“The impact of their time in the bush was etched into my colleagues faces and bodies – they looked older, their faces more gaunt.”

Within the sprawling marshlands that surroundthe small market town of Leer,a place marred for decades by civil war and the struggle for independence, lies a Médecins Sans Frontières (MSF) hospital.

For just over 25 years, MSF’s Leer hospital had provided a wide range of medical care for the 270,000 people across southern Unity state.  Until, in late January, it was looted and burned to the ground.

Six months after conflict broke out in December 2013 in South Sudan, thousands of South Sudanese have lost their lives and over one million have been displaced across the country

Sarah Maynard, from Southampton, UK, was the hospital’s coordinator at the time of the destruction in Leer. She was evacuated before the violence started while more than 200 local MSF staff had to flee into the bush with their families.

Now back with her team in Leer, Sarah tells their story and what they found on their return.

Returning to Leer

“I first returned to Leer for a brief visitin February, shortly after the violence came to Leer, to find a once busy and vibrant town completely empty and that our hospital had been burned, looted and destroyed.

In mid-April we heard that the population had begun returning to the town after spending months in the bush andon 1st May, a small MSF team and I arrived back in Leer to do an assessment.  It was also a reunion of sorts with the local staff.

When we came back, what we saw was alarming – hundreds of malnourished children in need of urgent treatment. The violence and displacement has clearly had devastating consequences for the people here.

Overwhelming first days

Not even one bed was left in our destroyed hospital, which had been the only secondary healthcare facility in the whole of southern Unity State. That destruction meant hundreds of thousands had been left without lifesaving care for months. 

The therapeutic feeding centre for malnourished children had been burnt and its roof had collapsed. So, on that first day back we set up a kind of waiting area in one of the half-finished buildings.

Our team was inundated with patients on that first day back in early May. We got off the plane,walked into townto the hospital grounds to find a queue of people already waiting.

They began streaming into the hospital. It was overwhelming. The levels of malnutrition were startling. I remember one of the national staff calling me over to look at a child just when we started the nutrition screening outside the hospital. I had never seen such an emaciated baby before. She was seven-months-old and she just looked tiny. Really, really tiny.

Starting over

The needs were huge, and we really wanted to get started treating people right away. So once we had set up the basics of the feeding programme, our South Sudanese colleagues continued on without us for a few days while we got ourselves organised for a proper return to Leer.

Over the weekend we cleaned out the hospital, which was a real mess after the destruction. Then on 5th May, we stopped the emergency bush clinic and started an emergency outpatient department in the hospital. Two days later my team and I were back, and on 9th May a therapeutic feeding centre for severely malnourished children under five years old started.

On the first Friday we opened, we admitted more than 100 children. By the end of the next week we had admitted 885 children into the feeding programme. We are seeing up to 1,200 patients every week in the outpatient department – mostly for malnutrition with acute watery diarrhoea, respiratory tract infections and malaria. All of those conditions are a result of bad living conditions, living in the open without mosquito nets.

Empty markets, not enough food

These people have suffered so much, and they continue to suffer. They returned to Leer with nothing and found that there was nothing here too. People lost their homes, their belongings and also the normal methods of producing and purchasing food.

It has started raining here and they are just starting to plant. However, it’s going to take a while for them to be able to reap the food from this harvest. In the meantime, the market is empty and people are going hungry.

Things do trickle into the market now and then, like dried fish, but it’s not enough. Whenever sacks of flour or sorghum arrive, they are sold at two to three times the normal price. They disappear so quickly. All those who can’t pay inflated prices are left hungry. It’s a desperate situation.

The number of cattle being slaughtered in the market is definitely more than it used to be. When people start killing their cattle, then you know things are bad in South Sudan, a country where cows are a symbol of one’s wealth.

Many people are now eating this wealth – killing their cows to survive today, knowing that their reserves for tomorrow will then be gone. When their cattle are gone they lose their milk, and the money they could bring to buy food. But they have to think about today - if that’s what they have to do to survive, then they will kill their cattle.

The next months will be dire

People want to stay here. They want to plant their crops. They want to rebuild homes where their former ones burned. They want to live. We’re doing what we can to help, but it’s not enough.

We’re treating hundreds of the most severely malnourished, but there are all the moderately malnourished children too. More aid agencies need to come here and start helping these children, to prevent their conditions from deteriorating and some from dying. There needsto be more food distributions.

The coming months will be dire as the rainy season has started and the health and sanitation situation in camps of the internally displaced is deteriorating. Other than malnutrition, people are dying of malaria, respiratory tract infections and other preventable diseases. The South Sudanese population is already living on a knife-edge. They need immediate help before things move to worst.