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Médecins Sans Frontières
Written by Agus Morales
Photographs and video by Anna Surinyach
Developed by Quim Zudaire

The day after independence

2011 was a volatile year. While countries across North Africa and the Middle East were rising up in the Arab spring, sub-Saharan Africa was also undergoing historic change, making a bid for democracy. On 9 July, the map of the continent was changed when, following a referendum, South Sudan was declared independent. After decades of war it seemed that there was a new political solution to the North-South rivalry. What has happened since then? What kind of future can the world’s newest country expect?

Optimism reigned at the dawn of independence. The referendum results were overwhelming: 98.38 per cent voted yes to the creation of a new state in January 2011. John Aken was living in Darfur, in western Sudan, when the referendum was called. “When we moved to Darfur due to the second Sudanese war, I was nine years old. I stayed there for 20 years and got married,” he says. After independence, he moved back and settled in the South Sudanese state of Northern Bahr el Ghazal. “I am a citizen of South Sudan, because when I walk on the street no one points at me to tell me I am not from here,” he says.

John has six children and is living in a hut in Gok Machar county, near the disputed border between the two Sudans. Upon his return, the South Sudanese authorities allotted him some land. He is one of the so-called returnees: the black population living in the predominantly Arab North who moved back to the newly independent South to reintegrate in a society with shared ethnic and cultural links. “I married in Darfur, but I realised I had to go back home,” says John.

Three years on, Khartoum and the old rivalry between the North and the South seem to be in the background. The internal crisis that broke out in South Sudan in December 2013 has hit a vulnerable population who were already living in deplorable conditions. Violence, malnutrition and epidemics are raging, yet the healthcare system is unable to address even basic medical needs. South Sudan has one of the highest maternal mortality rates in the world, and it suffers from extremely high levels of malnutrition in specific areas. These problems have been exacerbated by the current conflict, and almost half of the population – four million out of a total of 11 million – now face alarming levels of food insecurity, according to UN estimates. The humanitarian aid system, led by the UN, is failing to react and assist the desperate population. How did we get to this point?

Pending issues after independence

South Sudan occupies over 600,000 km2, making it roughly the size of Ukraine. It is a landlocked country surrounded by the Nuba Mountains, the deserts of Ethiopia and the forests of Central Africa, and the White Nile flows through it. Its economy depends heavily on petroleum: the main oil fields are located in the states of Unity and Upper Nile, near the northern border, which are paradoxically among the poorest regions of the country. These areas also hosted most of the camps where refugees from the north came seeking humanitarian assistance.

The failure to delimitate the border between Sudan and South Sudan means that there is still unrest. In many spots, it is almost impossible to know which country a road is in. Several territorial disputes, some of them intrinsically connected to the oil business, remain unresolved and cause suffering to thousands of people. These are the wounds of separation that are yet to heal. After independence, a huge number of refugees crossed the border, mainly from South Kordofan, in Sudan. South Sudan hosted over 230,000 refugees, most of them in Unity and Upper Nile states.

The border between Sudan and South Sudan after independence

Even though these refugees were able to register with the UN Refugee Agency (UNHCR), many others found themselves in a legal limbo. Their situation is evidence of the contradictions in the UN-led aid system and the process that led to the independence of South Sudan. At the end of 2012, some border hostilities moved to the west. Thousands of people fled the airstrikes along the Kiir River, a disputed no man’s land. Around 26,000 people reached the South Sudanese state of Northern Bahr el Ghazal. No one knew what to call them. UN agencies defined them as “spontaneous returnees” and, ignoring their specific needs, expected them to integrate in local communities. “For MSF, it makes no difference whether they are returnees, internally displaced people (IDPs) or refugees,” says Shaun Lummis, former MSF coordinator in the area, “but humanitarian agencies have struggled to understand what assistance to provide because it is difficult to determine the status of these people.”

  • No shelter, no assistance. This was the situation faced by thousands of people fleeing violence along the border between Sudan and South Sudan in early 2013. This camp for IDPs is in the South Sudanese state of Northern Bahr el Ghazal.

  • Entire communities left the Kiir River in 2013 and settled in dozens of camps neglected by humanitarian agencies.

  • “When I saw the burnt houses, I told my people there was nothing left, we had to leave,” says Anthilio Akon, the leader of a community that fled from violence in the Kiir River area.

  • Anthilio Akon’s family was one of the few with a proper shelter in Ajok Wol camp – many others had to do with fragile structures made out of tree branches.

  • The rainy season, which lasts several months, affects the lives of the most vulnerable sections of society in South Sudan.

  • For humanitarian organisations, it is a logistical challenge to work in South Sudan and gain access to the communities in need, like this one in a remote area of Northern Bahr el Ghazal.

  • MSF spoke out about the wretched conditions in these camps and the UN committed to providing food, but aid is still insufficient.

New conflict, old actors

To fully understand the present conflict, it is necessary to go back to the two Sudanese wars (1955–72 and 1983–2005), which left millions dead and many more displaced, and the role played in the second one by the Sudan People’s Liberation Army (SPLA). John Garang, the leader of this rebel group opposed to the Khartoum government, was never able to unify the movement and suppress internal revolts. Garang died in a helicopter accident in 2005, just as the peace process leading to South Sudan’s independence was beginning. He was replaced by Salva Kiir, who eventually became the president of South Sudan; another key figure in the SPLA, Riek Machar, was sworn in as vice president. However, their allegiance did not last: Machar was dismissed from office by Kiir in July and five months later led rebel forces against the government.

South Sudan after war broke out in December 2013

Based on UN data (September 2014).

Soon markets, hospitals, public spaces and entire towns were under fire. The conflict affected all the main ethnic groups (Dinka, Nuer and Shilluk), forcing 1.7 million people from their homes. Over 75 per cent were displaced within the country. One victim of the violence was Ronyo Adwok, a 59-year-old teacher from Malakal, a city on the banks of the White Nile, where over 150,000 people were living. A key location in oil-rich Upper Nile state, Malakal was one of the places most severely hit by war and control of the town has changed hands repeatedly.

Ronyo was resting at home on 18 February when one of the fiercest battles for control of the city broke out between the government and opposition forces. His home was attacked and he was injured in the leg. He left his home and managed to reach Malakal Teaching Hospital, but he found out that not even patients were to be spared from violence during the conflict. “Every day, 10 to 15 men entered the hospital with guns,” says Ronyo. “They’d ask for cellphones and money. If you didn’t give anything to them, they would shoot you. In my ward many people were shot. They even took some women away.” MSF teams found 11 bodies in the hospital and three more near one of the gates. “I feel there is less and less respect for humanitarian work nowadays,” says Carlos Francisco, MSF coordinator in Malakal. “Neither facilities, nor health staff, nor patients are respected.”

The atrocities in Malakal are not an exception; in many other areas entire towns have been destroyed and hospitals attacked. In Leer, Unity state, an MSF team returned to the hospital to find it had been looted, vandalised and then burned. In MSF’s compound in Bentiu, also in Unity state, as many as 33 people were killed last April, according to eyewitness accounts. Bodies of civilians were left decomposing in the streets.

Over 100,000 people are crammed into UN-administered camps – some of them have even been attacked. Tomping camp, in the capital, was flooded within the very first weeks of the rainy season, thus revealing the UN’s low level of preparedness. In Malakal camp, around 18,000 people live in appalling conditions and have inadequate access to drinking water.

One of the war victims taking refuge in Malakal camp last March was 20-year-old Amani Bashir. Her father is Sudanese and her mother South Sudanese. She was raised in the Sudanese state of Blue Nile but two years ago she moved with her mother to Malakal. Although the tensions between the North and the South had eased, Amani was now having to live through the civil conflict raging in South Sudan.

“When clashes erupted in town, we ran away from home and went to the river. We tried to hide but I was shot in the leg,” says Amani, looking down at her injured leg in an improvised MSF hospital within the UN compound in Malakal. “Armed men took us to a church, where many people were seeking refuge. They tried to rape my mother, but we resisted and they shot her in the leg too.” Amani looks at her mother, who also has a bandage around her leg, and at her sleeping son. She seems unmoved, as if she doesn’t want to show any emotion. She doesn’t know what she will do when she recovers – how she will look after her family or whether she will go back to Sudan. She is only clear about one thing: she won’t stay in Malakal.