Around 150,000 South Sudanese have fled to Ethiopia since conflict broke out in the world’s youngest nation in December.  Nine out of ten of the arrivals are women and children who often walk for weeks to reach safety.

“It’s a massive emergency,” Antoine Foucher, MSF’s head of mission in Ethiopia, told Thomson Reuters Foundation by phone.

“One child out of ten coming into our hospitals is actually dying for a variety of reasons ranging from late referrals to very bad health status that is practically not curable.”

The refugees are fleeing hunger as well as conflict, with food becoming increasingly scarce in South Sudan.

Fighting between government forces and rebels has driven 1.5 million South Sudanese from their homes and left 3.5 million, or a third of the population, suffering acute or emergency-level food shortages, the United Nations says.

FIGHTING OFF ILLNESSES

One in four of the children who arrive in Ethiopia are malnourished, Foucher said. In this weakened state, it is difficult for their bodies to fight off illnesses such as measles, diarrhoea and respiratory infections.

The start of the rainy season will aggravate the situation, worsening sanitary conditions and the incidence of malaria.

“It’s a race against time,” said Foucher. “We have a one month window of opportunity… to bring the conditions up to standard if we want to avoid a catastrophe on the catastrophe.”

MSF has two hospitals treating the refugees. In Lietchuor camp, seven percent of the children who are admitted die. In their hospital in the town of Itang, 10km from Kule camp, the death rate is 18 percent.

Ethiopia was home to just 50,000 South Sudanese refugees before the war erupted. Aid agencies have been struggling to cope with the sudden influx, which has been as high as 15,000 arrivals per day.

The population of the camps could reach 350,000 by the end of the year, the United Nations refugee agency has said.

TRANSIT CAMPS

New arrivals sometimes have to wait up to a month at transit sites before being resettled in the permanent camps, about 50km away.

“This period is naturally very critical because this is the moment when they do need the most intensive care,” said Foucher.

“MSF teams provide medical care in these transit camps, treating the children, some of whom die within the first days following their arrival.”

Conditions in the camps are little better, with half of the refugees living under plastic sheeting and a severe shortage of water and latrines.

“After several weeks in the camps, where living conditions are very precarious, they do not get any better,” MSF said, highlighting the prevalence of diarrhoea and pneumonia among hospitalised children.

In humanitarian emergencies, people are supposed to receive 20 litres of water per person per day. At the Burubiey transit centre, it is only seven litres.

Each latrine should be shared by a maximum of 20 people. At Kule 1 camp, MSF said, there are 288 people per latrine.

“If the situation is not improved – in terms of water supplies, in terms of latrines availability, in terms of shelter – then the medical unit that has been deployed by MSF will only be able to tackle the consequences,” Foucher said.

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by Katy Migiro

PHOTO: Children displaced by the fighting in Bor county, stand on the side of a boat in Awerial county, Lakes state, in South Sudan, January 15, 2014. REUTERS/Andreea Campeanu

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Central African Republic has descended into chaos since the mainly Muslim Seleka rebel coalition seized power a year ago. Its abuses on the majority Christian population triggered waves of revenge attacks, leading to thousands of deaths and displacing hundreds of thousands of civilians, including the majority of the country’s Muslims.

The Chadian troops were escorting the last 540 Muslim residents of the northwestern town of Bossangoa to Gore in Chad when militia attacked the convoy at night on April 11 as it passed through Boguila, around 310 miles (500 km) north of the capital Bangui.

The Chadian soldiers fought back, and three wounded were later admitted to MSF facilities in Boguila and Paoua.

“We witnessed the majority of the population fleeing in panic to the bush,” Stefano Argenziano, MSF head of mission in the country, said in a statement on Tuesday, estimating that around 7,000 people were displaced in the clash.

“We are worried that the gun battle may have resulted in more people being injured. For the moment we cannot access the area to verify if this is the case and evacuate the wounded,” Argenziano said.

The United Nations said earlier this month it was trying to urgently evacuate 19,000 Muslims from Bangui and other parts of Central African Republic who are surrounded by anti-balaka Christian militia threatening their lives.

Chadian troops, at the heart of African efforts to stabilise the country, have escorted convoys carrying tens of thousands of Muslims.

N’Djamena began withdrawing its troops from Central African Republic’s African Union peacekeeping mission, known as MISCA, earlier this month, however, following a series of violent incidents including an attack on a market that killed 30 civilians.

MISCA officers confirmed on Tuesday that Chad had competed its withdrawal and the AU mission and soldiers from a French intervention force had replaced them.

“They left with all their kit without waiting to be relieved,” said a MISCA commander whose Congolese troops had replaced the Chadians in the towns of Kabo and Batangafo.

The United Nations Security Council last week authorized the creation of a nearly 12,000-strong U.N. peacekeeping force in the Central African Republic in a bid to end the violence. The U.N. operation will assume authority on Sept. 15 from the 5,600-strong MISCA force.

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by Crispin Dembassa-Kette

PHOTO: Children stand during rain in front of Saint Michel Catholic church in the town of Boda, Central African Republic, April 14, 2014. REUTERS/Goran Tomasevic

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Despite the presence of international armed forces in the capital of Central African Republic (CAR), fighting, lynchings and violent attacks are still a daily occurrence in Bangui, and the situation in the city appears to be out of control.

Since early December, Médecins Sans Frontières (MSF) teams working in several surgical medical city projects have helped more than 1,000 victims of violence. Between 15 and 20 wounded people arrive each day at the Castor health center, where MSF teams have treated a total of 343 victims of violence since 7 December. At the Hôpital Communautaire, MSF teams are treating 15-20 wounded patients per day, and have provided care for a total of 648 victims of violence between 2 and 27 December. Some 428 of those patients were hospitalised; 368 had gunshot wounds and 128 had wounds caused by machete blades.

“We have been receiving more patients with serious injuries at the Hôpital Communautaire the last few days,” said Laurent Sury, MSF’s emergency coordinator in Bangui. “People are coming in with machete wounds to the head, hands and arms – injuries sustained as they tried to defend themselves. We’ve also seen people who have been stabbed, sometimes multiple times, in the abdomen, and people who have been either tortured or brutally beaten. We have even had a case of impalement. For the most part, these are young men.”

Violence hinders aid provision

Health facilities have also been affected by the violence, hindering the provision of medical aid. An armed man entered the MSF dispensary at Bangui airport on 24 December, while on the same day a man armed with grenades entered the Hôpital Communautaire. On 25 December, there was gunfire and large numbers of armed men in the vicinity of the Hôpital Communautaire, three of whom entered the building, and the teams had to temporarily evacuate the hospital.

On 29 December, a Ministry of Health ambulance was stopped and the ambulance staff were threatened with violence, preventing them from collecting the wounded. On the same day, armed men returned to the Hôpital Communautaire with the intention of lynching a number of patients, while Ministry of Health staff were threatened.

Although the situation was defused on each of these occasions, the security of patients has been repeatedly threatened.

Atmosphere increasingly tense

“The atmosphere is getting increasingly tense with each of these ‘visits’, as the attackers become more and more aggressive and angry,” said Thomas Curbillon, MSF’s head of mission in Bangui. ”It is totally unacceptable that health facilities are not being respected and are being invaded by armed people who constitute a threat to patients and staff. The insecurity and the gunfire in different areas, especially around the hospital, impede people’s ability to move around. It hinders us from reaching wounded people, and also hinders patients who want to reach medical care. The sick and the wounded do not have the timely and secure access to medical care that they need, when they need it.”

On 9 December, MSF called for an end to violence against patients and medical staff working in healthcare facilities in Bangui. Today, MSF reiterates its call to all parties to the conflict in CAR to allow the sick and wounded to receive the medical care that they need. MSF calls for an immediate end to violence against civilians, patients and medical staff working in healthcare facilities, in Bangui and in the rest of the country.

ABOUT MSF IN CAR:

MSF has been working in Central African Republic since 1997, and now runs seven regular projects in Batangafo, Boguila, Carnot, Kabo, Ndéle, Paoua and Zémio, and four emergency projects in Bangui, Bossangoa, Bouca et Bria. By the end of January, MSF hopes to initiate activities in hospitals and Bangassou Uango. In total, MSF is providing free medical care to about 400,000 people in the country, with more than 100 international staff and 1,100 local staff working in seven hospitals, two health centres and 40 health posts across the country.

> See this Doctors Without Borders article at its original location

The post (Doctors Without Borders) CENTRAL AFRICAN REPUBLIC: Civilians and hospitals affected by extreme violence in Bangui first appeared on MissionNewswire.

MSF said it had taken 11 months to procure affordable drugs to vaccinate children against pneumonia in Yida refugee camp in South Sudan due to bureaucratic and legal red tape.

It said it had obtained the vaccine from pharmaceutical firm GlaxoSmithKline to start vaccinating children in Yida camp and this should lead to a substantial cut in the number of deaths.

Sudanese refugees began streaming across the border into South Sudan in June 2011, fleeing conflict between the Khartoum government and rebels in South Kordofan.

Large numbers of children died in MSF’s hospital in the camp last year. Respiratory tract infections, such as pneumonia, were one of the main causes of death.

“The situation in Yida last year was excruciating, with children dying of diseases that vaccines could have protected them against,” Audrey Landmann, MSF project coordinator in Yida at the time, said in a statement.

Children in refugee camps are highly vulnerable to disease as they are often malnourished and living in overcrowded conditions with inadequate shelter, clean water or sanitation facilities.

The pneumococcal vaccine is a new vaccine, first introduced by the Global Alliance for Vaccines and Immunisation (GAVI Alliance) to Kenya in 2011. Pneumococcal disease, which can cause pneumonia, meningitis and sepsis, kills more than half a million people a year, half of them children under five.

BLIND SPOT

GAVI, set up in 2000, uses private and government donor backing to negotiate down vaccine prices for the developing world and then bulk-buy and deliver them to some of the world’s poorest countries.

It has made major strides in rolling out new vaccines in poor countries at affordable prices – but it does not cover vaccination in refugee and crisis-affected populations.

Pharmaceutical companies like Pfizer and GSK sell their new vaccines to GAVI at a discount but do not offer the same prices to medical charities like MSF.

MSF paid GSK $7 per dose for the vaccine, compared with the $3.40 a dose GAVI pays as a result of signing a 10-year deal with Pfizer and GSK to buy millions of doses of their patented pneumonia vaccine.

Three doses are needed per child.

“Why do we keep hearing the players in the global vaccination community tell us these kids aren’t their problem?” said Kate Elder, Vaccines Policy Advisor at MSF’s Access Campaign.

“We should be making every effort for refugee children to benefit from the newest vaccines, instead of letting them languish in the global community’s blind spot.”

FRUSTRATED

At the heart of the dispute is a difference in philosophy between GAVI’s development-oriented approach and MSF’s humanitarian creed.

GAVI is focused on building up governmental vaccination programs. It funds and supports governments to develop the health systems, staff and expertise needed to immunize their children over the long term.

The governments also pay a percentage of the price of the vaccines with a view to taking on the cost themselves in future.

“The whole idea is to build up their immunization system so that they can eventually do it themselves,” said a GAVI spokesman. “We don’t just parachute in when we feel like it and start immunizing kids.”

In contrast, MSF works in some of the world’s toughest humanitarian disaster zones where there is often no government presence at all.

In South Sudan, the fledgling two-year-old government is not yet providing the pneumococcal vaccine to its own children.

In April, MSF launched a ‘Dear GAVI’ campaign on the issue of accessing low-cost vaccines for refugees and crisis-affected populations.

It said it had been “frustrated by bilateral discussions, which have been ongoing for a few years now” and that it anticipated that it “will also be a challenge” to obtain other new vaccines, like rotavirus, at the prices GAVI pays.

MSF said it was looking for a sustainable solution to the problem so that it could act swiftly in future crises.

The GAVI spokesman said GAVI did allow non-governmental organizations to deliver vaccines in some countries, such as Afghanistan, where the state is weak or does not control the entire country.

“We are discussing some flexibility on how we support fragile states,” he said.

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by Katy Migiro (Thomson Reuters Foundation)

The post REUTERS: Child Refugees Dying Needlessly Due to Vaccine Bureaucracy, Says MSF first appeared on MissionNewswire.

By Athanas Makundi/UNICEF

Amina walked briskly with her 4-year-old son, Ismail Mohamed, to fetch water at the edge of the camp where they live in Mogadishu. As the sun rose, they could hear the sound of babies crying and distant gunfire.

“We have to wake up early to fetch water because it is so scarce,” Amina said. “If you don’t, then you find a long queue at the pump, and sometimes the water runs out altogether.”

Once she had filled her yellow plastic containers, she hurried home with to prepare breakfast. The family’s home, made of plastic sheeting, cardboard and colourful fabric, provides little protection from the heavy overnight rains.

“Our shelter is exposed and the children are often cold,” Amina said as she boils the water on an open fire. “But I prefer to be here than in the village because we get food, water and medicine.”

Finding treatment

A year ago, drought coupled with escalating fighting and lack of access for aid workers led to a terrible famine in the Lower Shabelle region of southern Somalia where Amina’s family lived.

“All our animals died and there was nothing left,” said Amina’s husband, Mohamed Ibrahim, as he sips his tea. “We had to leave; my son Ismail had fallen ill.”
Amina’s voice cracked with emotion as she narrated their ordeal.

“When we arrived in Mogadishu, Ismail was already very sick,” she said. “His body started to swell, and his skin started to peel off.”

Ismail was severely malnourished and, like many children in his condition, he contracted measles and cholera. His body swelled up so much he was unable to open his eyes.
“I was so worried when his eyes closed,” says Amina, shaking her head. “I didn’t know what to do. I used to ask myself, where can I find help?”

Ismail’s father heard from outreach workers at the camp about a feeding centre run by the Somali NGO SAACID and supported by UNICEF.

There, they learned that Ismail had a form of severe malnutrition known as kwashiorkor that required urgent treatment.

“When he was brought to us, the rate of the swelling – called edema – was very high,” said Abdullahi Mohamed, a nurse with SAACID, who was the first person to treat Ismail at the centre. “We could not do much for him then.”

Ismail was then sent to a hospital run by Médecins Sans Frontières (MSF) Belgium, where he was admitted for two weeks until the edema subsided.

“Then we took him to our feeding centre, where we put him on a therapeutic programme,” Mr. Mohamed said. “Now you can see Ismail is alive and kicking.”

Aid since the famine declaration

Thousands of children in central and southern Somalia died before famine was declared on 20 July 2011. But the massive humanitarian response helped save many lives.

Over the past year, UNICEF has treated more than 455,000 acutely malnourished children throughout Somalia, of whom almost 225,000 were severely malnourished – the vast majority in the central and southern regions.

Ismail has made extraordinary progress and his mother can still scarcely believe the change.

“When he recovered, I felt hope restored in my heart,” she said. “I’m very happy.”

Yet the situation in many areas of Somalia remains fragile. An estimated 2.5 million people – half of them children – still need assistance.

“Although the need is not high as it was a year ago, there are still children who are suffering like Ismail,” Mr. Mohamed said. “We do still see children like him in our feeding centres, but the scale of the need is not as it was a year ago.”

Emergency assistance is clearly needed, but it will not be enough. UNICEF is also working to boost the resilience of the most vulnerable by strengthening basic services at the community level. This, in the long term, is the only way to reduce the risks caused by crises such as drought and food insecurity and ensure that children like Ismail can look forward to a normal childhood.

The post UNICEF: One Year After Somalia’s Famine, a Story of Recovery first appeared on MissionNewswire.