The current conflict is instead an acute symptom of a crisis that has plagued the country for decades.

The people of Sudan have been suffering for far too long from political turmoil and economic instability.

The escalating humanitarian needs have left many Sudanese in "survival mode".

Last year alone, humanitarian needs reached their highest levels in a decade, with violent conflict and food insecurity among the many challenges people have been facing, while significant flooding hinted at the country's vulnerability to rapidly changing climate patterns.

The situation was further worsened by the surge in fighting between armed groups in Darfur, Kordofan and Blue Nile states, which displaced more than 3 million people, almost 2.5 million in Darfur alone.

Meanwhile, Sudan also hosted more than one million refugees from neighbours such as South Sudan and Ethiopia, who themselves fled violence only to find themselves stuck in another conflict further affecting their ability to cope with their escape from misery and death.

Shortages of food, water, medicines and fuel

Before the current conflict, the alarm had already been raised about the critical needs of people in West Darfur, and emphasising the urgency of scaling up the humanitarian response to the already fragile healthcare system.

Now, we have witnessed first-hand the collapse of the health system and fast-growing levels of medical and humanitarian need across the country, placing great numbers of people in a life-threatening situation.

The United Nations estimates a 57 per cent increase in needs since December 2022.

Since 15 April, people in Khartoum and other states have suffered due to heavy fighting, airstrikes and mass looting.

Another wave of displacement of 1.4 million civilians is being reported as newly displaced, with women and children particularly affected.

The current violence has led to shortages of food, water, medicines and fuel, causing prices to surge and making it increasingly difficult for people to access medical care at a time when they need it most.

In Khartoum, El Geneina, Zalingei and other cities and towns where heavy fighting continues, people remain trapped, while hundreds of thousands have been fleeing to safer areas of the country or across borders.

Despite immense obstacles, agencies like MSF remain determined to support the people of Sudan to the best of our ability, providing critical healthcare to those in desperate need.

Our teams are currently active in 10 states in Sudan, involved in various activities, such as treating war-wounded individuals in Khartoum and North Darfur; providing healthcare and water and sanitation services to refugees, displaced people, and local communities in Al-Gedaref and Al-Jazeera states; and donating medical supplies to healthcare facilities across Sudan.

Concerted attacks on healthcare facilities

However, there has been a pattern of attacks on healthcare facilities and disregard for civilian lives that has made it increasingly difficult to deliver vital healthcare services during this critical time.

For instance, in Nyala, south Darfur, we were forced to suspend activities after one of our compounds and warehouses were violently looted on 16 April.

In Khartoum, another warehouse was also looted and occupied, with medical supplies, fuel and vehicles stolen.

Fridges were unplugged and medicines left exposed and, on the floor, meaning they can no longer be used.

On 26 April, the El Geneina Teaching Hospital (where MSF managed the pediatric and nutrition departments) was also looted, with parts of the hospital damaged or destroyed.

The hospital remains closed following the attack.

The theft of supplies and vehicles, harassment of medical personnel, and the proximity of violence to healthcare facilities and infrastructure collectively impede the efforts of medical and humanitarian workers in responding effectively to the dire situation.

These attacks are not isolated incidents.

Rather, they are indicative of a broader pattern where warring parties show a disregard for civilian lives, infrastructure, and healthcare facilities.

This trend poses a serious threat to the provision of essential healthcare services and exacerbates the already challenging conditions the affected population faces.

Administrative and logistical challenges are also impeding the medical activities of Medecins Sans Frontieres/Doctors Without Borders (MSF).

Moving supplies from one part of Sudan to another can be extremely difficult.

Similarly, although MSF was able to bring emergency teams into Sudan during the first weeks of the conflict, obtaining permission for them to travel to project locations or securing visas for additional staff has been challenging.

How can we possibly continue carrying out our activities without an acceptable level of protection for our staff and for the people unable to reach medical facilities due to constant threats and obtaining a level of accessibility of our supplies and teams to move and deliver aid?

We cannot stand by as people are put at risk

From our humanitarian experience in conflict zones, we know the scale of danger that conflict poses to civilians who cannot or choose not to evacuate, including medical staff who remain to provide care to the sick and wounded.

Parties to the conflict must take all necessary measures to protect civilians from harm and ensure that those who are sick, wounded, or in dire need of medical support have access to healthcare facilities.

As I pen my closing words, I can't help but wonder how many lives that should have been spared are being lost at this very moment.

In the face of ongoing conflict and attacks on healthcare in various locations, it is imperative to ensure the safety of medical personnel and health facilities to ensure effective healthcare delivery.

This entails enabling safe passage for ambulances and individuals seeking medical assistance and facilitating access and rapid and unimpeded movement for humanitarian workers, organizations, and supplies to go where they are needed.

Too many lives are hanging in the balance, and we cannot stand by as people are put at risk. It is vital that civilians affected by the fighting are afforded access to emergency healthcare.

• Stephen Cornish is General Director of Medecins Sans Frontieres/Doctors Without Borders (MSF) in Geneva, Switzerland. Republished from La Croix International.

The Indefinite Despair report includes medical data MSF gathered during the past year while it was contracted by the Nauruan government to deliver mental health services.

These services were provided to Nauruans and to asylum seekers and refugees detained there under Australia's offshore detention policy.

The report says Nauruan and refugee patients show similar levels of mental illness that are far worse than other MSF projects around the world.

While stigma and a lack of understanding of mental illness were leading to poor healthcare for both Nauruan and detained people, the report says Nauruan patients were improving under MSF treatment while refugees and asylum seekers were not.

MSF also reports that rates of suicidal thoughts and suicide attempts among the refugees and asylum seekers were exacerbated by family separation and the violence they experienced on Nauru (some of which was allegedly inflicted by authority figures).

The refugees' and asylum seekers' prior detention on Christmas Island was also found to be an exacerbating factor in poor mental health outcomes.

Using a mental health scoring method known as Global Assessment of Functioning (GAF), MSF says it found the situation on Nauru to be more severe than in many global emergencies it deals with.

The report says waiting in limbo for five years meant the Nauru detainees had a lower GAF score than torture victims MSF had treated.

"We found this loss of control was associated with major psychiatric illnesses such as depression, anxiety disorders and post-traumatic stress disorder. We also found the loss of control was associated with higher rates of suicidal thoughts and suicide attempts," said Dr Beth O'Connor, one of the psychiatrists involved.

The report found among 208 refugee and asylum seeker patients, 60 percent had suicidal thoughts and 30 percent attempted suicide, one as young as nine years old.

A breakdown in the relationship between MSF and the Nauruan government saw the doctors expelled in October this year, just 11 months after the contract began.

Source

• Doctors Without Borders
• The Guardian
• Radio NZ
• Image:The New Daily
  

MSF said it was informed on Friday 5 October by the Government of Nauru that it was no longer required and terminated its provision of mental health care services on the island.

They were given 24 hours to leave the country.

MSF says that all of its international staff have now left the island where they had been working since November 2017.

Barri Phatarfod, the founder and president of Australian organisation Doctors for Refugees, told the ABC's Pacific Beat program she was stunned by the Nauruan Government's move.

"It's incredibly dangerous and it's grossly irresponsible," she said.

"Nowhere in medicine do you ever see 24 hours to stop, [there is] no basis to have suddenly stopped midway through.

"The explanation is that mental health support is no longer required.

"It's clearly required; self-harm syndrome, life-threatening psychiatric disorders."

Psychiatrist Beth O'Connor, who had been stationed by MSF on Nauru for 11 months, said the refugees would find it difficult to receive the critical health care they needed.

Court-ordered medical evacuations of refugees from Nauru would be hampered by MSF's removal, she said.

"The process of both children and adults with mental and physical illnesses being transferred off Nauru is complicated," O'Connor said.

"There is a lack of independent opinions and that is problematic."

It has been speculated that the MSF practice of giving patients access to their files, some of which have become public, was the trigger for the Government's decision to evict the organisation.

MSF had provided its refugee patients with their medical records which had been used in court applications for evacuation, but O'Connor said MSF had no control over what patients did with their records.

Source

• abc.net.au
• radionz.co.nz
• Image: abc.net.au

Shaun Cornelius is a Médecins Sans Frontières / Doctors without Borders Logistician Manager on the SOS Méditerranée asylum seekers rescue boat Aquarius in the Mediterranean.

Shaun, who comes from Wellington, is on his fourth assignment with MSF. He previously was in Ethiopia, South Sudan and on the Aquarius in 2016.

SOS Méditerranée is a European NGO that rescues asylum seekers in distress in the Mediterranean. Since launching its rescue operation in February 2016 it has rescued more than 11,000 asylum seekers.

"I'm honoured to participate to the humanitarian action achieved by the SOS Méditerranée - Aquarius ship," Shaun said.

"MSF's primary role is to look after people once they are on board and this involves getting them into dry clothing, showering to remove gasoline, providing food, water, toilets and shelter, and of course medical treatment."

"As a logistician, I keep all the MSF equipment and structures on board in good working condition. This includes the shelter structures, toilets, showers and plumbing, drinking water filters, radios, computers and medical equipment."

"I am also responsible for the stocks of emergency kits and food we provide to our passengers. I carry out the re-order of supplies' and I also liaise with the ship's crew and engineers if repairs or modifications are needed to the ship's equipment."

The Félix Houphouët-Boigny Peace Prize was created in 1989 to honor individuals or public and private bodies or institutions that have made a significant contribution to promoting, seeking, safeguarding or maintaining peace in conformity with the United Nations' Charter and the Constitution of UNESCO.

Past laureates of the Prize have included personalities such as French President François Hollande, Nelson Mandela and Frederik W. De Klerk; Yitzhak Rabin, Shimon Peres and Yasser Arafat; King Juan Carlos of Spain and former U.S.A. President, Jimmy Carter.

Read Shaun' story

• Part 1
• Part 2

Source

• Supplied: msf.org.au
• en.unesco.org
• Image: msf.org.au