Here in South Sudan

I have now been in South Sudan for nearly a month.

Juba is one of the most expensive cities in the world.  As the capital of the world’s newest country (South Sudan, which gained it’s independence from Sudan, just had it’s first anniversary on 9 July 2012) it is a created capital situated on the Nile.  It has grown very quickly, and there is a huge international population here with all the diplomatic corps and non-governmental organizations (NGOs – like us) based here.  So there are a lot of good restaurants – Thai, Indian, Ethopian, Italian, etc – but they are VERY expensive.  The Dinkas, who are the majority of the population, are herders so there is meat, but everything else must come from neighboring countries such as Kenya, Tchad, and Congo-Kinshasa making those products expensive also.  Fortunately, the do make (and consume) their own beer.

South Sudan’s primary resource is oil.  Unfortunately, the country is land-locked.  The pipelines to a seaport run through Sudan, its old enemy.  For the moment, the pipeline has been shut down, while South Sudan and Sudan haggle over the price of passage through Sudan for this precious product.  So no money is coming into the country.

At the same time, there is still fighting in Sudan just north of the border of South Sudan’s Unity State.  That is why many Sudanese living in that region have fled south into South Sudan.  And this flight has increased recently.  The camp in Yida, where MSF is working, grew from 20,000 people in May to an estimated 65,000 people last week.  The host community of Yida is about 700 people. 

We have been cooperating with several other NGOs and UN agencies to provide some infrastructure to the refugees.  Our part in all of this, since November 2011, has been to operate an out-patient clinic and a hospital, serving both the local population and the refugees.  We have also done some distribution of non-food items and have recently set up 3 outposts distributed within the camp to treat malnourished children.  

Obviously, with the increase of the size of the camp and with people arriving in worse and worse shape, we have had to greatly expand our out-patient and hospital facilities (which are housed mainly in tents) and the staffing to take care of these people.  There are no sanitary facilities either.  People have been urinating and defecating in the areas around their homes.  With the hot, dry weather, this was not so bad, but the rainy season started about a month ago, and this practice now creates a serious health hazard.  We will be cooperating with some other organizations to build communal latrines (out-houses) in the camp.  Using standard numbers of 1 latrine per 20 people, this means a total need in the camp of over 3,000 latrines!  We have committed to build 200 over the next few weeks.

I mentioned the start of the rainy season.  This is one of the defining phenomenas of South Sudan.  Rainy season starts end of July – early August and lasts until sometime in November.  During this time huge areas are flooded and roads are no longer passable.  Already, to get people in and out of the Yida camp we must rely on airplanes and helicopters – our own and those of the U.N.  (The camp, which is V-shaped has a short dirt runway running up the middle of the V.) But during the rainy season, all freight also has to go by air.  And because the runway is very short and becomes dangerous when wet, we can only fly in helicopters or Cessnas (with a small payload) during this time.  Right now, this airfreight capacity is the biggest limiting factors to our work.

For example, we currently have 872 malnourished children in our therapeutic feeding program, and the number is growing every week.  Just to treat these children we need around 200 boxes of therapeutic foods per week, about 3 tons.  That alone is the capacity of freight we have using our own plane.  And within the next 2 weeks are receiving about 25 tons of medical supplies plus more tonnage in logistical items for the latrines, plus a tractor (used to pull the Toyota landcruisers out of the mud when necessary).  All of this must be moved to Yida from 2 or 3 other airports as quickly as possible.  Our logisticians are pulling their hair out right now to find airplanes, helicopters, intermediate storage, and people to assure arrival of everything.

I arrived in Juba on 5 August, and made my first trip to the Yida camp about a week later, for 4 days.  We have a residence compound, again in tents, for around 22 people plus visitors.  It is adjacent to the hospital.  They were just moving from the old site to the new when I was there.  It should be much better now – they had completely outgrown their capacity already, and soon they will be 30 people living there.  The hospital has grown from 2 tents to 9.  The workload is tremendous – people were getting tired and sick.  

But with the new facilities, and the increase of staffing, we are slowly coming out of the emergency phase.  Our people have better living conditions, the residence sanitary conditions have improved, and the hospital mortality rate has dropped.  All of this greatly helps the health and moral of the team.

I will be returning to the camp this week for about 8 days.  There is still plenty of work to do.  I should be returning to France sometime in the beginning of October for 10-14 days.  Besides taking a break, I will be picking up my renewed French residence visa (which has been waiting for me since the end of July – I hope) and obtaining a second passport (working with the emergency department, that will allow me to have one in Paris for them to get new visas in one while I am in the field with another).  I will also be debriefing with the department heads on my time in Mali and South Sudan.  As of now, it is unclear if I will be returning to South Sudan afterwards, or if I go elsewhere.  It depends on the evolution of the situation here, and the emergence of other needs somewhere else.  I love this life!