I landed in August – I was told I was coming to research and analyse the situation in Southern Unity State, in the north of South Sudan. We wanted to reach the communities we were working with before the clashes in July and see if it was safe for us to restart our programmes.
Before the clashes we had two clinics – both with five inpatient beds and three maternity beds. We were also running mobile Primary Health Care clinics, small mobile teams going out into the community, offering basic healthcare. They covered eight large areas around Leer, a small town in Unity State. Without them, the tens of thousands of people living in this area don’t have access to even basic healthcare provision.
Then the clashes happened and in the process, both our clinics were looted and the population, including our own staff, ran. For their lives.
So here I am, landed in Juba, the capital of South Sudan, and handed a list of names and phone numbers of our former staff. Go.
First things first, I talk to the coordination team here in Juba to work out what we know. Then I try to contact the former outreach supervisor – the manager of our outreach teams. He tells me the situation is OK and we discuss trying to get two team members back to the area along with some essential medication.
I begin to arrange just that with the team in Juba. The night before we're due to load the plane with the medication I receive a text: “Man we are on the run. I will call you when I have time”. Cue 18 hours of worrying.
No matter how used to this danger people are and how normal this is for them, it doesn’t make it any easier or more acceptable. This man is just one of thousands upon thousands of people in South Sudan who are forced to spend their lives in cycles of running. Who or which side they’re running from doesn’t matter, this is what is happening throughout the country.
I spend the night and following day anxiously waiting to hear he is OK. In the meantime we make the difficult decision not to send supplies. We have no one to receive them at the other side and no idea if we would be able to get them to where they are needed.
Finally the call comes; he and his family are OK. I am relieved, it means we can now send the supplies along with the two additional team members who have been trying to return home from training in Kenya. We’ve spent weeks trying to get this essential equipment to where it is needed.
On top of this, all the time I’ve been here I have also been trying to reach Marco, another key team member who no one has heard from in the last week. We don’t even know if he is alive. After a week of no news I finally get a text. His phone had been water damaged while he was running but he was fine and would be in touch again when he could.
A new phone has now been sent with one of the team. Once they’ve delivered the medications they’re going to try and find Marco. It will probably take a two-day walk to do so.
When we talk about the challenges of getting access to different places and communities, I think it is almost impossible to really articulate what that means to someone who isn’t here. But just all the work it has taken to get in touch and coordinate two members of staff demonstrates a fragment of daily life here. Trying to find our staff members after a flare up of violence, trying to locate somewhere to land the plane or a boat to reach the islands. Nothing is simple.
The easy place for us to re-establish our activities is where the population - our patients - is not. The locations that MSF are still working in are on the other side of the frontline from the people. Restarting activities in the same places again puts the people at risk of being shot, captured or raped, as they would have to cross the frontline to reach us. So instead of asking people to come to our clinics, we have to expand our community health worker and outreach programme behind the frontline, so that we can offer enough assistance to truly help and treat people, but not so much that if the population moves we can’t move with them.
The rains are coming
We were running a project just like this in Northern Unity State three years ago when I was last here, where we re-established a project doing local primary healthcare. And so I know from bitter experience that it’s hard in the rainy season… really hard. The only way you can get everywhere is a helicopter and the only way you can get to some places is by plane, canoe or on foot.
But one good thing about the rains is that as long as the weather stops us moving, the fighting can’t move either; at least not as easily.
The intent from our team is here, and we aren’t giving up. But it’s hard, and whether we like it or not, it might not be up to us. I feel a sense of responsibility for these people but the truth is – how do we respond in a place where there is a marked diminishing of respect for humanitarian work?
And on top of all this, NGOs across South Sudan are leaving. Whether it’s because of a lack of funding, security concerns or the fact that they, like us, just aren’t sure what to do next, I don’t know. As an organisation which relies entirely on public donations we are in a unique position, we can and will continue to respond in South Sudan – our largest humanitarian response in the world. But for other organisations, who rely heavily on government grants, it has become clear that the money and willingness just isn’t there like it was three years ago.
The truth is, I just can’t work out what we need to do to help these people in a meaningful way at the moment, because there is no easy or clear option. But one thing I do know, is that we will continue trying.
Haydn at work. Photo: Gemma Gillie / MSF