South Sudan: “Many people have known war and displacement for their entire life”

Daniel Perez Martin, a 27-year-old nurse from Spain, has just completed his first mission with Médecins Sans Frontières in South Sudan. He speaks about his experiences during the six months he spent in the war-torn country, including the team’s evacuation from Kodok, in the Greater Upper Nile region of northern South Sudan.

When I arrived in early February the team was busy setting up mobile clinics and outpatient services in Kodok for people who had just been displaced from Wau Shilluk, a settlement 40km south, after it was attacked. It was complete chaos. Our local staff had just been through terrible events, and had been displaced along with the population. They had no shelter and were living under the trees, and there was very little food or water. People from our team were shocked and didn’t want to talk about what had happened in Wau Shilluk. Some couldn’t sleep at night, and yet they were still coming to work with the international staff to provide medical care. That is the most important thing that I came to learn during this mission: the sheer strength of people.

Some people were afraid to stay in Kodok as it was close to the frontline of the fighting. Many were moving north to a village called Aburoch, even though the living conditions there were even worse. Unlike Kodok, there is no river in Aburoch, so there is no water. It was just a small village and suddenly thousands of people were living there, in the heat, with nothing to grow and no water.

People were afraid. They were afraid of being forced to wear a uniform and fight, and they were afraid of having to flee Kodok. They were hoping that there wouldn’t be an offensive on the village, but they knew it would probably happen. They were still expecting to go back to Wau Shilluk, saying ‘we will be back very soon,’ while knowing that it would be difficult. The displaced community was starting to build houses. I don’t think they expected to stay for long but they had to settle somewhere. To try, at least. Some people had been displaced for the fourth time in four years. They never lose hope though. They start again from scratch, every time.

A further displacement

By April there were rumours that there would be fighting in Kodok. Part of our team was evacuated, including me, with only the most essential staff left behind. Finally the work in Kodok was moved to Aburoch, where we resumed and expanded activities in our field hospital. The situation was very volatile, so we started doing quick visits – called flash visits – to the people who had been displaced, going for a few hours to bring medication and provide healthcare, and then leaving the same day.

I saw thousands of people living under the trees with no water at all. There were around 25,000 people surviving on very little water, most of it dirty. It was 40 degrees Celsius. Most illnesses were those related to hygiene, water and bad sanitation: conjunctivitis, respiratory tract infections, skin diseases, watery diarrhoea. People were not able to clean themselves and the water they were drinking was contaminated. Seeing the community I had been working with in those conditions was terrible. Every time I returned, I asked myself how people could cope. I couldn’t sleep for several nights.

We decided to have a more permanent presence when a cholera outbreak was confirmed, and it was a huge relief to be able to provide healthcare again. Cholera spreads very quickly, especially if you don’t have clean water or enough latrines. At that time, the only water available was limited groundwater, which was contaminated as people would defecate or vomit nearby.  

We set up a cholera treatment centre. Most of our staff from Wau Shilluk had fled to Sudan. In the medical team there were only five people from Wau Shilluk; the others had to be recruited and trained in the middle of an outbreak. We were working day and night, sleeping just a few hours. It was overwhelming.

‘Please don’t forget us’

The people who didn’t go to Sudan stayed because they had no other option. It was simply too expensive to go. Some people were hoping to be able to go back to Kodok or Wau Shilluk, and they knew that living in Sudan would be very difficult. Refugees are allowed to be there but are not allowed to work, and must spend what little money they have on food. The route to Sudan is also very unsafe. But if there is another offensive on Aburoch, they will have no choice but to walk again, with no food, no water, and under the heat of the sun. They won’t have medical assistance on the way. This would be the third or fourth displacement in just one year.

Leaving a place like Aburoch is devastating. Many of the people have known war and displacement for their entire life. Those people are extraordinarily strong. They included me in their culture, they joked with me, they helped me. I will never be able to protect them the way they protected me. They are displaced, getting raped, getting sick. People here die because of simple, treatable diseases. With everything going on again now – the rainy season, the conflict, malaria – I feel terrible for leaving them. One of the chiefs used to tell me in the beginning, during the flash visits, ‘Please don’t forget us. Don’t leave us behind or forget us.’”