Ms Gillian Conway:

Recently I returned from a brief mission as an MSF nurse midwife in Malakal and Wau Shilluk in Upper Nile State in South Sudan. In the current context, the medical and humanitarian needs are immense. In such precarious conditions providing health care is a major challenge, even more so because the local population are constantly fleeing from one place to another in search of safety. I witnessed first-hand not only the horrific consequences of the current conflict but also the continuing devastating effects almost three decades of war have had on the people of South Sudan, particularly women and children.

In recent weeks growing numbers of infants have been presenting at our clinics with severe malnutrition. This is a direct impact of having malnourished mothers and inadequate access to health care and nutrition. Sexual and gender based violence perpetrated on women and girls is becoming one of the more prominent and insidious features of the conflict.

Survivors as young as three and four years of age have attended our facilities for treatment. The true extent of these heinous crimes may never be known owing to the insecurity and logistical challenges which make rigorous data collection extremely difficult. Due to the volatile security situation in the area it is impossible for our teams to attend the clinic in Malakal town to assist the national staff outside daylight hours. On numerous occasions I have encountered women and children who have suffered the devastating outcomes of conflict for health care. One particular young woman was admitted to our facility in a critical condition after a seizure as a result of severe eclampsia and a life-threatening post-partum haemorrhage. This young woman had received no ante-natal care and had to attend an inadequately staffed and poorly equipped local health centre for her delivery. Thankfully, she and her baby survived but she is left with an extensive physical and neurological disability as a direct consequence of lack of access to health care. Her future will be very uncertain.

Another tragic example of the impact of sustained conflict in South Sudan came in the form of a newborn baby boy who was admitted to our hospital in a very poor condition after a difficult breach delivery and inadequate resuscitation at birth. Sadly this baby suffered irreparable brain damage and died when he was only 10 days old.

I was also involved in the care of an eight year old boy who was admitted to the MSF hospital in a critical condition after having a catastrophic seizure as a result of no access to essential anti-convulsant medication. This child spent eight days in a coma being attended to by his heartbroken mother before dying.

These examples of totally preventable deaths and disabilities highlight the injustices that in particular the children and women of South Sudan face on a daily basis. The inability to recruit national midwives has greatly affected the clinic's ability to provide round the clock, safe maternity care. Prior to the current conflict Malakal as South Sudan's second largest city had a large teaching hospital and university both of which have been looted and destroyed and are currently being used as a military base.

Finally I would like to share a brief testimony from a national staff colleague, who works as an MSF nurse and who I had the pleasure of working with while in Malakal. He said that on 3 February he was on duty in the MSF hospital. The fighting was getting closer to the town and the remaining civilian population had started to flee. They carried on working until it was too dangerous to stay. They had patients who had been admitted that afternoon and the team did not want to leave the patients behind. It was a difficult decision to leave the hospital while they were receiving patients in a critical condition. He was the supervisor of the nurses in the hospital and they decided to load the patients onto a tractor and trailer and go with them to Kodok. On the way they saw people fleeing in the same direction with no water or means of transport. They picked up some of the wounded and the sick. Some of the staff jumped out to make space for them on the trailer. Unfortunately one of the patients died on the way. By midnight they arrived at the hospital in Kodok with 13 patients. When he arrived in Kodok he did not have a place to stay and ended up sleeping in the open with the rest of the people from Wau Shilluk. He decided to continue serving the sick and the wounded in any way he could. His future is very unclear and he does not know what will happen to all from Wau Shilluk. His family is in Yei in the greater equatorial region. He took them away in 2014 because he was afraid for them and wanted them to be safe. At the moment he is having trouble communicating with them. Last week he cycled 45 km to make a phone call to his wife and children. The telephone network was shut down in January 2017 and he is worried about their security. The situation there is incomparable with that in Wau Shilluk where they lived a few weeks ago. There is hardly any water, shelter or food. They are suffering.