In Jonglei state, South Sudan, civilians continue to bear the brunt of inter-communal fighting.
Wounded patients are still arriving at the Médecins Sans Frontières MSF (Doctors Without Borders) hospital in Pibor, three weeks after the violent attack on the main town and outlying villages in Pibor County.
Even running away is not enough. Many people were injured in the bush, where thousands have remained, too frightened to come out of hiding.
MSF medical teams are now treating seriously infected wounds, some several weeks old.
Since re-launching emergency medical activities in Pibor on 7 January, MSF has treated 47 patients with gunshot wounds – 16 women and eight children.
A further 43 patients have so far been treated for stab wounds, beatings or wounds sustained whilst fleeing to the bush.
MSF colleague killed
People displaced by cattle raiding in Pibor county, Jonglei State, South Sudan, April 2011.
Liang Zi
In the wake of the Pibor attack, MSF learned on 16 January the tragic news that Allan Rumchar, an MSF watchman, and his wife had been killed.
Three weeks after the attack, 25 of our 156 locally recruited staff are still unaccounted for, and we remain extremely concerned for them.
The violence in Pibor is not isolated. After the village of Wek in northern Jonglei State was attacked on 11 January, MSF evacuated 13 patients by air to our hospital in Nasir.
The majority of patients were women and children needing urgent surgery.
This follows an attack in August 2011 on the town of Pieri and surrounding villages, during which scores of villagers were killed. In the past six months, 185 seriously wounded patients have sought care from MSF teams in Lankien, Pieri and Yuai.
“We are seeing a cycle of attacks and reprisals throughout this area of northern Jonglei,” says MSF head of mission Jose Hulsenbek.
“For the civilians in this part of South Sudan, the fear of having to flee their homes or being killed is very real.”
Extreme Violence
One recurring characteristic of the attacks in Jonglei is their extreme violence.
One woman treated for a gunshot wound by MSF in Pibor said she had fled into the bush with her husband, children and 15 other family members.
After running for 11 hours, they were found by a group of men who shot at them.
“We scattered. My baby was hit as I carried him on my back and I was shot in the thigh.
"I tried to hide in the high grass but they found me because my baby was crying.
"They started beating my daughter until she kept quiet. They left us behind thinking we were dead.”
Her son was also treated by MSF for a bullet wound to the chest that remarkably left him alive.
Humanitarian concerns
MSF is extremely concerned for the health and wellbeing of civilians forced to flee, either from fighting or from fear of an attack.
These people hide out in the bush, with very little shelter, if any. They have limited access to food and are prone to illness.
They return, often to find only ashes where their home used to be.
Village and clinic destroyed
Lekwongole, a village north of Pibor town where MSF runs a clinic, scarcely exists now, and all that remains of the MSF clinic is the concrete floor and walls.
© Heather Whelan/ MSF
Lekwongole, a village north of Pibor town where MSF runs a clinic, scarcely exists now, and all that remains of the MSF clinic is the concrete floor and walls.
Karel Janssens, MSF project coordinator, says, “The people told me that during the day they dare to come out of hiding in search of food or to seek medical care, which MSF restarted on 18 January.
"But at night they return to their hiding places in the bush where they are at risk of contracting malaria or respiratory infections.”
In Pibor, approximately half the consultations since 7 January have been for malaria, as people are exposed when sleeping in the bush.
Civilians targeted
A deeply worrying pattern is emerging, where people and their scarce resources are deliberately targeted by all the armed groups in this inter-communal violence.
Hospitals, health clinics, water sources – these have become targets for armed groups on all sides, suggesting a tactic of depriving people of their basic life essentials just when they will need them most, after fleeing into the bush.
The targeting of civilians is the greatest concern for Colette Gadenne, MSF operations coordinator for South Sudan:
“After these attacks many women and children are coming to us shot, stabbed, beaten.
"They try to keep safe by hiding in the bush, but it seems that even running away is not enough”.
In a December 2009 report ,‘Facing up to Reality: Health crisis deepens as violence escalates in Southern Sudan’, MSF documented the escalation of inter-communal violence in Jonglei and Upper Nile States, and its increasing impact on civilian populations.
MSF treated 392 patients wounded by violence that year, and estimated that 86,000 people were displaced.
The situation has not improved. In the past six months, MSF has treated more than 250 patients wounded in violence in Jonglei State, the majority of them women and children.
MSF has been working in South Sudan since 1983, currently in more than a dozen projects covering eight states.
The medical humanitarian organisation runs its own medical facilities or supports Ministry of Health facilities in six locations in Jonglei State, providing basic healthcare, therapeutic nutrition and treatment for kala azar and tuberculosis, serving a total of some 285,000 people.
In 2011, the MSF medical facilities in Lekwongole, Pibor and Pieri were targeted and either destroyed or ransacked during inter-communal violence.
MSF condemns the targeting of unarmed civilians and of medical assets by any group carrying weapons.