Caroline Scholtes, a nurse working with Médecins Sans Frontières (MSF), has just returned from a three-month assignment in Jonglei state in South Sudan, an area that has suffered many outbreaks of violence in recent months. Since these clashes, some 80,000 people have gone missing in the state. In hiding, they are cut off from all humanitarian aid.
What is the situation in Jonglei state?
In the wake of a series of skirmishes between rebels and the South Sudanese armed forces, the people in Pibor county, in the south of the state, fled into the bush. Violent inter-communal clashes in the bush followed in mid-July, leaving many wounded. Since then, people have been afraid to return home or to go into villages or markets because they are scared of being targeted. We know that some have taken refuge in Kenya, Ethiopia and Uganda, and in Juba, the capital. 24,000 people have been located in the area surrounding the village of Gumuruk and 10,000 more in two remote areas of the county. But there are still 80,000 whose whereabouts are unknown, who are hiding, who have gone to ground and are having to survive in unsafe and difficult conditions.
What does MSF's work here involve?
Many humanitarian organisations have been evacuated because the health centres have been plundered. MSF has a clinic in Gumuruk that is providing basic medical care. In two days, our team set up a surgical unit in a tent at the clinic. From here, we are trying to access the war wounded and the people who have fled and are living in unprecedented isolation. We do not know what state of health these people are in.
We have also carried out mobile clinics by helicopter. We land in the bush with boxes of medicines, plastic sheeting and two stakes to provide a little shade and we go about our work with just the basics. Messengers travel through the bush and pass on the word to the people they meet. We would very quickly receive hundreds of people. Every day, we had more than 100 hand-picked consultations: people with serious infections, malnourished children, pregnant women with infections, and the list goes on.
We land in the bush with boxes of medicines, plastic sheeting and two stakes to provide a little shade and we go about our work with just the basics.Caroline Scholtes, MSF nurse in South Sudan
We noted that the people refused to go back to their villages when they needed to, even for food or treatment. In Gumuruk, we had patients from the bush, some of whom were war-wounded, but mainly women and children. The men stayed in hiding. These people gave accounts of days of flight in the bush, families dispersed, broken up, affected by the death of those close to them. I saw a small boy of three or four years old who was traumatised when an adult approached him because he had spent three days alone and helpless in the middle of the swamps.
These people truly have nothing. When I asked the women what their priorities were, they all said that it was food and access to medical care. They were afraid of famine because they are in an unprecedented situation: they no longer have any animals following the cattle raids in mid-July, they have not been able to farm their land and they have no means to feed their families. As they cannot go to the villages, these people are in a drastic humanitarian situation. I could sense a real call for help in their accounts.
What challenges are the MSF teams facing?
This region is a vast flat plain, with swamps and winding rivers that feed into the Nile. It is an open, barren landscape with barely any roads. The minute there is a major rainfall, these zones are flooded and become swamps. Firstly, therefore, there is the logistical challenge of accessing these people in the middle of the bush. Helicopter is often the only way. There is also a geographical challenge: in a vast region four times the size of Belgium you can imagine the difficulty of finding people in hiding. There is also a challenge that the people will very probably face, and that is the risk of epidemics. With very limited access to potable water and food, epidemics such as cholera, malaria and measles are a threat. We also fear a Hepatitis E epidemic, which has already broken out in the refugee camps up north near the border with Sudan, where MSF is also currently working.
It really is a daily battle for our teams. The clock is ticking for these thousands of missing people. When I left, the teams were going to receive a helicopter for carrying out intensive searches. We are also lobbying other organisations to distribute food, shelters, water purifying equipment and so on.
What struck you personally during your work in Jonglei state?
Day-to-day life was not easy for the teams: we were living in tents with very limited access to clean drinking water; we were cooking over a fire and our means of communication was limited to satellite telephone. But when you land in a helicopter in the middle of the bush and are surrounded by hundreds of men and women who still have their pride despite the unimaginable living conditions, you cannot remain indifferent. These people have an outlook and a physical strength that are awe-inspiring. Meeting these people, you cannot help but tell yourself that, despite the basic living conditions, you must persevere.