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South Sudan: Medicine on the Go

13 April 2017

Entire villages have been burnt to the ground during ongoing clashes. There are continual reports of gross human rights violations perpetrated by various armed groups operating in this area.

People have been displaced from their homes multiple times, or have fled the area completely. Many of the current 120,000-strong population of the UN protection of civilians (PoC) site in Bentiu originate from this southern area of the former Unity state.

Photo: Siegfried Modola

Following the restarting of conflict in July 2016, the population again had to flee, while Doctors Without Borders (MSF) had to evacuate international teams from both Leer and Thonyor. In September, MSF set up a mobile basic healthcare programme to continue to reach the population. Through a network of community health workers, community health promoters and women’s health promoters – themselves part of the affected population – MSF has been able to continue to provide healthcare.

Photo: Siegfried Modola

We take off early in the morning from the international airport of the capital Juba on an MSF flight. The airport in Juba is a hub of humanitarian activity: numerous aid organisations are trying to supply the population of the country, who are in desperate need of even the most basic services.

I am on the eight-seater plane with MSF medic Dr Philippa Pett and MSF security focal point Georg Geyer, our team leader. It is a nearly two-hour flight to Thaker in Leer county to the north of South Sudan.

The plane is full of medical supplies and other equipment needed for our stay in the bush for the next eight days. We land on a dusty and windy space of open bush. It’s a scene of desolation. At a distance are several tukuls [mud huts], but few people can be seen.  

Photo: Siegfried Modola

Nyalolah*, 16, attends the clinic with the help of her relatives, giving a history of episodes of collapse which we witness shortly after she arrives. During these episodes she becomes unresponsive and her whole body goes tense.

Dr Philippa tells me that the cause is unclear as the physical examination has not revealed any abnormalities, the episodes do not show features of epilepsy and the tests that they have, although very limited, have all been negative. In this setting it is difficult to manage these types of cases.

Another woman arrives with her daughter who shows signs of severe malnutrition. The baby looks much younger than her real age.

Photo: Siegfried Modola

An old woman arrives escorted by a relative – she walks slowly, supported by the other woman. Some of the people I meet have come a long distance for the chance to receive medical treatment.

Another woman lies on the ground in the queue to be seen; she is too weak to sit up straight.

A pregnant woman is stabilised after becoming unconscious.

In the three days I’m in Thaker, the MSF team treats more than 600 patients.

Photo: Siegfried Modola

James*, 33, is an MSF community area supervisor. He has been working for MSF for one year and he is the team leader in this location. He explains the perils of his work.

“It is a dangerous job that we do as health workers. We follow the population wherever they are or go. Once I spent eight hours with others in the swamps to hide from gunmen. Five people were shot and died around me during this time. I remember seeing a mother holding her child, trying to breastfeed him. She didn’t know the child had died. I love this job nevertheless. I love serving my community. People need medical care. They need us to be here to help them. Many are dying because they can’t reach a hospital in time. Many children are dying because of malnutrition and because they don’t have the appropriate vaccines,” says James.

Photo: Siegfried Modola

Richard*, 34, is an MSF community health worker. He has been working with MSF since 2013. In 2013 the project in his area was stopped because of insecurity.

“We work in an area of great insecurity. Because of this, the biggest problem for people here is a lack of food and medical care. We really have to concentrate and use at best what MSF supplies to us on a weekly basis,” says Richard.

Photo: Siegfried Modola

Georg Geyer, MSF security focal point, our team leader in this assignment, explains the difficulties of working in South Sudan:  

“I have worked for MSF in over eight countries but South Sudan has proven to be a very hard place to operate. I can clearly see the great needs of people here. They need food, medicines. Access in such areas of great insecurity can be a real challenge. I am responsible for my team. I need to keep them safe,” says Georg.

Photo: Siegfried Modola

 

Women, children and men queue be treated at an MSF outdoor support clinic in Thaker, Leer County, South Sudan. 

Photo: Siegfried Modola

Kuel* poses inside her Tukul in Thaker, Leer County, South Sudan. 

Photo: Siegfried Modola

Relatives comfort a woman who has fallen sick as they wait to be seen by a doctor at an MSF outdoor support clinic in Thaker, Leer County, South Sudan. 

Photo: Siegfried Modola

Doctors Without Borders (MSF) Medic, Philippa Pett (centre), MSF Community Area Supervisor James* (right) treat a woman who has fallen sick, at an outdoor support clinic in Thaker, Leer County, South Sudan. 

Photo: Siegfried Modola

Doctors Without Borders (MSF) Community Health Promoter, Gatbel*, tests a child for malaria at an outdoor support clinic in Thaker, Leer County, South Sudan. 

Photo: Siegfried Modola

A woman with pregnancy complications is escorted inside an MSF airplane for referral to a MSF hospital, Thaker, Leer County, South Sudan.

Photo: Siegfried Modola

Patients queue to receive medicines at a Doctors Without Borders (MSF) outdoor support clinic in Thaker, Leer County, South Sudan. 

Photo: Siegfried Modola

People sleep underneath mosquito nets at an outdoor support clinic in Thaker, Leer County, South Sudan. 

Photo: Siegfried Modola

People walk hours before arriving at a Doctors Without Borders (MSF) outdoor support clinic in Thaker, Leer County, South Sudan.

Photo: Siegfried Modola

South Sudan, which split from Sudan in 2011 after decades of conflict, has been mired in a civil war between the Dinkas and the Nuer, following political troubles between President Salva Kiir and his former deputy Riek Machar. The country is the world's newest nation. It is rich in oil but, following years of war, it is also one of the least developed regions on earth.

The fighting of the past three years has forced millions to flee their homes, split much of the population along ethnic lines and paralysed agriculture, leaving the country facing famine, according to the UN. The UN says that at least one-quarter of South Sudanese have been displaced from their homes. The southern part of the former Unity state, the home region of Riek Machar, has been greatly affected by the ongoing violence and the longstanding clashes between the government’s Sudan People's Liberation Army (SPLA) and the Sudan People's Liberation Army-In Opposition (SPLA-IO).

Civilians are paying the highest price, as they are on the frontline of the conflict. Local people are unable to access even the most basic services needed to survive.

Siegfried Modola, a freelance photographer, spent a week with the teams in Leer county and has reported about the MSF challenging operations and the living conditions of the population, three years into the conflict. 

Visit the exposure page to read more about the situation in South Sudan.