South Sudan: “Who will treat us when you leave?”

A CARE-supported health clinic in Bentiu (photo taken in July 2014)

As conflict flares again in South Sudan, CARE’s health and nutrition support has never been more vital, says Loice Mukabane, CARE Health and Nutrition Manager

When fighting breaks out, it is the pregnant women and children who suffer the most.

This is what Angelina tells me, a mother who had come for an antenatal visit to one of our CARE health facilities. She continues: “We pray to God to have peace. We don’t want the humanitarian workers, who have come to help us, to run away because of war.”

If we see them leave, we know the situation is really bad. When they are here with us, it is a form of security. Who will treat us when they are gone?

It is a question I cannot answer. When fighting erupts, such as last week here in South Sudan, my colleagues and I are all afraid of armed groups looting and vandalising the health facilities that NGOs such as CARE have worked so hard to equip. This will put the few gains we have achieved in the past years back to zero. This will mean that health workers will go back home, leaving already vulnerable communities without health and other services.

Here in South Sudan I have been able to save lives with critical health and nutrition services.

Having worked in the country on and off since 2015 and in different locations, I have been able to see positive changes. Now I fear this all will be lost.

South Sudan, the newest country in the world, gained its independence in 2011. Only two years later, the country descended into civil war. Previous challenges such as lack of basic health care services, disease outbreaks such as yellow fever and meningitis, and high chronic rates of malnutrition were exacerbated further by the conflict. It caused qualified health personnel to flee the country. Health infrastructure and supplies were destroyed significantly.

With the failure of rains last year, many farmers saw a poor harvest. The alarms bells are sounding loudly that millions of people have nothing to eat. South Sudan is on the brink of collapse and starvation.

Although fighting has broken out in Juba and other parts of the country last week, my colleagues and I continue our work.

I still visit the health facility in Mankien, Unity State, in the mornings, where I find long lines of pregnant women, crying children and groaning adults waiting for consultations.

At the moment it is rainy season, and all wards in the health facility are full. The clinicians are busy fixing intravenous treatments, clerks are hastily recording patients’ information. I hear voices of children wailing in the immunisation room, where vaccination of preventable disease resumed towards the end of last year.

This was because the ‘cold chain’ [refrigeration during transportation and storage of vaccines] needed to maintain the potency of the vaccines against measles, polio, diphtheria, whooping cough and tetanus was destroyed when the civil war broke out in 2013.

Working closely with UNICEF, CARE was able to restore this precious service. Mothers want to ensure that their children are immunised against the deadly diseases that kill so many.

In my role, I have to visit all these departments to ensure that work is going on well as per our health protocols. I do a bit of mentorship when I find a gap, for example a register which is not well filled, dispensing of medicines and even managing pregnant mothers in labour.

In this rainy season, malaria cases are high. Everybody is affected – even the humanitarian workers become sick.

The wards are so packed up, patients have to share beds. The CARE health promotion team informs the community about the prevention of malaria and the importance of seeking medical treatment early enough.

What brings joy to me is the fact CARE has managed to employ key qualified health personnel at the health facilities. Finding health personal to work in remote parts of South Sudan is a big challenge because the few qualified staff prefer to work in the safer towns.

As we all know, nothing bring more joys to a mother than the cry of a new born baby.

Sometimes we encounter very difficult deliveries in the health centre and have to refer these mothers for a caesarean section to a health facility, which is a three hour drive away on a dusty and bumpy road. The logistics during the rainy season become a challenge due to the poor states of the roads. This is when I start praying to God to just hold the skies so that the journey to the hospital is not delayed.

And whenever violence breaks out, such as last week, patients fear going to another hospital where they are far away from their families and community. The roads become very dangerous as fighting can happen instantly and without warning.

If the fighting continues, many lives will be lost not only in war but because of diseases and hunger.

Health workers will run away back to their homes. Many key South Sudanese health workers reside in either neighbouring Kenya or Uganda, where it is safe for their families.

Crops will get spoilt because there will be no one to harvest them. This will lead to more hunger.

The few schools, which had started operating, will go back to be empty facilities inhabited just by bees and other creatures of nature.

The only way forward for South Sudan is to have a stable peace through dialogue – so that mothers like Angelina are not left behind without crucial health services.

Loice Mukabane is Health and Nutrition Manager for CARE in South Sudan

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News and stories are provided by CARE staff working to support our emergency responses and long-term development programmes.