Doctors Without Borders

Doctors Without Borders/Medecins Sans Frontieres (MSF) is an international medical humanitarian organization that assists people whose survival is threatened by violence, neglect, or catastrophe. Its mission is to provide medical relief to the victims of war, disease, and natural or man-made disaster, without regard to race, religion, or political affiliation. The organization's work is based on the humanitarian principles of medical ethics and impartiality. MSF does not take sides in armed conflicts, provides assistance on the basis of need alone, and advocates for independent access to victims of conflict and other disasters.
Jul 28, 2016

Final Report on 2014-2015 Emergency Relief Fund

Your donations helped Doctors Without Borders/Médecins Sans Frontières (MSF) respond to a variety of neglected emergencies.

As MSF teams ran our ongoing projects around the world, they responded to humanitarian emergencies caused by internal conflicts across South Sudan, Yemen, Central African Republic, and Syria, the latter of which resulted in refugee crises in Jordan and Iraq. These programs were made possible, in part, by support from the Emergency Relief Fund.

Thank you for your support and very generous commitment to the Emergency Relief Fund, which enables MSF to launch programs based entirely on need.

2015 Emergency Relief Fund Projects

SYRIA: THE WORLD’S WORST HUMANITARIAN DISASTER

The suffering of the Syrian people is immeasurable: as the bitter conflict continues, millions of people are enduring the direct consequences of war, as well as being forced to leave their homes and belongings.  At least 220,000 people have been killed and over half the country’s population—a staggering 12 million people—have fled their homes.  At least 670 Syrian medical workers have been killed, and thousands have been kidnapped or displaced by violence, leaving a massive gap in medical expertise inside Syria.  As a result, hundreds of thousands of people are living in besieged areas inside the country, with extremely limited access to healthcare. 

MSF has been running programs inside Syria since the war began in 2011. By 2013, we were running six hospitals in opposition-held areas.  Due to an increasingly insecure environment, MSF international staff can no longer work inside most of Syria so MSF is managing its facilities in Aleppo and Idlib remotely with international teams based in neighboring countries.  A small number of international staff, however, are able to work safely at our programs in northeast Syria. 

The 27-bed Aleppo hospital run by MSF Syrian staff offers a wide range of services including outpatient and inpatient consultations, surgical care, an emergency room, and a maternity unit. In addition the MSF team provides mental health care, and can refer patients to other structures if they cannot be treated in the MSF hospital.

In Idlib, MSF is running the only burn unit in northern Syria where people can get the specialist care they need, such as skin grafts, dressing changes performed in an operating room under anesthesia, physiotherapy, and post-operative care.  MSF’s 15-bed burn unit is staffed by Syrian medical professionals and supported by an international team in southern Turkey.  In Hasakah, in northeast Syria, MSF runs several health clinics that offer primary health care services. 

Inside the Kobane Canton area of northern Syria, which is administered by the interim Kurdish government, MSF has worked alongside Kobane public health staff since March 2015.  We are re-establishing basic health facilities and vaccination services, providing outpatient health care, and creating mental health support programs.  

In addition to these projects, MSF has been supporting a growing number of medical structures in government-held and opposition-controlled areas throughout the country, with a particular emphasis on structures in areas under siege.  By October 2015, MSF was actively supporting more than 150 medical structures which vary from small rural health posts to full hospitals in urban areas.  The supported structures are located throughout the country, including Idlib, Aleppo, Homs, Hama, rural Damascus, and Deraa in the south.  Through all of these programs, we are reaching millions of people caught in one of the worst conflicts of our time. 

Outcomes at MSF programs in Syria in 2015 include:

  • Conducted 23,010 outpatient consultations, 1,069 inpatient consultations, 11,251 emergency room treatments, and 900 surgeries at Aleppo Hospital through August 2015.
  • Provided 18,000 consultations at MSF clinics in Hasakah between January and June and supported a maternity clinic that conducted 571 deliveries. 
  • Carried out 11,800 consultations at MSF clinics in the Kobane Canton area of northern Syria from March through September.
  • Supported the local health authorities in providing measles vaccinations and vitamin A for 5,776 children in August.
  • Received requests for fuel from a number of hospitals in northern Syria and donated more than 1,600 gallons to 15 health structures and ambulance networks in Aleppo, Idlib and Hama governorates.
  • Supported more than 150 medical structures throughout Syria, donating medical supplies and essential relief items and providing weekly distance training and technical medical advice to directors of makeshift hospitals. 

ASSISTING SYRIAN REFUGEES IN JORDAN AND IRAQ

MSF is caring for hundreds of thousands of refugees in Jordan, Lebanon, Turkey, and Iraq, where more than four million Syrians have sought refuge from the ongoing war.  To lessen the refugee burden on health systems of Jordan and Iraq, MSF has established a number of projects that perform surgery, treat non-communicable diseases, and offer maternal, pediatric, and mental health care.  Because more than three-quarters of the Syrian refugees are women and children, the majority of our programs focus on providing women and children with access to medical care. 

MSF’s Reconstructive Surgery Project in Amman, Jordan’s capital city, was established in 2006 to offer orthopedic, maxillofacial and plastic surgery, as well as physiotherapy and psychosocial support to victims of violence in the region.  As the conflict in neighboring Syria escalated, the number of Syrian patients increased, and today, more than 50 percent of patients are Syrian.  MSF renovated a new hospital for the project in Amman and moved to the new structure in August 2015, which has allowed our teams to improve quality.  Since the project began nine years ago, MSF’s Reconstructive Surgery team in Amman has conducted 8,238 surgeries.

For the past two years, MSF’s Emergency Surgical Program inside the Al Ramtha Government Hospital has been offering life-saving trauma surgery for patients injured in the Syrian conflict.  Located just a few miles from the Syrian border, the project has had more than 1,850 war-wounded patients arrive from Syria.  Around 75 percent of these patients were suffering from poly-trauma resulting from blast injuries. 

The northern Jordanian governorate of Irbid has one of the highest concentrations of Syrian refugees.  Following assessments in 2013, MSF established a maternal health and pediatrics hospital in this northern town, close to the border with Syria.  The project offers free obstetric and neonatal care, prenatal and postnatal care, inpatient and outpatient pediatric care, as well as a pediatric mental health program.  The urgent need for these services has increased as Jordanian authorities have decided that all Syrian refugees, whether registered or not, would have to pay for health care. 

The Kurdish Region of Iraq has been hosting the vast majority of the 251,000 Syrian refugees currently in Iraq.  Despite the overwhelming crisis affecting Iraq today, some international humanitarian organizations are scaling down their assistance to Syrian refugees in the country. 

Since May 2012, MSF has been the main provider of health services to Syrian refugees in Domiz refugee camp, including primary and reproductive health care, chronic diseases and mental health support.  MSF also offers emergency services and referrals to Dohuk hospital.  MSF also provides mental health services in two refugee camps in Erbil governorate – Kawargosk camp and Darashakran camp.

Outcomes at MSF programs in Jordan and Iraq in 2015 include:

  • Carried out more than 2,900 surgical interventions at MSF’s Emergency Surgical Program at Al Ramtha Government Hospital over the past two years.
  • Established a 40-bed post-operative care facility in the Zaatari refugee camp to treat patients discharged from MSF’s Al Ramtha trauma surgery project.  Between January and September 2015, 133 patients received medical treatment at the facility and around 400 psychosocial support sessions were conducted.
  • Upgraded the Irbid maternal health and pediatrics hospital with an intensive care unit and the ability to manage complicated deliveries and perform C-sections.
  • Opened two new clinics in Irbid governorate to treat Syrian patients and vulnerable Jordanians with chronic health conditions, such as hypertension, diabetes and asthma.  By the end of September 2015, there were 2,893 patients under treatment in the two clinics.
  • Carried out 63,314 consultations in Domiz refugee camp in Iraq and delivered 660 babies at the MSF-run maternity unit between January and June 2015.

EMERGENCY PROGRAMS IN SOUTH SUDAN

MSF is committed to providing lifesaving medical care in South Sudan, offering aid to people affected by conflict, as well as to many others who lack of access to medical care. Healthcare in South Sudan was already weak before the recent waves of violence started.  Now the coping mechanisms of hundreds of thousands of people are stretched to the breaking point. 

Since the beginning of April 2015, clashes in Upper Nile state have displaced tens of thousands of people who have sought sanctuary at a United Nations Protection of Civilians camp in Bentiu.  By the end of the year, the camp population had doubled to an estimated 110,000 people.  The increasing numbers of displaced people, however, is straining the few existing resources, including the MSF hospital at the camp, which is nearing full capacity. 

Teams treated a significant increase in malaria cases in the camp in Bentiu over the summer.  To handle the increase, MSF opened six new health facilities in the camp, providing care to as many as 4,000 malaria patients on a weekly basis.  To limit the complications of severe malaria, MSF provided immediate access to diagnostics and treatment, screening over 30,000 children under five and providing treatment to 16,000. 

Rising violence against civilians in southern Unity State is depriving the population of shelter, food, and medical care.  As the conflict intensified, violence against the civilian population escalated.  MSF teams in southern Unity State hear daily reports of extortions, abductions, mass rapes, and killings, and have witnessed villages burnt to the ground and crops looted and destroyed.  MSF has not seen this level of violence and brutality before.  An MSF compound in the town of Leer was looted on October 3rd, forcing MSF's Leer hospital to close for the second time since May.  MSF's staff was forced to evacuate, leaving vulnerable people in the surrounding areas without medical care, food support, or other assistance.

Outcomes at MSF programs in South Sudan in 2015 (through October) include:

  • Ran one of MSF’s largest programs in the world with MSF teams, made up of more than 3,200 South Sudanese staff and 350 international staff, at 18 projects across South Sudan. 
  • Provided outpatient care to 532,000 people, including 198,000 children under the age of five, and assisted in the delivery of 10,255 babies.
  • Hospitalized nearly 32,000 people in our inpatient facilities, including 11,738 children under five years old, performed 8,574 surgeries, and treated over 4,776 people with war wounds. 
  • Treated nearly 11,000 severely malnourished children, including 4,042 with complications who were so sick that they needed 24-hour care in our inpatient feeding centers.
  • Treated 151,681 patients with malaria, and responded to a severe outbreak in the Bentiu camp from July to October. 

WAR SPREADS TO YEMEN

The humanitarian crisis in Yemen grows more catastrophic each day. While the political struggle unfolds, civilians are caught in the crossfire and the population is suffering enormously.  The conflict in Yemen currently has the country divided between the Houthi movement which controls the north of the country and an anti-Houthi coalition based mainly in the South.  A coalition of mainly Gulf States led by Saudi Arabia started airstrikes against the Houthi in late March.  Fighting and indiscriminate airstrikes have harmed civilians, medical facilities, and critical infrastructure, disabling the only international airport.  The UN reports that in the first month of the airstrikes, at least 1,000 people were killed, over 4,350 were injured, and 150,000 fled their homes. 

Huge humanitarian needs exist on the ground in Yemen, and MSF is working nonstop to meet some of these needs through a variety of new emergency programs.  MSF currently works in Aden, Al-Dhale’, Taiz, Sa’ada, Amran, Hajja, Ibb, and Sana’a.  A total of 790 MSF staff are currently working in the country, including 64 international staff. 

MSF is running an Emergency Surgical Hospital in Sheikh Othman district, in the north of the city of Aden.  MSF is also providing mental health care and physiotherapy in the hospital. Victims of landmines and unexploded ordinances have been increasing since August (more than 60 cases between mid-August and late October).

In the southern part of Aden, MSF started working at an emergency clinic in April, where MSF staff provided trauma care and treated more than 1,200 wounded patients in the emergency room.  Between May and July, MSF had outpatient mobile surgical clinics in the health centers of Enma and in Al-Sha’b districts to provide outpatient care to surgical patients who could not get to the MSF hospital.  More than 1,220 war wounded were provided surgical follow-up consultations and wound dressings.  As movement is easier now, MSF is receiving these patients in its hospital in Aden, but is still providing drugs and dressing materials to the health centers.

Since the beginning of May 2015, MSF has been providing emergency medications and surgical supplies to five hospitals in Taiz.  During this period, MSF set up and equipped three extra emergency rooms at Al-Rawdah Hospital to allow extra space for handling mass casualties, while continuing to support the hospital’s main ER with supplies and staffing.  MSF has four medical doctors and one nurse working in the ER of Al-Rawdah Hospital.  The team also set up a hospital-to-hospital referral system with two ambulances.

  • Delivered more than 400 tons of medical supplies to MSF-run and supported facilities in Yemen.
  • Treated more than 15,500 war-wounded patients since March 2015, including 3,800 at the emergency room of Al-Rawdah Hospital, where MSF has been working since May
  • Performed more than 4,662 surgical interventions and received 6,478 war wounded at MSF’s surgical center in Aden from the beginning of 2015 through November.
  • Received 36,710 patients in the emergency room, including more than 2,000 war wounded, at MSF projects in Al-Dhale’ from March to November.
  • Opened a maternal and child health project in November in Taiz governorate, where many health facilities are closed or overloaded. 

RESURGENCE OF VIOLENCE IN CENTRAL AFRICAN REPUBLIC (CAR)

Renewed outbreaks of intercommunal violence have kept the population of CAR on edge in recent months.  The worsening situation also means that about 450,000 people who were displaced by violence, along with a similar number of refugees who fled to neighboring countries, have little hope of returning home due to continued religious tensions.

In September, violence erupted in the capital city of Bangui prompting thousands of people to seek refuge in camps for displaced people.  Many people in the camps have witnessed shocking scenes of violence and have had their homes pillaged and looted.  The families already living in refugee camps are now hosting even more people, especially in the Mpoko Camp, near Bangui Airport.  MSF runs a health structure in the camp and reinforced water, hygiene, and sanitation services to handle the increase in the population.  Many health centers in Bangui were closed due to the violence in the city, forcing more people to seek care at MSF’s health center in the Mpoko camp. 

Shortly after the outbreak of violence, MSF teams set up mobile clinics in five camps across town. These mobile clinics received more than 1,000 patients per week, mainly for malaria and respiratory infections.  MSF also conducted a measles vaccination campaign for children six months to ten years of age living at 12 sites, including all MSF sites and the Central Mosque in the Muslim enclave of PK5, where MSF runs a mobile clinic once a week. Throughout the unrest, MSF continued to receive patients in the general hospital, provided maternal care at Castor maternity, and supported the Mamadou Mbaiki Health Center.

Outcomes at MSF programs in CAR in 2015 include:

  • Ran programs in Bangui and 15 other locations across the country using than 300 international and over 2,000 Central African staff—the third-largest MSF program and nearly doubling its staff since 2013.
  • Provided more than 400 consultations daily in Mpoko camp during the unrest and assisted with 42 deliveries per week.
  • Delivered care to residents of Benzvi camp using a mobile clinic that saw around 150 patients per day, mostly patients seeking care for malaria, respiratory infections, and diarrhea, diseases that stem from the deplorable conditions in the camp.
  • Ran a water pumping and purifying station to deliver purified water to a number of camps.
  • Vaccinated close to 10,000 children in the Gadzi area, west of the capital, in two weeks after several cases of measles led local authorities to raise the alarm. Nearly 1,000 young children—including about 700 babies under six months old—were also vaccinated against pneumococcal disease.
  • Performed emergency surgery and trauma care for adults (3,276 surgeries between January and September 2015 in Bangui) and cared for 556 victims of sexual violence.
  • Provided assistance for the displaced in the Mpoko camp and in the Muslim enclaves of Carnot, PK5, and Bambari, and started mobile clinics for newly displaced persons in seven new sites in the city following the violence in September 2015.
  • Continued MSF’s regular programs focused on malaria, HIV, tuberculosis, immunization and maternal and child health, and performed more than 15,000 deliveries in 2015.

ONGOING ATTACKS IN BORNO STATE OF NIGERIA

In northeast Nigeria's Borno State, fighting between the Nigerian government and the Islamic State’s West-African Province (ISWAP), formerly known as Boko-Haram, is having drastic consequences on the health and wellbeing of civilians.  People have fled their homes out of fear or from direct attacks by ISWAP, whose brutality has driven roughly a million people into Maiduguri, the capital of Borno State, and another 600,000 people to other parts of Borno state.

In late December 2015, the Islamist militants launched a large-scale attack in Maiduguri and a wave of suicide bombings were carried out the following day.  Responding to the high numbers of people wounded in these attacks, an MSF team working in Umaru Shehu Hospital in Maiduguri began performing trauma surgery and treated about 40 patients, including seven critical cases, over three days.  Our team was struck by the number of children with shrapnel wounds. 

The MSF team began working in the emergency room at Umaru Shehu hospital in September, treating patients referred from smaller health structures and providing care to people wounded during attacks.  MSF set up a surgery program at the hospital, provided essential medicines and medical materials to the hospital, refitted the operating theater, and set up a mass casualty plan. 

MSF teams in the city also offer primary health care, maternal health care, nutritional care for severely malnourished children, epidemic and health surveillance, and water and sanitation activities.  While 90 percent of the displaced live in the community, 100,000 of them are spread across ten camps in the town.  MSF is providing health and epidemiological monitoring in all of Maiduguri’s camps, hygiene and sanitation in seven of them, and medical care in two camps. 

The authorities in Borno plan to close down several of Maiduguri’s camps and house the displaced in six locations, all located in the capital.  Once the total number of camps drops to six, MSF will continue to ensure comprehensive health monitoring, as well as medical, hygiene, and sanitation activities at two of the sites, and will continue our work in two clinics and at Umaru Shehu hospital.

Outcomes at MSF programs in Nigeria in 2015 include:

  • Received about 200 patients per week in the Umaru Shehu hospital's emergency room since opening the project in September and treated 20 patients (including 6 children and 11 women) wounded by suicide attacks on October 1.
  • Provided emergency medical and logistics services to fight a cholera outbreak in the camps for displaced people in Maiduguri, which began in August. From September 10 to 15, 187 patients were admitted to MSF's cholera treatment center.
  • Improved hygiene and sanitation in three camps affected by cholera, including chlorination of water sources, provision of chlorine solution for hand-washing, and home disinfection once a case was identified.
  • Working in the host community in the former Boko Haram strongholds of Maimusari and Bolori II and opened clinics in both towns, where teams conduct outpatient consultations and deliver maternal health and nutrition services. 

Conclusion

Last year, MSF teams provided medical and humanitarian aid to vulnerable people all over the world—in conflict zones, refugee camps, reception centers, urban slums, and rural villages.  MSF’s financial independence is critical to our ability to respond immediately and solely based on needs, and support for the Emergency Relief Fund makes this possible.  The Lloyd A. Fry Foundation helped MSF to continue this vital work, and MSF thanks the Foundationfor its very generous support. 

Jul 28, 2015

Wounded Syrians Fleeing Barrel Bombs

Over the past two weeks, more than 65 war-wounded Syrian patients—most injured by barrel bombs—arrived at the emergency room of Al-Ramtha hospital in northern Jordan, marking a significant spike in the number of patients treated there by Doctors Without Borders/Médecins Sans Frontières (MSF).

In late June, 34 wounded Syrian patients arrived in just three days. Some were stabilized by MSF medical teams and referred to other hospitals. The rest continue to receive surgical and rehabilitative treatment at Al-Ramtha hospital, which sits about three miles from the Syrian border, and where MSF works in close collaboration with the Jordanian Ministry of Health to provide quality medical care to Syrian patients.   

"More than 70 percent of the wounded we receive suffer from blast injuries, and their multiple wounds tell their stories," said Renate Sinke, project coordinator of MSF’s emergency surgical program in Ramtha.

MSF and many other organizations have called repeatedly for an end to the bombing of populated areas inside Syria. These calls have had no impact. Patients of all ages continue to arrive at Al-Ramtha hospital in large numbers with injuries that they say were caused by barrel bombs dropped by helicopters on residential areas and health structures in southern Syria.

There have been reports of health facilities coming under attack in Syria’s Dara'a Governorate in the past two weeks, leading more Syrian patients to risk the dangerous trip across the Jordanian border, seeking medical care that has become extremely difficult, if not impossible, to access in their home country. Many hospitals inside Syria now lack the personnel, medical expertise, or equipment to deal with highly complex injuries.

"A significant proportion of the patients we receive have suffered head injuries and other multiple injuries that cannot be treated inside southern Syria, as CT-scans and other treatment options are limited," said Dr. Muhammad Shoaib, MSF medical coordinator in Jordan.

One recent patient at Al-Ramtha Hospital was Majed, a 27-day-old baby with a head injury caused by shrapnel from a barrel bomb.

Majed's father, Murad, gave the following account:

"At 9:00 a.m., a barrel bomb hit our house in Tafas. I was not around at that time. I have to work to feed and take care of my family. When I heard the news, I dropped what I was doing and I ran to the house as fast as I could.

"I found my wife and mother both injured, but their injuries did not look too severe. Then I saw my little boy. He was quiet and his head seemed to be injured. I took him to the field hospital in Tafas. They tried to help him but couldn't, since the appropriate equipment is not available in Syria. He needed to go to Jordan for treatment.

"It took us one-and-a-half hours from the time of injury until we arrived at the border, and some more before arriving in Ramtha. Now, all I want is for my baby to be better and go back to Syria."

Since the Syrian conflict began, more than four million Syrians have sought refuge in neighboring countries, including Jordan. MSF has been present in Jordan since August 2006, running a reconstructive surgery program in Amman. Since 2013, MSF has been working to support refugees and patients through the Al-Ramtha emergency trauma surgical program, as well as a mother and child hospital and two noncommunicable disease projects in Irbid to support Syrian refugees and vulnerable Jordanians in host communities.

May 11, 2015

Perpetual Displacement as Conflict Continues

Beatrice Debut/MSF
Beatrice Debut/MSF
Continuing violence in South Sudan’s Upper Nile State is leading to more death and displacement.

Many of those affected are already been displaced and living in dire conditions. In Malakal, more than 6,600 people have fled their homes to seek shelter at the United Nations Protection of Civilians (PoC) base. Meanwhile, in Melut, a town north of Malakal, more than 1,665 families have sought refuge across the Nile River since the beginning of April.

MSF has repeatedly called on all parties to the South Sudanese conflict to allow for necessary humanitarian access to all parts of the country.

The security situation in Upper Nile remains unstable. Mistrust between communities leads to clashes, with profound humanitarian consequences. People are constantly on the run, but the areas to which they flee do not offer favorable living conditions. In states like Upper Nile, some people have been forced to flee so many times that they no longer have a place to call home.

This new wave of displacement, sparked by clashes at the beginning of this month, is putting pressure on the capacity of humanitarian agencies currently working in the area. A total of 26,500 internally displaced people have sought shelter at the UN base in Malakal since the beginning of the conflict in December 2013.

The new arrivals are living in big tents, with dozens of families sharing quarters and sleeping on the floor. MSF continues to provide medical services at the UN base hospital. Other agencies are on site to ensure sufficient water supply and proper sanitation, but the increasing numbers of displaced people is straining the few existing resources.

"The rainy season is just setting in and with the congestion in the PoC, we have started to see open defecation, long queues at water points due to low water quantity and pressure," said Juan Prieto, MSF head of mission in South Sudan. "Cases of acute diarrhea are increasing, so we are reinforcing our surveillance measures to ensure that outbreaks are prevented. Last year, MSF launched a cholera intervention and vaccination campaign in the camp, and we are ready to replicate actions if needed. However, we are afraid that if fighting continues, there will be more displacement, further congestion in the PoC, and a deterioration of health and general living conditions."

In Melut, more than 1,665 families—mostly ethnic Shulluk, who were previously displaced and living in a camp—have fled to the west side of the Nile, most to the Noon area. These families are living under trees, with extremely limited access to latrines. They must travel long distances to fetch water from the Nile that, unless treated, is not safe to drink. Other families are scattered all over the west bank of the Nile in Kaka, Kuju, and Toruguang Payams, some 80 kilometers (approximately 50 miles) away from Melut. With no shelter either, the food stocks families managed to salvage when they moved are dwindling.

"The biggest problem is water," said 17-year-old Teresa, a Shilluk who recently fled to Noon. "I have to go to the Nile three to four times a day. It is a 25-minute walk each way. We are worried for our lives and for the future, if we survive."

MSF is supplying each family with water treatment kits, as well as transporting food and non-food items by speedboat and donkey to families scattered in different parts of Noon. MSF also regularly conducts mobile clinics with outpatient and emergency room services for the population in Noon, referring acute medical cases to health facilities in the towns of Melut and Kodok.

In Melut, MSF treats an average of 150 patients a day for diseases like measles, acute watery diarrhea, and respiratory tract infections. However, due to continued fighting in the area, MSF is sometimes forced to suspend its activities as a preventive measure, leaving the population in an even worse position.

"The people here have been on the move since the war started," said Joao Martins, MSF project coordinator in Melut. "They have nowhere to call home anymore, as insecurity has made them nomads, moving from one place to another in search of safe havens to stay. Whenever clashes start, they are prompted to move. Children under the age of five years and pregnant women are especially vulnerable during these times."

As more people are displaced, some to remote areas where they have hardly anything to live on, MSF calls upon all armed groups to facilitate the free movement of humanitarian assistance and personnel to all parts affected by the South Sudanese conflict.

MSF has been working in the region that today constitutes the Republic of South Sudan since 1983. MSF responds to emergencies, including large-scale displacement, refugee influxes, alarming nutrition situations, and peaks of diseases such as measles, malaria, acute watery diarrhea, and kala azar, in addition to providing basic and specialized health care services.

Since conflict began in South Sudan in December 2013, two million people have been displaced from their homes. Some live in camps, while others have fled across the border to neighboring countries of Kenya, Uganda, Ethiopia, and Sudan.

 
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