‘We have known nothing good', say impoverished South Sudan citizens

Nyanhial Chan Thiep wrings out a beige cloth, sending water droplets cascading onto the half-naked body of her six-month-old son, Goemar Gathyang Kai. The boy cries as the cool water touches his skin.

The child is sick, and had been for two weeks when the Sunday Times encountered him and his mother at a field hospital in South Sudan. When Thiep took Goemar to a doctor on February 17 he was convulsing. He had been ill for three days. His temperature was high — in the high 30s and occasionally spiking above 40.

His life was hanging in the balance.Two-and-a-half weeks later, on March 3, Goemar was recovering. His temperature was still high during the day, hence the damp cloth to cool his tiny body. But he was stable. He would go home soon afterwards.

Goemar was being treated at the Médecins Sans Frontières (MSF, or Doctors Without Borders) hospital in Leer, South Sudan. The facility is small, made up of mostly tented structures. It is in a small, war-ravaged village in Unity state, 420km north of the capital, Juba.

“I brought him here because I knew he would get treatment,” Thiep says, looking up from the mattress on the floor.

Sunday Times photographer Thapelo Morebudi and I were given rare access to the hospital, granted interviews with local and foreign doctors and nurses, and patients — and were allowed into the maternity tent when two babies were born just minutes apart.

Hours later we would hear the tormented midnight cries when another baby didn’t make it.

Goemar is too young to know it, but he is lucky to be alive.

In 2011 South Sudan gained independence after a bloody war with Sudan. But instead of bringing prosperity, life in the world’s newest country only got worse when rival factions turned on each other.

After 12 deals that did not bring an end to hostilities, opponents have once again agreed to re-commit to peace in 2020.

Leer suffered much of the violence that has characterised South Sudan’s brutal civil war. Stories of cruelty, murder, torture, rape and other human rights abuses are rife. Amnesty International reports that war criminals acted with impunity — “Anything that was breathing was killed.”

The violent past continues to haunt the villages and villagers around Leer. There is also malnutrition, disease and extreme poverty. Shells of destroyed vehicles litter the route between the gravel airstrip and the MSF hospital.

At least one tank lies in ruin on the side of the road.An old MSF hospital on the outskirts of town is nothing more than crumbling walls and cracked paint, its corrugated-iron roof, solar panels, medicines and equipment looted as government-aligned forces tore through in 2015.

At the airstrip, an orange-red shipping container is a remnant of a particularly cruel war atrocity. In October 2016, 60 men and boys were locked inside the metal box with their hands tied behind their backs and left to die a slow death through heatstroke and suffocation.

According to a report published by the London School of Hygiene and Tropical Medicine, almost 400,000 people have died in the internal conflict, almost half of them from disease and hunger.

The scars of the repeated bouts of violence — physical, emotional and developmental — are a long way from healing, even if there is currently an air of relative peace.“We have never known anything good in South Sudan,” an MSF staffer says as we chat under a thatched boma one night.

He’s from South Sudan, and knows first-hand the suffering his compatriots endured. He fled to Uganda during the conflict eight years ago. His matter-of-fact tone is heartbreaking. To him, it’s indisputable. The South Sudanese have known nothing good. And nobody around the table moves to disagree.

The man treating Goemar, nurse aide Sedat William Machok, is acutely aware of the problems in his home nation. He’s from Leer, but fled in 2015 as the town came under attack. First he went to Juba, and then to Bentiu, where the UN runs a massive Protection of Civilians camp for as many as 140,000 internally displaced South Sudanese people.

The area around Leer has extensive wetlands, particularly during the rainy season, and it was there that Machok took shelter when the attack started.

“There was a lot of water,” he said, standing next to Goemar’s bed. “You would run into the water and hide yourself. When the soldiers came, you run into the water. Even that became very difficult. They were even searching in the river.”

He, his family and other villagers from Leer hid for almost two years. During the day they would lie, almost completely submerged, and at night they would hunker down on an island.

“There was a dry land, very small, so we used to sleep there. When we heard the gunshots, we ran inside [the swamp]. I was there for almost two years, across 2014 and 2015,” says Machok.

The International Committee of the Red Cross would drop food parcels — the only food they could get.

“We take the food and hide on the island. When it was finished, we survived on the fruits in the bushes,” he says.

Eventually, he knew he had to risk leaving for somewhere safer.

“I left my mother and my brother; I said that if it’s OK, I’ll come and call them,” he said.

His mother and brother survived, and have lived with him in Leer since he moved back in January 2019. But not everyone in the family survived.

“I lost my older sister because of sickness from being in the swamp.”

He started working for MSF in the Leer field hospital in June that year.

“We normally work hard because it is serving your community, which is very important,” he says.

Machok was on duty when Goemar was brought in. He treated the little boy throughout his illness. He says it was touch and go at times.

“It was very difficult. In the beginning I battled to help because he was convulsing for three days. After improvement … I was very happy because he was taking milk and the child was able to breathe normally.” On March 5, Goemar was discharged.

But what if Machok, his colleagues, and the MSF field officer weren’t there?

“The child may have died,” he says.

Next to Goemar, a metre away on a matching sponge mattress, is two-year-old Jany Riak Dhiel, his left arm and upper body almost completely wrapped in bandages. His mother, Nyabany Chuol, says he burnt himself badly with boiling water at home.

He would likely have faced a life-or-death battle with infection if not for the medical care he received at the primary-care facility.

The MSF hospital in Leer is made up of five tents, each one 6m long and 4m wide, used for outpatients, consultations, treatments and maternity care.

The facility is surrounded by a corrugated-iron boundary wall topped with barbed wire. A UN barracks is directly across a gravel road.

A small camp down the road protects citizens. A generator hums constantly in the background, the only power in an area without a single tar road and almost no formal buildings.

The hospital treats everything from malaria to respiratory infections and pneumonia, and from meningitis to malnutrition and diarrhoea. Sometimes gunshot wounds inflicted by armed youngsters — with weapons left over from the civil war — are treated.

On several occasions during the visit civilians were seen walking freely in the streets with automatic rifles slung over their shoulders.

The facility in Leer offers hope to a nation under severe threat, but it is a rare beacon in a country struggling to care for its own.

In March and April the facility treated 1,080 people, of whom 146 were admitted. This excludes the maternity section.

A January 2020 report from the UN Commission on Human Rights in South Sudan states that more than 1.4-million civilians are internally displaced, “languishing in camps unfit to meet … basic needs and subsisting on diminished humanitarian aid”.

“The consequent dire situation of human rights throughout South Sudan is characterised by the deliberate starvation of civilians, the largest refugee and internal displacement crises in Africa, and sexual and gender-based violence,” the report says.

South African human rights lawyer Yasmin Sooka, who is chair of the Commission on Human Rights in South Sudan, says the South Sudanese government has “abdicated all of its responsibility” to the international community.

“It’s not a surprise that any infrastructure, food and health care comes from international NGOs or the UN, or in the form of different agencies.

“The government itself doesn’t take any trouble to pay for any of that, or supply any of that,” she says.

Fewer defences in the face of Covid-19

World’s poorest country

South Sudan is the poorest country in the world. The World Bank estimates that about 82% of its people live in poverty. After it split from Sudan in 2011 a bloody civil war erupted. After 12 previous attempts failed, it was only this year that rivals agreed to work together for peace.

Coronavirus raises its head

The Sunday Times visited the Médecins Sans Frontières facility in Leer before the coronavirus became a worldwide pandemic.

The country’s count of 231 cases and one death by Friday seems low, but the virus has spread to two of the civilian protection camps run by the UN, of great concern in a country with severe existing health-care challenges.

Francesco Rancati, the project co-ordinator in Leerwho hosted the Sunday Times, says that Covid-19 “has become the number one health priority for everyone”. The Leer hospital is bracing for cases.

“We have built a new triage area to separate patients presenting with respiratory distress from patients with other symptoms. We have placed hand-washing points all over the compound and we have erected a couple of isolation tents, which will be dedicated to patients showing up at the facility with Covid-like symptoms.”