This article is part of HuffPost’s Project Zero campaign, a yearlong series on neglected tropical diseases and efforts to fight them.
Everyone takes work home with them sometimes. But in civil war-torn South Sudan, some health workers take theirs on the run.
In areas where armed groups have stormed into hospitals and shot people dead in their beds, or gutted and burned clinics, staff for the medical charity Doctors Without Borders (MSF) at times has had to run with patients and hide in the bush to continue treatment.
Last year, a group of MSF health workers in the particularly hard-hit town of Leer, in Unity State, took things one step further. Instead of fleeing from and returning to their hospital again and again, they stuffed backpacks full of stethoscopes, disinfectant and medicine, and began setting up mobile clinics anywhere they could find a safe spot.
Aided by community volunteers, these health teams treat people taking refuge in hard-to-reach places ― like the islands of the Sudd, Africa’s largest marshland ― and can escape with their equipment if attackers catch up.
Bodies have littered the streets of Leer, a once-bustling market center, several times since fighting broke out in 2013. There were four attacks on MSF’s hospital in the town before the group stopped rebuilding and restocking it. The facility was leaving the group’s workers, patients and supplies open to violence and robbery.
In July 2016, just under 200 local health workers fled the hospital for the final time. Sixty-seven of them decided they couldn’t abandon their patients in the wilderness. Most of those patients had already lost their cattle and crops and had been displaced from their homes many times. The MSF workers in Leer were local community members themselves, many with no formal education, who had been trained to treat common illnesses.
This mobile clinic experiment, while extremely challenging and limited in scope, is one of the few ways to provide life-saving health services to people in dangerous, remote areas of a war-ravaged country plagued by famine and disease.
Reaching people stripped of everything and scattered across the countryside can involve paddling a canoe for over 18 hours, explained Nicolas Peissel, an MSF project coordinator in South Sudan. People are “living in the bush, hiding in the swamps,” where they are “forced to drink swamp water and to forage for food,” he said.
Civil war has added to the already immense logistical challenges of health care in the world’s youngest country, which was forged in 2011 after five decades of war with Sudan, its neighbor to the north. Substandard health systems and almost nonexistent infrastructure meant treatment delivery to those in need was already tough; the war made circumstances much more deadly.
In addition, more than 3 million people across South Sudan have fled their homes because of the fighting.
“With very few functioning health care facilities across the country, it is impossible to provide any reliable statistical data about the health situation,” explained Bart de Poorter, health coordinator in South Sudan for the International Committee of the Red Cross (ICRC).
ICRC, which also provides emergency frontline medical care in some of South Sudan’s hardest-hit areas, sees people having to walk for many hours or days to reach the nearest health facilities, many of which closed their doors because of the ongoing violence.
“In this situation, curable and preventable diseases can become fatal,” de Poorter said.
Tens of thousands of people from around the Leer area were forced to hide in swamps and survive on water lily roots, wild fruits and filthy water. Life-threatening outbreaks of diarrhea and cholera were rife. Others battled the many neglected tropical diseases prevalent in South Sudan ― like kala azar, the second largest parasitic killer in the world after malaria.
Far from remaining health services, often reachable only by crossing frequently shifting battle lines, these displaced people are now at the epicenter of a famine.
“After three years of fighting, people are just worn down ― they have no resources to help them cope,” said Peissel.
By using backpacking medics, MSF could truly follow their patients’ treatment, despite the challenges of keeping their bags full. The health workers would have to paddle or walk, sometimes through the night, to collect fresh packs flown hundreds of miles in small, light aircraft from South Sudan’s capital, Juba, to a number of remote locations in Leer and neighboring Mayendit county.
In these places, an MSF “clinic” today looks like an informal outdoor gathering attended by between four and eight medics sitting under a tree with their packs.
“It’s very low profile because at any time there can be an attack. Anything that will call attention to yourself will likely make you a target,” said Peissel.
Humanitarians across South Sudan face threats to their lives as they carry out their work. On March 25, six aid workers from a Unicef partner were killed in an ambush as they traveled to a town in the eastern part of the country. At least 79 aid workers have been killed in South Sudan since 2013, according to the United Nations.
“Our health workers are living with these populations and are just as at risk as the civilians,” said Peissel of MSF’s mobile teams.
To ensure these makeshift clinics are working well, international MSF staff from Juba visit every month to do training and assessment. They have found that the dozen mobile clinics embedded within displaced communities receive double the patients that the Leer hospital once did.
In February, an attack by armed men on the swamp island of Loth in Leer County put MSF’s mobile tactics to the test, as patients and staff fled further into the swamp, along with medics and their moveable clinics.
“Small amounts of medication were destroyed,” Peissel said. “Within 24 hours we had resupplied our team and they were running a new clinic.”
Even when the bullets aren’t flying, lack of access is one of the biggest barriers to providing emergency health care. And South Sudan isn’t alone in facing these challenges. In the east of the Democratic Republic of Congo, teams of doctors and nurses have to trek for days through steep, water-logged land to give people life-saving vaccinations. In northern Kenya, mobile clinics come on four legs ― in the form of camels ― to reach semi-nomadic communities living on arid plains.
Having to seek safety from violence with tens of thousands of people in squalid camps dramatically increases the risk of disease. The World Health Organization considers South Sudan’s overcrowded camps ― home to 1.9 million people ― to be more dangerous breeding grounds than the cities or swamplands for highly infectious diseases like cholera.
“Conflict takes a major toll on health,” said Peissel.
South Sudan is also one of the few countries that is home to almost all 18 illnesses designated by the World Health Organization as neglected tropical diseases.
In 2015, South Sudan’s government launched an ambitious plan to eliminate these diseases by 2020. But before the civil war broke out, disease experts such as Peter Hotez had warned that conflict would spell a public health tragedy.
“The renewed hostilities in South Sudan could portend a public health crisis from neglected tropical diseases,” he wrote.
Mobile medical teams may be one of South Sudan’s best chances of battling these illnesses, as well as expected spikes in malaria, diarrheal disease and respiratory infections, in the country’s most deprived areas.
This series is supported, in part, by funding from the Bill & Melinda Gates Foundation. All content is editorially independent, with no influence or input from the foundation.
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