Improving treatment of sleeping sickness and malaria amid civil war

International staff: 93
National staff: 1293
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Over the past two decades, civil war and famine in Sudan
have led to the loss of 1.5 million lives and the displacement
of millions more. The effects of the war have been devastating:
violence, malnutrition and disease, and disruption of local
economies and services. Areas of particular concern are in the
conflict zones: Kordofan, Unity/Western Upper Nile, Blue
Nile and the Nuba mountains. Humanitarian access to these
areas is difficult if not impossible. Drought in Northern
Darfur and Northern Kordofan has also led to significant
population displacements.
MSF has been working in Sudan since the 1970s in activities
largely responding to the ongoing civil war. Current activities
include mother-and-child health care, surgical intervention,
nutrition support at feeding centers, vaccinations, primary
health care, water supply, hospital support and programs to
fight diseases such as sleeping sickness, tuberculosis (TB), river
blindness and kala azar (visceral leishmaniasis). MSF projects
are located across the country: from Khartoum and Gedaref in
the north and Bahr el Ghazal in the west, to the Lakes Region
and Western and Eastern Equatoria in the south.
Western Upper Nile
In April 2002, MSF brought attention to the miserable conditions
of civilians in Western Upper Nile in the report
"Violence, Health and Access to Aid in Unity State/Western
Upper Nile, Sudan." MSF provides aid in several locations in the
disputed province, offering basic health care, inpatient and outpatient
care, therapeutic feeding, and tuberculosis and kala azar
treatment. Based on 14 years of work in Western Upper Nile,
the report shows that repeated displacement and continued
fighting, coupled with lack of access to health care and humanitarian
aid, are slowly killing off the region's people.
Disruption of aid activities – only one element of the fatal
consequences of Sudan's long-running conflict on Sudanese
civilians – is all too common in Sudan. In an attack on the village
of Nimne in Western Upper Nile in February 2002, an MSF
compound was looted. Days later a local MSF health worker
was killed when three bombs were dropped on the village. MSF
was forced to suspend its program in Nimne. A health clinic
in Bieh also suffered disruption following a helicopter gunship
attack. In March, another MSF team in the area was
evacuated due to shooting. The attack on Nimne came in
the same days that government planes bombed Akuem in the
southern state of Bahr el Ghazal, where MSF runs a primary
healthcare program and a feeding center.
New treatment achieving positive results
Until September 2001 MSF teams had to treat patients suffering
from second-stage sleeping sickness, a tropical disease
endemic in southern Sudan, with the toxic and sometimes
deadly arsenic-derivative melarsoprol, because no other drug
was available. After years of lobbying by the World Health
Organization and MSF a much safer drug, eflornithine, has
now become available. MSF's first program to document the
effects of eflornithine in the field, the Ibba sleeping sickness
project in Western Equatoria, is showing positive results. The
number of patients seeking treatment has tripled in recent
months and drug-related fatalities are now rare. MSF also
treats the disease in Kajo Keji, in Eastern Equatoria. Also in Kajo
Keji, an MSF study showed that area malaria strains were
resistant to common malaria treatments; in June 2002, MSF
introduced artemisinin-based combination therapy (ACT),
allowing for better treatment of malaria cases.
In March 2002, after years of donating drugs and medical
material, MSF established a health center and eight health units
in Nagorba in the Nuba mountains. For the past ten years the government
had refused to allow humanitarian access to the region.
In December 2001, after a year of trying to get access to the
area, MSF began a kala azar program in Malakal, in Western
Upper Nile, with pediatrics and tuberculosis support planned
to begin by mid-2002.
In northern Sudan, MSF phased out clinics in three camps
for displaced people on the outskirts of Khartoum and in a
hospital in Meiram, because other health facilities were available
and the needs no longer acute. MSF continues to support
a therapeutic feeding center in Mayo camp.
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