Key findings from the MSF nutritional and retrospective mortality survey conducted in Batil refugee camp, South Sudan, from 25th to 30th July, 2012

Tragically, some of the refugees whose family members had died before they reached Batil camp cited “tired of walking” as the cause of death. This suggests an incredibly weak and vulnerable population arriving at the camp, and points to the massive need for assistance to those that managed to arrive alive, but weak.

Mortality more than double emergency levels*
Since the refugees’ arrival in Batil camp, mortality for the total refugee population is substantially above the emergency threshold, and mortality for children under five is more than double the emergency threshold.

Technically, the data is 1.75 per 10,000 per day for the total population, and 4.2 per 10,000 per day specifically for children under five, comparing to emergency thresholds of 1 and 2 per 10,000 per day respectively.

To put this in perspective, for children under five this is more than four times the ‘norm’ in a low-resource setting, meaning that four times more children are dying than we would expect to see if everything were ‘normal’.

Or to put it in other words, between three and four children under five years old have been dying on average every day in Batil camp.

More than half (58%) of reported deaths among the refugees since arrival in Batil camp have been children under five years old. More than 25% of reported deaths were for people over 50 years old. In many emergency interventions children under five are the first priority, but to see this level of mortality in over-fifties is unexpected and indicates a very vulnerable and weak population indeed.

Cause of death
The major cause of death reported while these refugees have been in Batil camp is overwhelmingly diarrhoea, constituting more than 90% of causes of death, with malnutrition likely to have been a contributory factor in many of the deaths.

Shocking malnutrition
A quarter (27.7%) of children under five are malnourished, and 10% are in the most severe acute stage of malnutrition requiring urgent therapeutic feeding. Even more shocking, nearly half (44%) of the children under two years old are malnourished, with 18% of them being in the most severe, potentially life-threatening stage of malnutrition.

Respiratory diseases rising
While respiratory tract infections constituted around one in ten consultations in Batil in June, they have been rising alarmingly and last week they constituted more than four in ten consultations in Batil.

MSF response
MSF has more than 180 expatriate staff and more than 800 locally recruited staff on the ground in the five refugee camps for Sudanese refugees in South Sudan. The first emergency interventions were started in November 2011 when refugees first arrived in Yida and Doro camps in South Sudan. MSF rapidly expanded its emergency activities over the following months as the number of refugees grew, as the rainy season started, and as the health situation in the camps deteriorated.

In its tented field hospital in Batil camp, MSF now has more than 1,600 children suffering from severe acute malnutrition in the therapeutic feeding programme. Every week about 30 of these children need to be admitted into intensive care with life-threatening medical complications such as diarrhoea or respiratory diseases. Since the Batil camp was set up in May, MSF has conducted more than 14,500 medical consultations, as well as assisting with the set-up of water distribution networks and the distribution of basic survival essentials when the refugees first arrived.

“This new data reflects exactly what I see every day,” says Helen Patterson, MSF’s medical coordinator for Batil camp. “This is a health catastrophe. With half the children under two years old malnourished, and living in cold, wet conditions, and hundreds falling ill with diarrhoea and respiratory diseases, our field hospital is overwhelmed with critically ill patients. We’re pushing the boundaries of what’s possible logistically to get staff and supplies here and continue saving lives.”

Note on time period of the data presented:
The mortality data presented here focuses entirely on the period since the refugees arrived in the camp. The arrival date for households in the camp differed per villages. The households had arrived in Batil refugee camp between 2nd May 2012 and 14th May 2012. To calculate both the recall period before arrival in the camp and while being in the camp to assess mortality accordingly, the recall period was calculated for each individual, individually.

*Emergency thresholds and 'norm' levels
- Crude Mortality Rate (CMR) (total population) of 1 per 10,000 per day and under five years old Mortality Rate (U5MR) of 2.0 per 10,000 per day are commonly used as the thresholds of gravity in emergency situations.
- CMR of 0.5 per 10,000 per day and U5MR Mortality Rate of 1.0 per 10,000 per day are levels considered 'normal' for developing countries (UNHCR, 2002; MSF, 2006)