A brutal attack on Kreinik town, Sudan, in April 2022, left more than 200 people dead and many more injured. The town's hospital, supported by Médecins Sans Frontières (MSF), came under attack; two hospital staff and eight patients were killed, and the hospital pharmacy was looted. In December 2022, our teams returned to Kreinik to renovate the hospital. Dr Prince Mathew, MSF project coordinator, takes up the story.
"West Darfur in Sudan is very volatile and Kreinik has been particularly affected by violence over recent years. What looks to be very calm today can be incredibly violent tomorrow. Violence affects everyone, regardless of where they are from.
Kreinik town today is a burned-out spectre after last year's attack. Hundreds of houses were completely burned down. Many people live in densely populated displacement camps surrounding the hospital. Public spaces and schools are now filled with hundreds of tents and makeshift shelters. The only water supply is by donkey carts.
People in both the town and rural areas face difficulties getting to markets to buy food. On market days there have been attacks on people coming into town. In the days following such violence, the situation in the area remains volatile and tense.
Many farming communities are also unable to access their farming lands located outside the area where they live, while pastoralist communities are unable to graze their cattle, which is essential for their livelihoods. Along with 300 per cent inflation in Sudan, this situation has made life incredibly difficult.
An MSF team returned to Kreinik after the attack, running mobile clinics in the villages and nomadic settlements surrounding the town. We are seeing increasing numbers of malnourished children coming to our mobile clinics, many of whom we refer to El Geneina or Kreinik hospital.
What looks to be very calm today can be incredibly violent tomorrow. Violence affects everyone, regardless of where they are from. Dr Prince Mathew, MSF project coordinator
Kreinik hospital is the only specialised healthcare facility for about 480,000 people. After the attack, key services were disrupted, and the hospital was overwhelmed by the number of patients seeking healthcare. There were few doctors or nurses to provide treatment.
Community engagement is vital: if we don't know what a community needs, we will never be able to serve them in the way that is most appropriate. They told us that the biggest needs were trauma care for accidents, gunshots and other emergencies. They also highlighted the need for women to have a safe place to deliver their babies and the need for paediatric care.
We set up our project in Kreinik hospital very fast. Our priority was the emergency room. In a place where there is a lot of violence, every life and every second counts. We then quickly scaled up and opened the maternity ward - already our first few babies have been born there. We're on track to open the paediatric ward very soon.
Many of our staff have worked with MSF in other projects and bring a tremendous amount of devotion and experience with them. We worked together with the ministry of health's staff. We set aside our usual roles as doctors or nurses. We cleaned up, repainted the facility and unloaded medical equipment, medical items and surgical kits.
Many of the team members are from West Darfur. Some of them lost family members in last year's attack. For them, rebuilding the hospital was personal and involved a lot of emotions.
We also established a referral system between Kreinik and the general teaching hospital in El Geneina, the capital of West Darfur. We wanted to ensure that timely referrals could take place, day or night, with an MSF nurse and medical equipment on board the ambulance.
In a place where there is a lot of violence, every life and every second counts. Dr Prince Mathew, MSF project coordinator
Most people in Kreinik use donkeys, horses and camels to get around. Many patients arrive on donkey-cart ambulances as motorised transport is expensive and not easily available. However, this mode of travel is slow and brings with it security considerations, especially after dark. This is why we run mobile clinics outside town - we go to the community rather than them coming here.
On 22 January, we reopened the emergency room, where injuries related to accidents, gunshot wounds or violent incidents can be treated around the clock. We have also opened a new maternity ward where babies can be born safely.
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Our first baby was born on Thursday 26 January. The mother had lost a baby previously because she could not afford the hospital fees. She was very happy that the Kreinik maternity opened and is free of charge. Two weeks later, she came with her baby girl Nemat for routine immunisation and postnatal care. We're hoping that our presence in Kreinik will contribute to an improvement in healthcare for all the people who need it the most."
Within its first week of reopening, our teams together with the ministry of health staff in Kreinik hospital's emergency room treated 16 patients, mainly for gunshot injuries and burns. Since 22 January, MSF midwives have helped nine women to give birth safely in the hospital's maternity ward. Meanwhile, our teams are continuing to run mobile clinics in the nomadic settlements in Galala, Mogshasha the Kreinik area, and in Wadi Rati and Gelcheck south of El Geneina city, and to transfer patients in need of specialist medical care to El Geneina teaching hospital.
