Last year, a group of MSF health workers in the particularly hard-hit town of Leer, in Unity State, took things one step further. Instead of fleeing from and returning to their hospital again and again, they stuffed backpacks full of stethoscopes, disinfectant and medicine, and began setting up mobile clinics anywhere they could find a safe spot.
Aided by community volunteers, these health teams treat people taking refuge in hard-to-reach places ― like the islands of the Sudd, Africa’s largest marshland ― and can escape with their equipment if attackers catch up.
Mobile health workers in South Sudan sometimes have to walk for long hours, so they hire people from the local community to help them haul the supplies they can't carry on their backs. (Photo: Nicolas Peissel/MSF)
Bodies have littered the streets of Leer, a once-bustling market center, several times since fighting broke out in 2013. There were four attacks on MSF’s hospital in the town before the group stopped rebuilding and restocking it. The facility was leaving the group’s workers, patients and supplies open to violence and robbery.
In July 2016, just under 200 local health workers fled the hospital for the final time. Sixty-seven of them decided they couldn’t abandon their patients in the wilderness. Most of those patients had already lost their cattle and crops and had been displaced from their homes many times. The MSF workers in Leer were local community members themselves, many with no formal education, who had been trained to treat common illnesses.
This mobile clinic experiment, while extremely challenging and limited in scope, is one of the few ways to provide life-saving health services to people in dangerous, remote areas of a war-ravaged country plagued by famine and disease.
Reaching people stripped of everything and scattered across the countryside can involve paddling a canoe for over 18 hours, explained Nicolas Peissel, an MSF project coordinator in South Sudan. People are “living in the bush, hiding in the swamps,” where they are “forced to drink swamp water and to forage for food,” he said.
Children play in the water on Feb. 21, 2014, just off one of the islands in the Sudd swamplands in Unity state, central South Sudan, where they have fled with their families for safety. (Photo: TONY KARUMBA via Getty Images)
Civil war has added to the already immense logistical challenges of health care in the world’s youngest country, which was forged in 2011 after five decades of war with Sudan, its neighbor to the north. Substandard health systems and almost nonexistent infrastructure meant treatment delivery to those in need was already tough; the war made circumstances much more deadly.
“With very few functioning health care facilities across the country, it is impossible to provide any reliable statistical data about the health situation,” explained Bart de Poorter, health coordinator in South Sudan for the International Committee of the Red Cross (ICRC).
ICRC, which also provides emergency frontline medical care in some of South Sudan’s hardest-hit areas, sees people having to walk for many hours or days to reach the nearest health facilities, many of which closed their doors because of the ongoing violence.
“In this situation, curable and preventable diseases can become fatal,” de Poorter said.
An MSF community health worker examines a 4-year-old girl suffering from malnutrition. (Photo: Nicolas Peissel/MSF)
Tens of thousands of people from around the Leer area were forced to hide in swamps and survive on water lily roots, wild fruits and filthy water. Life-threatening outbreaks of diarrhea and cholera were rife. Others battled the many neglected tropical diseases prevalent in South Sudan ― like kala azar, the second largest parasitic killer in the world after malaria.
Far from remaining health services, often reachable only by crossing frequently shifting battle lines, these displaced people are now at the epicenter of a famine.
“After three years of fighting, people are just worn down ― they have no resources to help them cope,” said Peissel.
By using backpacking medics, MSF could truly follow their patients’ treatment, despite the challenges of keeping their bags full. The health workers would have to paddle or walk, sometimes through the night, to collect fresh packs flown hundreds of miles in small, light aircraft from South Sudan’s capital, Juba, to a number of remote locations in Leer and neighboring Mayendit county.
An MSF plane resupplying drugs to a mobile clinic. (Photo: Nicolas Peissel/MSF)
In these places, an MSF “clinic” today looks like an informal outdoor gathering attended by between four and eight medics sitting under a tree with their packs.
“It’s very low profile because at any time there can be an attack. Anything that will call attention to yourself will likely make you a target,” said Peissel.
Humanitarians across South Sudan face threats to their lives as they carry out their work. On March 25, six aid workers from a Unicef partner were killed in an ambush as they traveled to a town in the eastern part of the country. At least 79 aid workers have been killed in South Sudan since 2013, according to the United Nations.
“Our health workers are living with these populations and are just as at risk as the civilians,” said Peissel of MSF’s mobile teams.
To ensure these makeshift clinics are working well, international MSF staff from Juba visit every month to do training and assessment. They have found that the dozen mobile clinics embedded within displaced communities receive double the patients that the Leer hospital once did.
In February, an attack by armed men on the swamp island of Loth in Leer County put MSF’s mobile tactics to the test, as patients and staff fled further into the swamp, along with medics and their moveable clinics.
“Small amounts of medication were destroyed,” Peissel said. “Within 24 hours we had resupplied our team and they were running a new clinic.”
To keep a low profile and leave quickly in case the situation deteriorates, this mobile medical team stays in the open air under a tree. (Photo: Nicolas Peissel/MSF)
Even when the bullets aren’t flying, lack of access is one of the biggest barriers to providing emergency health care. And South Sudan isn’t alone in facing these challenges. In the east of the Democratic Republic of Congo, teams of doctors and nurses have to trek for days through steep, water-logged land to give people life-saving vaccinations. In northern Kenya, mobile clinics come on four legs ― in the form of camels ― to reach semi-nomadic communities living on arid plains.
“Conflict takes a major toll on health,” said Peissel.
South Sudan is also one of the few countries that is home to almost all 18 illnesses designated by the World Health Organization as neglected tropical diseases.
“The renewed hostilities in South Sudan could portend a public health crisis from neglected tropical diseases,” he wrote.
Mobile medical teams may be one of South Sudan’s best chances of battling these illnesses, as well as expected spikes in malaria, diarrheal disease and respiratory infections, in the country’s most deprived areas.
This series is supported, in part, by funding from the Bill & Melinda Gates Foundation. All content is editorially independent, with no influence or input from the foundation.
If you’d like to contribute a post to the series, send an email to ProjectZero@huffingtonpost.com. And follow the conversation on social media by using the hashtag #ProjectZero.
Lymphatic filariasis, more commonly known as elephantiasis, is a leading cause of disability worldwide, according to the U.S. Centers for Disease Control and Prevention. It affects over 120 million people globally and can cause severe swelling of body parts, including the legs and scrotum. While people are usually infected in childhood, the painful, disfiguring symptoms of the disease only show up later in life.
Onchocerciasis
Onchocerciasis, commonly known as river blindness, is an eye and skin disease that can cause severe itching and visual impairment ― including blindness. Around 18 million people are infected. Of those, over 6.5 million suffer from severe itching, and 270,000 are blind. The disease is caused by a parasitic worm, transmitted through bites from infected blackflies. The worm can live for up to 14 years in the human body, and each adult female worm can be more than 1.5 feet long.
Chagas
Chagas disease is a potentially life-threatening illness. In the first months after infection, symptoms are mild, including skin lesions and fever. But in its second, chronic phase, up to 1 in 3 patients develop cardiac disorders, which can lead to heart failure and sudden death. The disease is transmitted to humans by “kissing bugs,” which live in the walls or roof cracks of poorly constructed homes in rural areas, according to the World Health Organization. Of the estimated 6 million to 7 million people affected worldwide, most live in Latin America, but the disease has also spread to the United States. Around 300,000 people in the U.S. have Chagas disease, according to the Dallas Morning News.
Dengue
Dengue is a flu-like illness that can sometimes be lethal. In 2015, more than 2 million cases of dengue were reported in the Americas. In some Asian and Latin American countries, “severe” dengue is a leading cause of serious illness and death among children. Dengue is spread by the Aedes aegypti mosquitoes, the same type of insect that transmits Zika. To reduce the risk of bites, WHO recommends covering water containers, using insecticide, having window screens and wearing long sleeves.
Human African Trypanosomiasis
Human African trypanosomiasis, commonly known as sleeping sickness, is a chronic infection that affects the central nervous system. People can be infected for years without signs, but in the second stage, patients can suffer behavior changes, hallucinations and even slip into a coma and die. Many people affected live in remote, rural areas that don’t have easy access to quality health services. This makes diagnosis and treatment more difficult. WHO has identified sleeping sickness as a disease that could be eliminated worldwide by 2020 if the right resources are dedicated to it.
Leishmaniasis
There are several forms of leishmaniasis, including visceral, which can be fatal, with symptoms including fever and weight loss; and cutaneous, the most common form, which causes skin lesions, leaving lifelong scars and disability. The disease, spread by sandflies, affects some of the poorest people on earth, according to WHO, and is associated with malnutrition and poor housing. Around 1 million new cases occur annually, causing 20,000 to 30,000 deaths. Leishmaniasis is climate-sensitive, affected by changes in rainfall, temperature and humidity ― which means it could be exacerbated by global warming.
Trachoma
Trachoma is an eye disease, which if untreated, can cause irreversible blindness. It causes visual impairment or blindness in 1.9 million people, per WHO. The disease is present in poor, rural areas of 42 countries in Africa, Latin America, Asia and the Middle East ― but Africa is the most affected.
Rabies
Rabies is almost always fatal once symptoms show up. Initial symptoms are fever and tingling around the wound. As the virus spreads, people with “furious” rabies become hyperactive and die by cardiac arrest; people with “paralytic” rabies become paralyzed, fall into a coma and die. Transmitted by pet dogs, rabies causes tens of thousands of deaths every year. The disease is present on all continents except Antarctica ― but more than 95 percent of human deaths due to it occur in Asia and Africa. It is a neglected disease primarily affecting poor populations, where vaccines are not readily available.
Leprosy
Leprosy is a chronic disease, which when untreated can cause permanent damage to the skin, nerves, limbs and eyes. There were 176,176 cases at the end of 2015, according to WHO. While the stigma associated with the disease means people are less likely to seek treatment, leprosy is curable, and treatment early on can avoid disability. Leprosy was eliminated as a public health problem in 2000 ― meaning there is now less than one case for every 10,000 people worldwide.
Schistosomiasis
Schistosomiasis is a chronic disease that causes gradual damage to internal organs. Symptoms include blood in urine, and in severe cases, kidney or liver failure, and even bladder cancer. Around 20,000 people die from it each year. Transmitted by parasites in infested water, the disease largely affects poor, rural communities in Africa that lack access to safe drinking water and sanitation. “[People] get it as kids bathing in water,” Sandrine Martin, a staff member for the nonprofit Malaria Consortium in Mozambique, told HuffPost. “But the symptoms, like blood in the urine, only develop later ― and then people tend to hide it because it’s in the genital area.”
Chikungunya
Chikungunya is a disease that causes fever and severe joint pain, according to WHO. While it is rarely fatal, it can be debilitating. Since 2004, it has infected more than 2 million people in Asia and Africa. There is no cure for the disease, which is transmitted to humans by infected mosquitoes. The name comes from a word in the Kimakonde language, spoken in some areas of Mozambique and Tanzania, that means “to become contorted” ― a nod to the hunched-over position of people who are affected with joint pain.
Echinoccosis
Echinoccosis is a parasitic disease that leads to cysts in the liver and lungs. While it can be life-threatening if untreated, even people who receive treatment often have a reduced quality of life, according to WHO. Found in every continent except Antarctica, the disease is acquired by consuming food or water contaminated with tapeworm eggs, or through direct contact with animals who carry it, such as domestic dogs or sheep.
Foodborne Trematodiases
Foodborne trematodiases can cause severe liver and lung disease, and on rare occasions death. Most prevalent in East Asia and South America, the disease is caused by worms that people get by eating raw fish, shellfish or vegetables that have been infected with larvae. While early, light infections can be asymptomatic, chronic infections are severe.More than 56 million people were infected with foodborne trematodes, and over 7,000 people died in 2005, the year of WHO’s most recent global estimate.
Buruli Ulcer
Buruli ulcer is a skin infection caused by bacteria that often starts as a painless swelling, but without treatment, it can lead to permanent disfigurement and disability. In 2014, 2,200 new cases were reported, with most patients under age 15. The exact mode of transmission is still unknown. The majority of cases, if detected early enough, can be cured with antibiotics.
Yaws
Yaws is a chronic, disfiguring childhood infectious disease. Affecting skin, bone and cartilage, the symptoms show up weeks to months after infection and include yellow lesions and bone swelling. More than 250,000 cases of yaws were reported from 2010 to 2013, WHO told HuffPost. A lack of clean water and soap for bathing contributes to its spread. Only 13 countries are known to still have cases of yaws, including Ghana, Papua New Guinea and Solomon Islands.
Soil-Transmitted Helminth
Soil-transmitted helminth infections are among the most common infections worldwide and affect the poorest communities. People are infected by worms transmitted by human feces contaminating soil in areas with poor sanitation. People with light infections usually have no symptoms. Heavier infections can cause diarrhea, abdominal pain, general weakness and impaired cognitive development. Depending on the number of worms, it can lead to death. Up to 2 billion people are infected worldwide, according to WHO. But because infections can be light, not all patients suffer, WHO’s Ashok Moo told HuffPost.
Taeniasis
Taeniasis is an intestinal infection caused by tapeworms, which mostly causes mild symptoms, such as abdominal pain, nausea, diarrhea or constipation. But if larvae infect the brain, causing neurocysticercosis, the disease can cause epileptic seizures and can be fatal. People get it by eating raw or undercooked infected pork. The ingested tapeworm eggs develop into larvae and migrate through the body. Taeniasis is underreported worldwide because it is hard to diagnose in areas with little access to health services, according to the CDC.
Guinea Worm
Guinea worm is a crippling disease that it is close to being eradicated. There were only 22 human cases reported in 2015, according to WHO ― down from around 3.5 million cases in 21 countries in the mid-1980s. The disease is usually transmitted when people with limited access to quality drinking water swallow stagnant water contaminated with parasites. About a year after infection, a painful blister forms ― most of the time on the lower leg ― and one or more worms emerge, along with a burning sensation. It is rarely fatal, but can debilitate infected people for weeks. The Carter Center, founded by former President Jimmy Carter and his wife, has been instrumental in efforts to eradicate the disease.
Affluent Americans may want to double-check how much of their bank deposits are protected by government-backed insurance. The rules governing trust accounts just changed.
Former NBA guard Darius Morris has died at the age of 33. He played for five teams during his four NBA seasons. Morris played college basketball at Michigan.
Teams have made their big splashes in free agency and made their draft picks, it's time for you to do the same. It's fantasy football mock draft time. Some call this time of year best ball season, others know it's an opportunity to get a leg up on your competition for when you have to draft in August. The staff at Yahoo Fantasy did their first mock draft of the 2024 season to help you with the latter. Matt Harmon and Andy Behrens are here to break it all down by each round and crush some staff members in the process.
It’s key to note that we’re not saying the “best team” or “best roster.” Instead, we’re talking about the best confluence of factors that can outline a path for survival and then success.
With free agency and the draft behind us, what 32 teams look like today will likely be what they look like Week 1 and beyond for the 2024 season. Matt Harmon and Scott Pianowski reveal the post-draft fantasy power rankings. The duo break down the rankings in six tiers: Elite offensive ecosystems, teams on the cusp of being complete mixed bag ecosystems, offensive ecosystems with something to prove, offenses that could go either way, and offenses that are best to stay away from in fantasy.
The average 30-year fixed mortgage rate edged back toward 7% this week but remains elevated, prompting housing experts to revise their forecasts for the rest of 2024.
Jake Mintz & Jordan Shusterman discuss the Padres-Marlins trade that sent Luis Arraez to San Diego, as well as recap all the action from this weekend in baseball and send birthday wishes to hall-of-famer Willie Mays.
![Schistosomiasis is a chronic disease that causes gradual damage to internal organs. Symptoms include <a href="http://www.who.int/mediacentre/factsheets/fs115/en/" target="_blank">blood in urine</a>, and in severe cases, kidney or liver failure, and even bladder cancer. Around 20,000 people die from it each year. Transmitted by parasites in infested water, the disease largely affects poor, rural communities in Africa that lack access to safe drinking water and sanitation. “[People] get it as kids bathing in water,” Sandrine Martin, a staff member for the nonprofit <a href="http://www.malariaconsortium.org/pages/who_we_are.htm" target="_blank" data-saferedirecturl="https://www.google.com/url?hl=en&q=http://www.malariaconsortium.org/pages/who_we_are.htm&source=gmail&ust=1480609103751000&usg=AFQjCNG03VPF1XL5zli4__XAjDWpDmBOvw">Malaria Consortium</a> in Mozambique, told HuffPost. “But the symptoms, like blood in the urine, only develop later ― and then people tend to hide it because it’s in the genital area.”](https://s.yimg.com/ny/api/res/1.2/9f9As.sw0iNn_ENR93iBhA--/YXBwaWQ9aGlnaGxhbmRlcjt3PTk2MA--/https://img.huffingtonpost.com/asset/5845a09e1700002500e7dd42.jpg)
