While travelling across the country’s vast swampland – the Sudd – doing medical assessments, Chandra Gilmore, International Medical Corps’ South Sudan famine response team leader, took photographs and notes
Chandra Gilmore
Main image: The Sudd, South Sudan Photograph: Chandra Gilmore
Mon 8 May 2017 10.57 BST Last modified on Fri 6 Oct 2017 13.12 BST
Last week I travelled by airplane, then by helicopter, and finally via canoe to reach some of the most remote communities on Earth; the inhabitants of the tiny islands scattered across South Sudan’s vast swampland known as the Sudd. There are only 200km of paved road in the entire country. In this photo, the helicopter pilot cleans grass out of the engine to prevent overheating on our 20-minute hop from Leer to Nyal, a town in Panyijiar County, Unity State.
Welcome to the Sudd, one of the world’s largest wetlands. Our destination, Nyal, is on a peninsula of land stretching into the Sudd. The canoe is the optimal form of transport throughout the vast network of channels and lagoons that make up the area. Livestock and rain-dependent family farms are the primary forms of livelihoods for this rural population. Many have fled to the islands seeking safety from the country’s violent civil war. Four years in, the war has brought the world’s youngest nation to its knees, with 100,000 people facing famine and 5 million on the brink of starvation.
Our assessment begins from the air as we fly over Nyal. You can see UN tarpaulin sheets and thatch for roofing on single story dwellings. The absence of tin sheets, cement, or multi-storey buildings is our first indication of the level of scarcity in Nyal. We can expect communities outside of Nyal and those on the islands to have even fewer resources as they are further removed from economic centres, education and health services.
This is me with Ponyo Salumu, our nutrition manager. This area has seen brutal fighting since the war started in December 2013. Due to its relative safety at present, people have fled here from the active fighting and famine conditions in Leer and Meyandit counties. The International Medical Corps runs mobile medical units and provides nutrition services in Nyal.
We set up nutrition stations near the mobile medical units so that people can access primary healthcare and nutrition services in one complete package. Here, Ponyo works with one of our nutrition promoters on the metrics used – such as mid-upper arm circumference – to understand if a child is healthy or suffering from acute malnutrition.
IMC’s nutrition team saw a child with severe acute malnutrition. In addition to her mid-upper arm circumference in the red, she showed a number of signs of chronic malnutrition, such as reddish hair and skin discolourations on her feet and ankles. She also presented with a medical complication – a respiratory infection – which meant she had to be referred to a stabilisation centre nearby for 24-hour care for her illness and severe acute malnutrition.
We took to the canoes to assess the island populations. I travelled with our security manager, Atiq Shaikh (middle), Ponyo (not pictured), and other IMC famine response team members. Stephen, a representative of the County Health Department (back), introduced us to the communities.
One of the three islands we visited was Nyop 1. The needs there – and on all the islands we saw – are enormous. They drink water from the swamp. people have no access to healthcare, little food, no shoes and whatever clothes they have are tattered and worn. The tarpaulin sheets on the roofs of these villages tell us that these families were displaced to the islands due to the conflict.
I saw some shelters using latrine slabs for doors. These houses on Nyop 2 likely belong to families who have lived on the islands for a long time, rather than those who fled to the islands seeking safety from the fighting.
People eat whatever fish they can catch in the swamp. In this photo, a family dries fish to preserve the catch; they can eat these later or sell them. Apart from fish and water lilies, we did not see other food across the three islands. We saw many children with distended bellies and reddish hair, both signs of malnutrition. Their living conditions make parasites like worms an everyday reality, which further rob them of nutrients. One of our first priorities will be to provide de- worming medication to the island communities.
The people we met on the islands were enthusiastic and insistent on attaining health services. Today, they have to travel two hours or more by canoe to reach the nearest health facility. This leaves them dangerously isolated and unable to access care for common illnesses, as well as dangerous disease outbreaks such as cholera. There are cholera outbreaks in the Sudd and in nearly every county bordering the Nile River, which cuts through the centre of South Sudan.
People are leaving their homes in search of food and water and many families have started to depend on leaves and weevils from bushes as their only source of food. In some areas, our health facilities are reporting a doubling of the number of malnourished children over the last few months. For some it’s already too late, but for millions on the knife edge, what we do over the next days and weeks will determine whether they live or die.
