Treating Global Childhood Malnutrition

Since the beginning of April , Simon, his wife, and their six children have been sleeping under a tree in a tiny village called Noon, 25 minutes away from the Nile river by foot. They spend the night on floor mats, among the few belongings they managed to save while fleeing Melut, the town on the other side of the river. Living outside is nothing new for 41-year-old Simon; he has had to move over and over again.

Since March 2014, this Shilluk family has been on the move, fleeing fighting and ethnic tensions in Upper Nile State, South Sudan. When the conflict erupted in December 2013, Simon was living in Panyikang County, in the southern part of Upper Nile State. He was the headmaster of Dolieb Hill Combine Primary School, where 1,200 children studied.

"When the war started, my family and I had to flee," said Simon. "We left everything behind us and walked for two months. At night, we would sleep under trees. If we came across a school, we would sneak in and sleep there. We survived on food given by NGOs, some relatives, and friends we met along the way. Sometimes, I caught some fish in the river. It took us two months to reach Melut [in the far north of Upper Nile state]."

In Melut, an hour’s drive from the oil fields of Upper Nile, Simon settled in a camp called Hai Soma, populated mostly by people from the Shilluk tribe. "I spent a lot of energy building a nice tukul [a traditional hut made of grass and mud]. We were planning to stay."

His plan was cut short in early April, when clashes erupted in Upper Nile. "People were carrying guns near our camp," he says. "We feared for our lives. Everybody in the camp started to flee to the other side of the Nile, to Shilluk territory. We could not stay in the camp alone, we had to move."

In this part of Upper Nile, the river is a natural border between traditional Shilluk land and Dinka land. There are now barely any Shilluk left in Melut. The few who remain live in fear of being attacked. Simon crossed the Nile in a traditional boat after paying three South Sudanese pounds for each of his seven family members and himself.

"We took some pots and rugs with us, and that was it, it was all we could carry." They then walked to Noon and chose a tree big enough to protect them from the sun during the harsh sunny days. About 1,600 other Shilluk families are living under trees, in the same dire conditions.

"We are going to run out of food very soon," Simon said. "I don't know what we are going to do. The other problem is water. We have to walk 25 minutes to fetch water from the Nile. Old people and the blind can't go. The water is not safe for drinking. The rainy season is coming. We don't have time to build a tukul. We need some wood, plastic sheets, and ropes to build shelters before the rain starts in May. We also don’t have enough blankets."

Last week, Doctors Without Borders/Médecins Sans Frontières (MSF) distributed 25 sachets of water purifiers and 30 sachets of therapeutic food per person. These supplies should help the displaced people for about 25 days, before the next distribution takes place.

Simon is now working as a community health worker for MSF. But he wishes he could go back to his beloved job. "I miss teaching. I miss my colleagues. Some are dead, some are soldiers."

Life has taken a different turn than he expected. For now, Noon is his home but he cannot say about tomorrow, when he and his family might have to move once again.

Starting in February 2014, Doctors Without Borders/Médecins Sans Frontières (MSF) has been providing medical assistance to more than 30,000 South Sudanese refugees who fled their homes and sought sanctuary in Sudan’s White Nile state. Most came from Upper Nile state, which borders Sudan to the southeast, part of the large population of South Sudanese who’ve been displaced from their homes, fearing for their lives, since conflict erupted in their homeland in December 2013.

Working with Sudan’s Ministry of Health, MSF is providing medical care and nutritional support to refugees in White Nile State. To date, teams have conducted more than 36,174 consultations and vaccinated 2,333 children under 5 years old for polio and 8,566 children under 15 for measles (following a positive diagnosis). This preventive care approach has helped curb disease outbreaks in the area.

“Most of those arriving are women, children and the elderly,” says Dr. Amir Osman, MSF medical team leader in White Nile State. “They are coming on foot or by public transport. Since some of them are in poor health and nutritional condition, we are conducting medical consultations and nutritional screening on arrival. Severely malnourished children are immediately enrolled into the therapeutic feeding program, while supplementary food is provided for those moderately malnourished.”

Currently, there are 3,230 people enrolled in MSF’s therapeutic feeding program. They receive regular medical check-ups and supplementary food, particular attention is paid to malnourished pregnant and lactating women. Thus far, MSF has conducted 2,111 antenatal care consultations and assisted 152 safe deliveries.

Most of those in White Nile come from the towns of Waddakona, Kaka, Al-Renk, Malakal. All left due to insecurity. Some managed to salvage a few of their possessions while others left with nothing. “I walked for three days from Waddakona, Upper Nile State to North Kweik, in Sudan, where I had to sell my cows, sheep and goats to get money for other necessities,” says one woman. “I used to be a government employee and self-dependent, now I’m in another country and dependent on aid.”

Most people entered Sudan through the western area of the Nile and settled around Um Jalala, an area commonly known as “Kilo 10.” They’ve since been relocated to three transitional areas, namely Jorai, El Kashafa and El Rades. Others entered from the eastern side of the Nile settled in an area called Al-Alagaya.

These areas are near the Nile, which facilitates water transportation, which is crucial during the rainy season when roads become impassable and only boats can be used to transport patients with complicated medical cases to hospitals in Kosti. In the El Kashafa area, MSF has constructed a 20-bed clinic to be able to respond rapidly to critical cases while using mobile clinics to reach those in the two other transitional areas in the vicinity.

The medical needs of the population are apparent; on average, MSF conducts some 4,300 consultations per month and refers about 15 cases to Kosti. Moreover, living conditions are very congested, with six or seven people living in Tukuls (huts) meant for three or fewer. The congestion increases the spread of communicable diseases—respiratory tract disease, in particular—one of the main illnesses that MSF teams in White Nile are treating. To prevent the spread of communicable diseases and diseases associated with water, hygiene and sanitation, MSF has identified groups of community health workers to carry out health education activities.

Heavy rains have likely prevented some people from coming into Sudan, as most people cannot cross the river when it floods. However, whenever renewed violence erupts in parts of South Sudan bordering Sudan, numbers automatically go up. Despite the border that divides them, the commonalities and mutual relations between those arriving and the host communities have allowed the two populations to coexist peacefully.