“This Story Should Be About Local Aid Workers on the Ground”
They are the ones who stay behind when we leave
South Sudan: the world’s newest nation. It is rich in oil but, following years of war, it is also one of the least developed regions on earth.
The fighting of the past three years has forced millions to flee their homes, split much of the population along ethnic lines, and paralyzed agriculture, leaving the country in a humanitarian crisis. The UN says that at least one-quarter of South Sudanese people have been displaced from their homes.
Following the restarting of conflict in July 2016, the population again had to flee, while Doctors Without Borders/Médecins Sans Frontières (MSF) had to evacuate international teams from both Leer and Thonyor. In September, MSF set up a mobile basic health care program to continue to reach the population.
Through a network of community health workers, community health promoters, and women’s health promoters — themselves part of the affected population — MSF has been able to continue to provide health care.
These community health workers are trained in treating the most common health problems (skin diseases, respiratory tract infections, water-borne disease, malaria). They stay with the community and, if the community needs to flee, they go with them, thus continuing to provide health care. MSF resupplies them with medical supplies and provides ongoing supervision and training through international teams.
Compiled below are testimonies from South Sudanese MSF staff. All names have been changed for security reasons.
My name is Gatkuoth. I am 31 years old. I am a community health worker for MSF. I am from Payak, in Leer County, South Sudan. I was in Bentiu in 2014 when war erupted. I went back to Payak, where we had a tea shop. Although armed men were shooting, we did not need to run from their vehicles in Payak for a long time. There was a lot of water and mud on the roads, so vehicles did not come that way. We would just lie down when there was gunfire. But when the small streams dried up [and the roads opened], armed men came and the people living in Payak had to flee west and south.
In 2015, I started working for MSF as a casual worker on a measles vaccination campaign. That same year, my brother James, who was working in the MSF Leer hospital in the operating theater, was killed at home.
There came a time when the armed men attacked civilians. Cattle and goods were raided by armed men. They looted and burned down houses.
They did not only loot.
Even though you are not holding a gun, they can kill you. You can be male or female and they can beat you. In one instance, about 50 people were captured and all of them were killed.
When the looting became common, we dug a hole to hide bags of sorghum. But when the fighting worsened, we came at night and divided the sorghum between me and my wife, and moved.
There were seven of us moving together. We met armed men on the road to Mayendit, who pointed their guns at us. They released four of us, captured one, and two ran away. They told us to go another route. We then went to Nyangpoa Island. We were there for just one day when I was captured a second time. They shot at me three times but did not hit me. We said we had nothing to give them, but they kept me for several hours. I asked them, “Are you going to release me or kill me?” In the end, they released me.
I was thinking a lot. I was captured yesterday, captured today. That is enough for god. We stayed for seven days and returned to Payak.
In October 2016 we went back to Mayendit again for three months to escape the fighting, and then to Dhorkheen and Bahr islands. My oldest and youngest children are with us. The other kids are with my mother in Mayendit. We have a big family. My mother and brothers were with us in Payak. We had four tukuls [huts] plus one for cattle. I went back to Payak last week just to look. Our home was burned, but the shelter I built with plastic sheeting is still there. I will go back to Payak when there is security. If there is peace of course we can go back.
My name is Nyagoa. I am 38 years old and I was born in Rieri, South Sudan. My father was a pastor. I remember singing in the church choir. Most of the young men went to fight in the war with the North [Sudan], but there was no huge impact of the war on our day-to-day lives. There were bombings by the North, but most people were not afraid; you could see and hear the planes from a long way away. There was no gun fighting in those days and very little cattle raiding. Sometimes there were quarrels with spears.
When I was 15 I married my husband. I was happy to marry a good Christian man. He worked for MSF in the Leer hospital. When South Sudan became independent, my husband decided to work as a full-time pastor. I went to work for MSF in 2013 as a cook.
By 2014 the second civil war had come to Rieri. Armed men burned and looted the hospital in Leer. They were killing everyone: women, children, and the elderly. Every family lost relatives. We lost my husband’s brother and my sister’s son. In the first year  things were a bit better. Attacks were infrequent and there was plenty of warning. We would run into the bush and stay the whole day. In the bush, things were calm. Our children would look out for dangers. The next year armed men from other areas came. The attacks became more frequent. They targeted civilians and even came into the bush and to the islands looking for us. If an attack wasn’t sudden we would put some food and the young children on a plastic sheet and pull them through the bush. We drank water from the swamp and prepared sorghum grain there. If an attack was sudden, we just ran.
In 2016 things became very bad. The attacks were almost constant. The scariest thing was when soldiers were shooting at us while we were running and someone near me was shot, or when someone was caught and beaten, shot, or raped.
In December we left Rieri. We took our five children to Nyal and then sent them on to Uganda. We took two canoes from Mirnyal [near Rieri] to Mayendit and then to Nyal. The trip took two days. Many other people left, both to escape the violence and so their children could go to school. I stayed in Nyal for two weeks, and then moved to Mayendit. My husband stayed in Nyal.
I came back to Rieri on January 11, 2017. Our house is remote enough that it had not been burned, but everything inside had been looted. I think my husband will come back soon. I miss my children but I am happy they are getting an education. Now I am a Women’s Health Promoter with MSF in one clinic. I feel good working for MSF. MSF is the number one organization dealing with suffering and health here, and is really appreciated by the community. They are providing support for victims of sexual and gender-based violence and referrals for complicated maternal cases
Since god is in all things, I think that things will get better and the community will still have services. I am hoping for peace so things can get better.
James, 33, is an MSF community area supervisor. He has been working for MSF for one year and he is the team leader in this location. He explains the perils of his work to photographer Siegfried Modola:
“It is a dangerous job that we do as health workers. We follow the population wherever they are or go. Once I spent eight hours with others in the swamps to hide from gunmen. Five people were shot and died around me during this time. I remember seeing a mother holding her child, trying to breastfeed him. She didn’t know the child had died.
I love this job nevertheless. I love serving my community. People need medical care. They need us to be here to help them. Many are dying because they can’t reach a hospital in time. Many children are dying because of malnutrition and because they don’t have the appropriate vaccines.”
South Sudan: Providing Care to People on the Move
People are constantly on the move in South Sudan's Leer and Mayendit counties, where shifting front lines of conflict…