Today, Monday 17 October, independent South Sudan is 100 days old. Many will have preoccupations other than celebrating. The families of the 20 people killed by a freshly laid landmine in Unity State last week will not celebrate. The 100,000 people who fled the disputed region of Abyei will not celebrate. And the people trapped in violence between militia groups and the army are certainly more worried about their own safety than any sort of celebration. Independence has brought a lot of hope and promises but emergency needs are not a thing of the past; any such premature assumption would endanger the lives and health of South Sudan’s still vulnerable population. Paradoxically, the very enthusiasm about the future could be putting people’s lives at risk right now.

Médecins Sans Frontières (MSF) sadly witnessed this premature assumption in 2009. The overwhelming majority of international funding was directed at development and provision of basic services in support of the state — to the detriment of emergency preparedness and of civilian populations at a time when violence was resurgent.  While the international community recognizes the new start for South Sudan, aid is not only about  state-building — it cannot lose sight of the humanitarian reality on the ground that may not be as rosy as the projected political future.

So far in 2011 nearly 3,000 people have been killed due to violence in South Sudan and around 300,000 displaced, giving a hollow ring to the idea that South Sudan is now ‘post-conflict’. The violence is painfully real, along the Sudan–South Sudan border and particularly in the states of Blue Nile and Kordofan in Sudan and around the disputed region of Abyei whence refugees are currently fleeing to perceived safety in South Sudan. Elsewhere violence is an ever-present threat, in the south-west with incursions of the Ugandan rebel group Lord’s Resistance Army (LRA), and in numerous locations throughout the country where southern militias are challenging the central authorities.

Repeated attacks in Jonglei State have caused hundreds of deaths and frequent displacement of thousands of people. The threat of imminent violence has forced MSF to evacuate from the hospital at Pibor twice in 2011, and the situation remains extremely volatile. Without MSF’s presence in Pibor, the population would have to travel over 100 km to seek the nearest secondary health facilities.

The people living in these areas have a hard enough life as it is. Recurring violence and displacement leave them teetering on the edge of an emergency with only one thing to rely on-- the provision of effective and responsive humanitarian assistance. When an emergency response is needed, the material, human and financial resources must be ready for immediate deployment in often remote and logistically challenging regions.

This is made extremely difficult when humanitarian aid and state-building activities are mixed together. In the fragile environment we find in many parts of South Sudan, humanitarians must be able to operate with no strings attached, addressing the needs of people in need as their sole objective. In a nutshell, we must remain strictly neutral and be clearly recognised as such.

Now, after independence, most of the influential donors and partners are revising their strategies for assistance to South Sudan. Many are explicitly “coherent” or “comprehensive,” joining up humanitarian aid with overall development and state-building efforts at a time when violence, insecurity and urgent needs continue. For example, the government’s new development plan envisages all aid — humanitarian, development and peace building — as contributing to the creation of peace, stability and development in the fledgling state. The new mandate of the UN peacekeeping mission (UNMISS) includes the protection of civilians caught up in violence in its support to stabilising the new government, even though some belligerents are likely to be hostile to the government. Likewise, the EU is currently developing just such a “comprehensive” strategy for South Sudan, linking its support to humanitarian aid with wider political objectives.

While development and state-building are understandably on the agenda, incorporating humanitarian aid into the same agenda risks urgently needed medical care being perceived as part of wider aid efforts supporting the state. The people we assist — and emerging, often shifting belligerent groups in our working environment — may feel we have chosen sides and lost our neutrality. This perceived loss of neutrality risks humanitarians losing their ability to reach populations in contested areas and to assist them safely and effectively.

Indeed, in remote and marginalized places like Jonglei State or Abyei, safe access is far from a given for humanitarians. With militias forming and shifting alliances, MSF and other humanitarian organisations need to manage the difficult balance of providing assistance and remaining distinct both from the state itself and from the politics of state-building. The ability to assist individuals in need, hard won during decades of civil war by neutrality demonstrated in daily practice, must not now be thrown away in a generalised rush to support state-building.

South Sudan is not an isolated case; from Afghanistan and Pakistan to Congo and Haiti, MSF regularly faces donor and government policies that aim to bring humanitarian aid into the service of wider political strategies. Humanitarian aid is stretched beyond its limits where policy-makers want it to stabilize emerging states, to ensure overall security, to reinforce governance or to construct health systems rather than “just” treating individual patients. Exactly these temptingly positive approaches risk humanitarians losing the independent emergency response capacity that enables us to reach people in need in the most remote, volatile regions worldwide.

It would be a needless failure if emergency aid were not longer present or could not get through to people during the next crisis in South Sudan because humanitarians are seen to have taken sides. In South Sudan, the habit of ignoring today’s emergency for tomorrow’s political advances is one that bears being re-examined and finally broken.