Fieldset
COVID-19 in South Sudan: Waiting for the wave - Part 1

As the pandemic disrupts medical supplies and staff, doctor Ayla Emmink is relocated from her rural project to a vast UN displacement camp – where our teams are racing to prepare for the arrival of COVID-19

It’s hotter than ever before and here I am, covered in sweat, squeezed in between two very tall South Sudanese men in a tiny propeller plane.

The men both have the forehead markings which are traditional for the Nuer people. The Nuer are one of the largest ethnic groups in South Sudan – and one of the tallest!

The contrast between these tall men and this tiny plane is almost cartoonish, but for me they symbolize our destination; the Protection of Civilians (POC) camp in Bentiu.

The camp hosts about 120,000 internally displaced people, mainly South Sudanese people who have suffered from the civil war. Most of them are Nuer.

Planning with the pandemic

We are halted at the runway of Juba airport, waiting for the green light to take off on our flight to Bentiu. I can barely believe I’m actually in the plane. Even when the motors start, I wonder if it is really going to happen.

the plan is that I will support the medical team in the Bentiu project for the coming weeks. I'll be helping in MSF’s 150-bed field hospital, which treats both the inhabitants of the camp and the surrounding communities.

Almost all MSF projects in South Sudan are now suffering staff gaps because of this, and expectations are that this will only become worse in the weeks or months to come

I can hardly imagine a bigger contrast with my previous work in Mundri, where I was supervising two emergency wards and five outreach field clinics scattered over a spacious area of mango trees, weeds, bushes and farmlands.

While COVID-19 rules the world and the preventive measures in South Sudan are getting stricter and stricter, it has become close to impossible to get any international staff in or out of the country. Almost all MSF projects in South Sudan are now suffering staffing gaps because of this, and expectations are that this will only become worse in the weeks or months to come.

This is why I find myself being relocated to the Bentiu project, despite the fact that there won’t be a replacement for me in Mundri either. The needs for my skills in Bentiu are currently higher.

The risks of getting stranded

Unfortunately, at the moment the question is if I will ever arrive in the camp. There are rumours going around that even domestic flights will be restricted to contain COVID-19. Basically, I have a high risk of getting stranding in Juba, the capital city, without permission to either proceed to Bentiu or return to Mundri.

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A small MSF plane landing at Bentiu to deliver staff and supplies
A small MSF plane landing at Bentiu to deliver staff and supplies

It’s a very unpleasant prospect. I would hate the idea of being stuck in Juba while I am needed both in projects.

The plan has changed multiple times since the day before I left Mundri, depending on the latest news. Only once I hear the sound of the motors intensifying and the plane gains speed for take-off, do I dare to trust the plan.

Fears for Bentiu

Though I used the majority of the flight to catch up on some sleep, I wake up shortly before landing with a view of the Bentiu camp below.

While we descend, hundreds of huts, people walking through markets, children playing in the drainage canals and mothers washing their laundry slowly grow to life-size. The scale of the camp begins to sink in.

The risk that the virus will reach the camp suddenly seems hard to ignore

It makes me sad and a little scared, as it's obvious how closely packed together people live here. I understand that limited living space, water supplies and other forms of infrastructure barely allow any social distancing, hand hygiene or self-isolation.

A few days ago, the first COVID-19 case in South Sudan was confirmed. While we hope local transmission is still limited to Juba, the risk that the virus will reach Bentiu suddenly seems hard to ignore.

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Crowded conditions as women and children queue for water in a PoC camp
Crowded conditions as women and children queue for water in a PoC camp

One look at the camp shows that slowing down the transmission wave will be very challenging once the virus reaches here. The fact that many people are malnourished and have TB and or HIV doesn’t help the prognosis. It shines a light on the rumour that people are encouraged to leave the camp, since it seems the only realistic chance to reduce the spread of the virus.

The base

We land on a dusty airstrip of red soil, surrounded by nothing else than dry grasses and a few leafless bushes. A white MSF land cruiser awaits me, the driver greets me but does not leave the car and when I enter I see he is wearing a fabric face mask.

Whether the virus or the supplies will reach us first remains the question

We drive on a bumpy dirt road from the airstrip through the empty plain to the UN base, walled by stones covered by camouflage nets and wire, with watchtowers of metal sheets flanking the gates. After a short interaction with the blue-helmeted soldiers guarding the entrance, we are allowed into the UN base, with its warehouses, staff residence and the MSF hospital and compound.

The contrast with the rural surroundings of Mundri could hardly be bigger. I don’t know it yet, but the watchtowers and wire fences will come to mark my new running track. As we pass a building made from shipping-style containers, the driver points it out and explains that this is the hospital. Shortly after he reports our arrival via the radio.

Happy faces greet me as my backpack and I tumble out of the Land Cruiser; my new colleagues are clearly relieved to see a new face!

Waiting for the wave

While everyone tries to continue normal activities, even now the impact of COVID-19 is hard to ignore.

All training areas and meeting spaces I’m shown during my welcome tour are empty. The HR manager is recruiting extra medical staff to create a COVID-19 team. The logistician and his team are preparing the new isolation area. The supply manager negotiates restrictions and regulations to maintain a continuous flow of supplies and equipment coming in to meet the hospital's needs.

One of my fellow medical doctors shows me the isolation area they are preparing while we are discussing the patient flow through the screening, triage and treatment area for (suspected) COVID-19 cases. Tents, huts and containers involved in this are currently all empty and it seems surreal that these empty beds will soon be in use. We are awaiting more equipment to prepare this area for the many expected patients.

Whether the virus or the supplies will reach us first remains the question.

Read the second part of Ayla's blog, here.

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