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The hidden impact of the conflict in South Sudan

This week Jany * underwent surgery again. After being shot in the leg during the latest wave of violence to hit Jonglei state at the end of July and after two and a half months of recovery at the Doctors Without Borders (MSF) hospital in Bentiu, he seemed ready to to have the external fixator removed from one leg. Unfortunately, in the operating room it was seen that the wound was not well healed and it was not possible to remove it yet.

Jany is one of 32 patients MSF managed to evacuate during the first days of August, in the latest peak of fierce fighting in the Jonglei and Greater Pibor administrative areas so far. Severe flooding, which has displaced hundreds of thousands of people across the country, is also affecting this area and has prevented further retaliatory attacks for the time being.

The call for help arrives

“45 injured in less than 24 hours and reports of hundreds more on the way.” This is the information we received in Juba, the capital of South Sudan, on August 3, 2020, and thus began our response to the latest spike in violence. It was the beginning of my third month in the country. As the Emergency Coordinator, he was there to support the response to covid-19 and handle the work overload caused by shortages of supplies and personnel due to coronavirus restrictions.

The call came from a satellite phone. It was the MSF team in Lankien, which in turn had received information from another team in Pieri, a town in Jonglei state, in the northeast of the country, where we have a primary health care center.

In fact, we had been closely monitoring the situation in Jonglei State, in the Greater Pibor area for weeks. In May, another attack on Piere had already left hundreds injured and several dead, including a member of our staff. Now a large number of armed youths had mobilized to retaliate.

On August 1, taking advantage of the good weather giving us a window of opportunity, we sent a plane with medical supplies to Piere. In addition, two additional workers supported the team there until they had to catch the plane back. We knew that such support was vital to keeping all essential health services open for the community facing a difficult period.

More support is needed

Two days after being able to bring the supplies, dozens of wounded arrived at the clinic. Our team worked day and night to treat them. In just three days, Pieri’s staff assisted 73 injured people, more than 100 in the week.

In Juba, we received regular updates. We decided to send a small team to support our colleagues on the ground as soon as possible. Staff at Pieri were exhausted, treating dozens of critically injured, and under great pressure due to the security situation.

As the airstrip in Pieri had been flooded for days, we contacted various organizations in the area to organize a helicopter for the next morning.

Two days after they were able to bring the supplies, dozens of injured arrived at the clinic. Our team worked day and night to treat them

We landed on the muddy runway at Pieri, where several of our colleagues were already waiting for us. Around him, hundreds of women, children, elderly and armed men from the local community who had returned home from the fighting. They knew that we were coming and that we would try to evacuate the most seriously injured.

From the airstrip, we headed straight to the clinic to assess the wounded. You could feel the urgency of the situation. We could evacuate some of them with the helicopter to the MSF hospital at the United Nations Protection Center for Civilians in Bentiu, where our organization has a surgical team. But we would have to make decisions quickly.

Treat as many critically injured as possible

By the time we arrived at the clinic, our field team had already grouped the most critical patients in the first tukul, a kind of cabin. Six patients with gunshot wounds lay on the ground with blood-soaked bandages.

During the rapid medical evaluation, some of the patients coughed. We immediately thought of covid-19, an additional challenge to the already complicated evacuation. We have already had staff who have had to be quarantined when confirming that a patient was positive.

We were only able to do one round of medical evacuations that day, because the helicopter takes three and a half hours between Pieri and Bentiu. Physical distancing measures to prevent covid-19 are practically impossible in a helicopter, especially when we are trying to evacuate as many critical patients as possible. We mitigate risks to the maximum with masks and protective equipment for everyone. The other critically ill patients who remained in the clinic had to wait until the next morning.

In the next 72 hours, our team performed five bowel movements for a total of 36 patients. This cleared the Pieri clinic, improving access to medical services for the rest of the local community. For evacuated patients it meant going from being cared for in a clinic to a tukul of mud to a hospital with an operating room, surgeon and anesthetists.

Back to normal

The first days were hectic. Hundreds of armed youths from the local community were returning to the area after the fighting, bringing with them thousands of cattle that they had captured during the attacks. They celebrated his arrival with gunfire day and night.

After a week, the situation began to return to normal. People returned to work, the sounds of gunfire stopped. As the effervescence waned, we took the opportunity to visit the villages around Pieri to assess people’s living conditions and their access to medical care after the previous attacks in May.

It is rainy season, which means walking in water and mud, sometimes knee deep. The living conditions for the population are extreme.

After fleeing the May attacks, some people returned to the area to cultivate the land only days later. Others had returned only a day or two before our visit, feeling more secure with the return of the local armed youth.

All the people we spoke to shared the same concern: fear of retaliatory attacks that could occur within a couple of months with the end of the rainy season, if not sooner.

The impact of violence goes beyond the gunshot wounded

Although we never saw the “hundreds more injured” announced in the first reports, some of the young people never returned to Pieri. Perhaps they died from injuries or illnesses like malaria along the way, or wandered off to other places in the area.

Peaks of violence like this have been repeated in Jonglei and Greater Pibor during 2020, with devastating effects on the community that loses access to health care, food, housing, livelihoods and education. In addition, treating the injured makes it difficult to respond to acute and chronic illnesses.

* The patient’s name has been changed to protect his anonymity.

Jean-Nicolas Dangelser He is the Emergency Coordinator for Doctors Without Borders (MSF) in South Sudan.

The section First line is a space in Planeta Futuro in which members of NGOs, international organizations and institutions, who work in the field, narrate their personal experiences in relation to the impact of their activity. They are always written in the first person and the responsibility for the content rests with the authors.

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