re seeing a lot of severely malnourished children, who we’ve been able to treat either on an outpatient basis or in our therapeutic feeding centre. Just this morning I was treating a little child of a year and a half, who only weighed five kilos. Now that the rains have arrived and it’s colder, we’ve had several cases of hypothermic children and respiratory tract infections.

On my first day we had a child with a temperature of about 40, suffering from pneumonia. We were out in the tents and had to put in an intravenous line before transferring her quickly to the hospital here.

The mud is making our job doubly hard. Even getting around is difficult. By the end of the day you’re carrying about ten kilos of heavy mud on the bottom of each boot. Today I spent hours cleaning the entire clinic with chlorine because it was completely covered in mud. I don’t want to be trying to teach people about the importance of hygiene, only for them to then come into a clinic full of mud.

MSF Doctors Without Borders South Sudan

Weighing a child in the muddy clinic tent ©Corinne Baker/MSF

That’s because maintaining hygiene in a situation like this is vital. We’re seeing hundreds of cases of watery diarrhoea, perhaps 40 percent of our consultations. This week, we’re averaging between 250 to 300 consultations a day, so that is a lot of people affected. And, of course, watery diarrhoea is directly related to the lack of water and the subsequent lack of hygiene.

Lack of water is a problem everywhere in this area, and although our water and sanitation teams are doing an amazing job in finding new sources of water, there just isn’t enough, which means that the refugees have a huge problem in keeping themselves and their families clean and hygienic.

So as well as diarrhoea, there has been an absolute explosion in conjunctivitis and of eye diseases. I’ve seen hundreds of children and small babies with their eyes completely closed shut with pus, which we’ve been cleaning and treating.

I’ve never worked in a situation with so many refugees and with so many problems; problems with lack of water, problems with the terrain that is so swampy. And we’re worried now about cholera breaking out, because it’s endemic in the Blue Nile state where the refugees have come from. So some of them could be carrying it, and with the lack of hygiene, there is a real risk. We’re preparing for it, but if that happens, the water issues are going to be a big problem

MSF Doctors Without Borders South Sudan

A young person collects flood water in the transit camp ©Corinne Baker/MSF

The camp at Batil is on higher ground, and hopefully the water situation there will be solved. But who knows when these people will be able to return to their homes. That was something that struck me horribly.

Often when you ask a mother in other parts of the world how old her child is, she will reply by telling you the season the child was born in. In some countries, they’ll say something like ‘the season of the mangoes’, which sounds rather romantic and nice. But here I asked a mother that question, and she thought for a bit before replying: ‘when the fighting started’." That’s how these people are now measuring their time, by war and fighting. That is terribly sad.

Today five new families turned up at the camp. They had walked some 74 km from El Fuj, on the border between Sudan and South Sudan, taking two days to get here. There was a grandmother, a three-year-old child and all ages in between.

They’d left their homes in Blue Nile State when the fighting broke out in September, and since then – some nine months – they had been living in the bush, surviving on leaves and berries. Finally they’d decided to seek more security and shelter, and set off on this long walk. I found it amazing that none of them were severely sick; they have just learned to be incredibly resilient, at least physically. One can only guess at the emotional toll this life is taking on them.

Ultimately, it’s absolutely tragic that more isn’t being made of this situation internationally. Compassion fatigue is one thing, but nobody could see the condition these people are living in and not have compassion for them and want to do something to help.

Nobody could have seen these people when they were walking in desperation, fleeing fighting and walking for miles in horrific conditions, with many of them just lying down and dying by the roadside – nobody could see that and know the story behind it and fail to be affected.