Improving care one step at a time in West Darfur

MSF nurse Aghendia Alemngu worked in Geneina Teaching Hospital in West Darfur. Sudan, 2021. © MSF


Aghendia Alemngu Nurse Sudan

I first encountered Doctors Without Borders/Médecins Sans Frontières (MSF) in my home country of Cameroon in February 2014 when I was working for the Ministry of Health at a district hospital close to the border with Central African Republic. There was a huge influx of refugees and we were overwhelmed with patients. MSF sent in a team to do an assessment and quickly established a project to support the refugees. There and then I said I had to work for MSF before I died.


I was working in the maternity unit. The number of women coming in to give birth soared and we had problems treating premature and severely underweight babies. The MSF team set up a neonatal unit using tents next to the maternity unit and introduced what became known as the “magic box”: a locally constructed incubator made from wood and foil survival blankets.


The “magic boxes” saved many lives, and made me realize you don’t always need a lot of technology to make a difference. Small changes adapted to the medical reality of a particular context, a bit of creative thinking and a strategic approach can be transformative. I’ve seen this first-hand in Geneina Teaching Hospital, West Darfur, where I am just finishing my assignment.

Geneina, the capital of West Darfur state, has been affected by sporadic intercommunal conflict for many years. Thousands of people have had to escape the violence, leaving behind their homes and livelihoods. Even at the best of times, people suffer from a shortage of nutritious food and poor water and sanitation conditions, while medical care is sparse and expensive.

MSF has been supporting the hospital in Geneina since mid-May [2021]. The focus has been on training the current staff on things like triage, mass casualty planning and infection prevention and control measures. We also run mobile clinics that visit the “gathering sites” – areas where people who have had to flee the violence are now living.

I have been spending my time in the hospital’s malnutrition ward, working with the Ministry of Health team to care for malnourished children under the age of five.

We’ve been seeing a rise in malnutrition. Many of the parents I spoke to told me work is precarious and they have to make difficult choices about what to spend money on and when they eat. Lots of families here are going hungry or eating nutritionally poorer diets.

The mother of a child admitted to our care told me that after losing her husband in the last conflict, food became a constant struggle. Some days she would have to leave her child’s bedside and work carrying bricks, just to scrape some money together to eat.


The 51-bed malnutrition ward, where we treat complicated cases of malnutrition, is already 85 to 90 per cent full.

Sometimes we can be overwhelmed by the challenges of a task. But during my time in Geneina, I’ve tried to remind myself small changes can lead to big results, just like I’d seen in Cameroon.

In Geneina, I saw how motivated the hospital’s doctors and nurses are. They are all eager to further develop their skills and enhance care in a difficult environment. We worked together to develop their skills, and to identify new ways of working that could benefit our patients.


As I come to the end of my assignment here, I can already see improvements to hygiene, sanitation and other infection prevention and control measures, as well as in documenting patient files. These changes might seem small, but they are key to protecting patients, caretakers and health personnel. This includes an 18-month-old patient we treated on the malnutrition ward. She was unable to eat because she had lesions in her mouth, but after 13 days on the ward she had improved enough that we were able to discharge her.

© Stephan Oberreit