A 'Runaway Bag' For Health Care When People Are Fleeing

In South Sudan, millions of people have been on the run, fleeing violence since civil war broke out in December 2013. The U.N. is calling it the world's largest refugee crisis.

Health workers are on the run, too.

How do they tend to the needs of civilians in perpetual flight? Doctors Without Borders is testing a new strategy: a "runaway bag."

It's a backpack made of waterproof canvas and weighing about 12.5 pounds when fully packed. What's inside? Antibiotics, painkillers, anti-malaria medicine (and a rapid test), material to bandage wounds, oral rehydration solution, water purification tabs and a pen and a register to record what has been handed out. A single bag is meant to carry enough supplies to treat 50 to 70 people over a period of about two weeks, says MSF, the abbreviation for Medecins sans frontieres, as the group is called in French. The idea is to enlist local staff to carry the bags if a mass evacuation occurs.

In the early stages of development, MSF thought some of the bags should carry a satellite phone and have solar panels for recharging. Then the staff realized that a bag with a high-tech device might look as if it belonged to a member of an armed group. So MSF scrapped that idea.

The bags were also designed to appear generic: They're black with a small MSF logo on the back. MSF doesn't want people wearing them to become targets on either side of the conflict.

The idea for the runaway bag came from the organization's displacement unit, a team in Nairobi that supports "failed missions." They talked to MSF staffers in South Sudan who were putting sacks of medicine on boats that served as operating mobile clinics in swamps.

"We were late for people fleeing," says Ana Santos, the head of the displacement unit, referring to a government offensive in January 2016 in South Sudan's Upper Nile.

That's when mortars were fired into a marketplace in the town of Wau Shilluk. It was an atmosphere of chaos. "People didn't have a chance to go home, to take their things. They just grabbed their kids and ran out of town," says Philippe Carr, an MSF communications adviser. Some ran into the surrounding bush, while others made their way to villages in the north for safety. MSF's hospital was evacuated, looted and now sits as "just an empty shell of a building," says Carr.

Santos says the 30,000 people who fled Wau Shilluk had no access to health care for at least two weeks. They were walking long distances with scarcely any possessions. Even the healthiest among them were at risk of dehydration. They might injure their feet. They could catch malaria from mosquitoes along the way. And during the dry season, they might turn to stagnant swamp water in a desperate attempt to drink. Santos wanted to create something "very specific for the conditions you have if you're walking two weeks in that setting."

Even without the health risks, the journey on foot is dangerous. Santos says some civilians who fled were robbed and assaulted, and her team received a report of bags being taken by force.

Amnesty International documented how, in addition to homes being looted and torched with elderly people inside, government troops were shooting people in the back as they tried to run.

Santos didn't know how quickly the runaway bags, first thought up in February, would be put to use. By April, an outbreak of fighting between government and opposition forces caused some 25,000 people to flee Kodok, a town where thousands of people had resettled three months after leaving Wau Shilluk. Santos says that 29 health workers, each carrying a runaway bag, followed the fleeing population.

Ten runaway bags are currently at the ready in Aburoc, a small village. It was a major destination for people fleeing Kodok in April. But in May, a scarcity of food and water, in addition to nearby fighting, caused about 20,000 people to flee Aburoc for the neighboring country of Sudan. And this fall, the sound of artillery fire was heard near MSF's 12-bed Aburoc medical facility.

Thomas Quinn, director of Johns Hopkins Center for Global Health, thinks the runaway bag is a useful idea. He compares it to a doctor's bag but with more room for supplies. And he says backpacks leave the arms free so the medical staff can help as many patients as possible: "When you gotta move fast, nothing helps you move faster than backpacks."

Not every aid group thinks a bag is the solution. It's a different approach than that of the International Medical Corps, says IMC senior health adviser Jill John-Kall. IMC asks its staff, local or foreign, to wait in vehicles at various points along the route where the population might be moving in search of safety. The health workers treat dehydration, diarrhea and other afflictions often found in people who are displaced. Sometimes locals open their homes to medical staff so they can serve people. Still, John-Kall agrees, "It's extremely important to keep monitoring people that are continuously displaced. With each displacement, they become that much more vulnerable."

MSF doesn't claim that its runaway bags can help an entire population on the move. And it's still ironing out the kinks based on early feedback from two people who carried runaway bags. Both of them had followed a flow of people who crossed the border into Sudan. One runaway bag carrier reported that he gave oral rehydration solution to five people but wished the backpack included asthma medication.

Aziz Harouna, MSF's medical coordinator in South Sudan, says the new fleet of bags prepared in Aburoc about a month ago are improved. "There are some items we have removed in order to make the bag less heavy," says Harouna, such as liquid infusions for intravenous rehydration. That change has lightened the load. As a replacement, there's more oral rehydration solution, which doesn't require a trained health worker to administer it.

The organization says the bags are a way to reach people when helicopters or mobile patrols aren't an option. "In this case, we measure our impact not by the volume of people we help, but by how we potentially save individuals on their journey," says Santos. MSF is considering putting runaway bags in volatile parts of Latin America, too.

People fleeing violence aren't necessarily thinking about the medical items they'll need in their escape, says Santos. They're terrified. But if they know that health workers along the way are carrying these bags, she says, "it will give [them] the strength to go that extra step."

Sasha Ingber is a multimedia journalist who has covered science, culture and foreign affairs for such publications as National Geographic, The Washington Post Magazine and Smithsonian. Contact her @SashaIngber.

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