Fieldset
My favourite worst time

This was the time of day I dreaded. Almost like clockwork the screams and cries would start in unison from the children’s ward. What is it about a baby’s cry? That unique sound that activates such a primitive unnerving instinct in all of us.

This was the time of day I dreaded. Almost like clockwork the screams and cries would start in unison from the children’s ward. What is it about a baby’s cry? That unique sound that activates such a primitive unnerving instinct in all of us. It was feeding time and the children, so weak from malnutrition, didn’t want to eat. It was that odd paradox. Their skinny tired little bodies were rejecting the one thing they needed the most.

Yet weirdly it was also the time of day I looked forward to. It filled me with a sense of hope. MSF’s dedicated nurses and hospital staff doing what we were there to do; save lives and alleviate suffering. They worked tirelessly, every few hours, to gently encourage the children to eat.

This was my third visit in a year to the Bentiu Protection of Civilian (PoC) camp in Unity State, South Sudan. The internally-displaced people (IDPs) were fleeing the violence that erupted across South Sudan in December 2013. The country, which was less than three years old, had quickly descended into a major conflict marked by violence against civilians and widespread humanitarian suffering.

New arrivals wait to be registered at Bentiu POC. They reported insecurity, continued fighting and lack of food as factors for coming into the POC. September 2015.Photo: Brendan Bannon

New arrivals wait to be registered at Bentiu POC. They reported insecurity, continued fighting and lack of food as factors for coming into the POC. September 2015. 

The PoC camp was created in Spring 2014 by the UN Mission in South Sudan (UNMISS) to protect civilians living in Bentiu, a focus of heavy fighting due to its strategic importance (it’s located close to oil fields). I first visited the camp during that period. The camp was a sorry sight. People were living in makeshift shelters, open defecation was occurring everywhere and there were heaps of rubbish wherever you looked. And if it rained, the entire camp became a putrid lake.

But as the conflict raged on in South Sudan, the situation in the camp improved. The IDPs were gradually being moved to land with better drainage and food distributions were taking place regularly. MSF was instrumental in increasing the supply of clean water, building latrines and providing appropriate health care.

But then recently, in spring 2015, fighting escalated throughout Unity state once again. The civilian population suffered wide scale violence that led to another wave of displacement. The camp population that had stabilised at around 40,000 people suddenly tripled to almost 120,000 in only six weeks!  Bentiu PoC was now the size of a small city.

Blood transfusions underway for malaria patients with anemia. Blood is collected on site by family donors whose blood is tested for Malaria, Syphilis, Hep B and C, HIV and blood grouping. Photo: Brendan Bannon

Blood transfusions underway for malaria patients with anemia. Blood is collected on site by family donors whose blood is tested for Malaria, Syphilis, Hep B and C, HIV and blood grouping. 

The camp struggled to provide enough shelter, clean water and nutrition. IDPs were arriving in a poor state after walking for several days and hiding in the bush, with little access to food. We were soon seeing severely malnourished children in our hospital.

I arrived during this IDP influx to support the teams with community surveillance. The aim was to monitor mortality rates in the population and understand disease trends so we could target our programmes appropriately. We noticed an increase in cases of acute jaundice syndrome and became concerned that a hepatitis E outbreak was imminent.

Hepatitis E is an infectious disease associated with poor water and sanitation. MSF has responded to several outbreaks in refugee camps in recent years. It can cause fulminant liver failure, altered consciousness and coma. In some settings Hepatitis E can be particularly serious for pregnant women and their unborn babies who can suffer disproportionately high mortality from hepatitis E (up to 25%). We increased surveillance and constructed an isolation area for the management of these patients.

Kume is a three-year-old boy tested positive for malaria. He had a fever of 39.7 when his family brought him into the hospital at Bentiu POC.Photo: Brendan Bannon

Kume is a three-year-old boy tested positive for malaria. He had a fever of 39.7 when his family brought him into the hospital at Bentiu POC. 

At the same time the camp was experiencing a malaria outbreak, and given the size of the population, an unprecedented magnitude of cases. Between June and September 2015 MSF treated almost 33,000 people for malaria, the majority of whom were children aged less than five years old.

Children are more vulnerable to the severe consequences of malaria such as cerebral malaria and anaemia, often leading to death. In response, MSF scaled up under-fives malaria treatment centres in the camp and carried out community malaria case management campaigns. The number of deaths among children related to malaria decreased drastically.

But in the midst of all this there were moments of pure joy such as one of our medics attempting to make balloon puppets to cheer up the children. Or movie nights in the hospital, enamoured children watching cartoons projected onto a white sheet blowing in the wind, while gunfire and explosions could be heard in the distance.

It’s hard to imagine how much more these people can take. MSF continues to receive reports of widespread violence against civilians, particularly in southern Unity State from where many people living in the Bentiu PoC have fled. The population has suffered a loss of livelihoods and has not been able to farm or harvest food. MSF’s access to the most vulnerable has been intermittent due to insecurity and looting of its compound. But the MSF teams that have been able to reach the population with mobile clinics have found alarmingly high rates of malnutrition among these people, who’ve had so little access to assistance after months of displacement.”

 So we brace ourselves for the next medical crisis and the distressing cries of more malnourished children.