Looking out across the vast and empty landscape of South Sudan on my flight to Juba, South Sudan’s capital, I realized how little I really knew of one of the largest and most influential regions in Africa. I’ve flown over and worked in countries bordering South Sudan many times, but this was my first visit.
We at International Medical Corps often talk about working in some of the most remote and forgotten crises in the world, and on visiting some of our primary health care clinics in Akobo County I can honestly say I have never felt more remote or isolated. From Juba I flew an hour and a half north-east across the emptiness of Jonglei state, to the border town of Akobo. From there I travelled three hours by river to a handful of villages where we have set up eight primary health care clinics, which across a 25 km stretch of river serve a population of nearly 47,000.
The health needs here and across South Sudan are huge. In a region the size of France, beset by conflict and displacement, there is no infrastructure and virtually no functional basic services. One in four children born here never sees their fifth birthday, whilst maternal mortality is the highest in the world. There is an ever present threat of disease, high malnutrition, and large areas are prone to severe flooding, exacerbating these threats. There is also a massive shortage in trained health workers – in a region of over eight million people there are only 300 midwives.
On meeting our community volunteers and villagers alike, it quickly became clear to me how necessary and appreciated our clinics are, providing maternal health care, vaccinations for children and pregnant women, treatment for malnutrition, and crucially, training for local health care workers and community education on health care services and practices.
But there is tension in the air and a nervousness of what lies ahead in the coming months.
Less publicized than the troubles in Darfur to the north, the history of conflict in South Sudan is arguably as disturbing. Twenty-five years of civil war claimed nearly two million lives and left four million others homeless. The Comprehensive Peace Agreement (CPA), signed in 2005, officially ended the civil war, giving South Sudan autonomy and its people the right to self-determination through a referendum on independence after six years.
That vote is now only a few days away, on January 9th, and I was amazed to see even out in the remoteness of Akobo County voters registering to take part in the referendum. Unfortunately, whatever the outcome of the referendum, tensions between north and south remain high and renewed conflict is a possibility.
International Medical Corps has been in South Sudan for over 15 years. Up to 2005 our efforts were mainly focused on humanitarian relief to those displaced and affected by the civil war. In the past six years, in the relative stability following the CPA, we have been able to expand the type of work we do and even begin training local nurses and midwives.
The referendum will see a new chapter begin in South Sudan and it is our hope that this will be a peaceful one. This would allow us to expand our capacity building efforts further, working with the Ministry of Health to try and develop the health care infrastructure of South Sudan. The government of South Sudan is working hard to build up the health system to provide health care across the region. They’ve made admirable progress given the challenges but international assistance is still needed here.
Whatever the coming months hold, International Medical Corps will use its experience and knowledge of the region to carry on providing lifesaving medical services and training. As Dr Wubeshet, our surgeon at the BPRM-supported Akobo Hospital, explained, “We’re here, deeply embedded. We understand the needs and we’re ready and able to deal with whatever the future brings.”