One in ten South Sudanese children admitted to Medecins Sans Frontieres (MSF) hospitals for refugees in Ethiopia are dying, the medical charity said, warning that conditions are likely to worsen as seasonal rains set in.
Around 150,000 South Sudanese have fled to Ethiopia since conflict broke out in the world's youngest nation in December. Nine out of ten of the arrivals are women and children who often walk for weeks to reach safety.
"It's a massive emergency," Antoine Foucher, MSF's head of mission in Ethiopia, told Thomson Reuters Foundation by phone.
"One child out of ten coming into our hospitals is actually dying for a variety of reasons ranging from late referrals to very bad health status that is practically not curable."
The refugees are fleeing hunger as well as conflict, with food becoming increasingly scarce in South Sudan.
Fighting between government forces and rebels has driven 1.5 million South Sudanese from their homes and left 3.5 million, or a third of the population, suffering acute or emergency-level food shortages, the United Nations says.
FIGHTING OFF ILLNESSES
One in four of the children who arrive in Ethiopia are malnourished, Foucher said. In this weakened state, it is difficult for their bodies to fight off illnesses such as measles, diarrhoea and respiratory infections.
The start of the rainy season will aggravate the situation, worsening sanitary conditions and the incidence of malaria.
"It's a race against time," said Foucher. "We have a one month window of opportunity ... to bring the conditions up to standard if we want to avoid a catastrophe on the catastrophe."
MSF has two hospitals treating the refugees. In Lietchuor camp, seven percent of the children who are admitted die. In their hospital in the town of Itang, 10km from Kule camp, the death rate is 18 percent.
Ethiopia was home to just 50,000 South Sudanese refugees before the war erupted. Aid agencies have been struggling to cope with the sudden influx, which has been as high as 15,000 arrivals per day.
The population of the camps could reach 350,000 by the end of the year, the United Nations refugee agency has said.
New arrivals sometimes have to wait up to a month at transit sites before being resettled in the permanent camps, about 50km away.
"This period is naturally very critical because this is the moment when they do need the most intensive care," said Foucher.
"MSF teams provide medical care in these transit camps, treating the children, some of whom die within the first days following their arrival."
Conditions in the camps are little better, with half of the refugees living under plastic sheeting and a severe shortage of water and latrines.
"After several weeks in the camps, where living conditions are very precarious, they do not get any better," MSF said, highlighting the prevalence of diarrhoea and pneumonia among hospitalised children.
In humanitarian emergencies, people are supposed to receive 20 litres of water per person per day. At the Burubiey transit centre, it is only seven litres.
Each latrine should be shared by a maximum of 20 people. At Kule 1 camp, MSF said, there are 288 people per latrine.
"If the situation is not improved - in terms of water supplies, in terms of latrines availability, in terms of shelter - then the medical unit that has been deployed by MSF will only be able to tackle the consequences," Foucher said.