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Community health workers: A lifeline for communities trapped by violence

23 Jan 24

Community health workers: A lifeline for communities trapped by violence

5 December 2022 

Mostly mothers, but also some fathers are waiting with their children and babies in the waiting and triage area of the MSF run paediatrics department at the El Geneina Teaching Hospital.  Caption
Mostly mothers, but also some fathers are waiting with their children and babies in the waiting and triage area of the MSF run paediatrics department at the El Geneina Teaching Hospital. 
© Susanne Doettling/MSF

El Geneina, West Darfur, Sudan - “During the last violent events here, the team did a great job to help and provide first aid to the injured and then referred them to the closest clinics.” explains Entisar Mohammed Khamis, MSF health promotion team supervisor in El Geneina, who managed 10 trained community health workers (CHWs) living in different gathering sites.

 

In April 2022, community health workers – men and women from displaced families who serve their own communities – assisted and stabilised wounded people during days of active fighting in El Geneina, the capital of West Darfur state, Sudan. The community health workers provided assistance when teams from Médecins Sans Frontières (MSF) and other healthcare providers could not move due to the fighting.

Emily Wambugu, Kenyan nurse and midwife, MSF PMR in El Geneina Teaching Hospital project in the triage area of the MSF run paediatric ward. Caption
Emily Wambugu, Kenyan nurse and midwife, MSF PMR in El Geneina Teaching Hospital project in the triage area of the MSF run paediatric ward.
© Susanne Doettling/MSF

Around 200 people were reportedly killed during the violent attack on Kreinik town in April, located about 80 kilometres from El Geneina. Within hours the violence had also reached the state capital. Many more people were wounded and nearly 87,000 people displaced, thousands not for the first time.

 

“The day the fighting came to the shelter and our neighbourhood, I heard heavy shooting. Me and my children, with other families, fled for our lives.” Says Ekhlas Abu Bakr Ali, who returned shortly after with some families and continued to work as community health worker with MSF when our team restarted a mobile clinic in an empty school building in May. We chose the school as it was centrally located and accessible for different surrounding communities of displaced and host families.

MSF mobile clinic in El Geneina in gathering site in a school structure. The clinic is held in a classroom, the site’s makeshift shelters are still there, but the families who had lived there fled from the last fighting end of April. Caption
MSF mobile clinic in El Geneina in gathering site in a school structure. The clinic is held in a classroom, the site’s makeshift shelters are still there, but the families who had lived there fled from the last fighting end of April.
© Susanne Doettling/MSF

For decades Darfur is caught in a cycle of violence and displacement, uprooting families and robbing whole communities of their livelihoods: livestock, crops and farmland. Violent attacks in West Darfur have again increased over the two past years.

 

Ekhlas found refuge in a small and stifling hot room with nine other women plus their children in the school building. She was displaced with her children several times in the past couple of years. “I like my job. We are visiting people in their homes in the gathering sites to reinforce good hygiene practices with them. I would like to return home once it’s safe, where we used to live and work. We had farmlands and worked in agriculture.”

Ekhlas is working as a Community Health Worker with MSF in El Geneina in the gathering site and lives with 9 more people in a room of the empty school building where MSF once a week conducts the mobile clinic.  Caption
Ekhlas is working as a Community Health Worker with MSF in El Geneina in the gathering site and lives with 9 more people in a room of the empty school building where MSF once a week conducts the mobile clinic. 
© Susanne Doettling/MSF

Our teams set up a decentralised model of care in and around El Geneina. They trained community health workers and volunteers and equipped them with emergency medical kits. They guarantee access to healthcare, at all times, and especially during peaks of violence when people are trapped, which was the case during the attacks in April.

 

MSF-trained community health workers played a vital role to guarantee first aid for people unable to access healthcare facilities during the fighting. They live in some of the over 100 informal gathering sites spread throughout the city, which today host more than 100,000 people who have fled recurrent episodes of deadly violence.

MSF clinic in El Geneina in gathering site in a school structure, which is known and accessible from several other nearby gathering sites in the city.  Caption
MSF clinic in El Geneina in gathering site in a school structure, which is known and accessible from several other nearby gathering sites in the city. 
© Susanne Doettling/MSF

“We work [-ed, in June 2022] in five gathering sites and in each, we have two community health workers. We work with dozens of other community health workers [who are not MSF employees but who receive incentives]. The team spreads health messages to people and displaced families to improve health practices and raise awareness among the communities on communicable diseases and how to protect themselves and their households. They conduct nutrition screenings for children. We also work with community leaders who attend awareness sessions and help spread the messages.” describes Entisar the team set up in June.

Entisar is the MSF health promotion team supervisor in El Geneina. She manages 10 trained community health workers (CHWs) who are living in five different gathering sites.  Caption
Entisar is the MSF health promotion team supervisor in El Geneina. She manages 10 trained community health workers (CHWs) who are living in five different gathering sites. 
© Majd Aljunaid/MSF

Hidar Abugassim Adam at the gathering site in the Sudan Open University compound, explains what motivates him to work as a community health worker: “We are out in the gathering sites six days a week explaining how to maintain good hygiene and prevent the spread of disease, and to discourage the children from playing around dirty water. There is lots of diarrhoea and malaria here. I get to help my family and community. I am studying nursing at university. I love helping people and that’s what nurses do.”

 

Community health workers provide basic healthcare, conduct health education sessions, stabilise the sick and injured. In the first half of 2022 they arranged 90 per cent of the referrals to clinics and hospitals in El Geneina.

 

In the coming months MSF will replicate the decentralised model of care in host and displaced communities in and near the town of Kreneik.