Starvation takes hold in southern Sudan where leaves are the only food

© James Lorenz/MSF Click for larger view "The malnourished babies have sunken eyes and thin discoloured hair," explained Desma Anindo, an MSF nurse at the Paliang feeding centre. "They look like old men... Dying is a matter of days, not months."
With the rains failing in 2004, much of the population in Tonj County, in southern Sudan, has virtually nothing to eat. The poor harvest of the staple food - sorghum - was consumed long ago, so for the past few months people have been reduced to eating leaves from trees and diarrhea-inducing nuts. "It has come to the point where mothers have to make the choice between which child they are going to feed, as they don't have enough for them all," explained MSF medical team co-ordinator, Patrick Murphy. "This is a terrible choice for any mother to have to make." The worst is to come The worst period has not even begun and already 20% of the population is 'moderately malnourished' according to a recent MSF nutritional survey. The rains have once again come late, which bodes ill for the next harvest which is due in September. Currently the hospital therapeutic centre is filled with 120 children under five years of age. "But we are only seeing the tip of the iceberg," continued Murphy, "for every child in here, there could be another 20 in the same situation that we haven't reached." A major reason for the unknown levels is access - the nature of the region limits MSFs ability to reach the people and their ability to get to MSF. Tonj County is like much of southern Sudan, a model of underdevelopment. Infrastructure such as basic medical facilities, roads and schools are rare in the extreme. Two decades of war have assured this. To travel the few kilometres from the MSF hospital in the main town of Marial Lou to the feeding centre in Paliang takes over an hour across a parched landscape only punctuated by occasional huts and clutches of thorny trees. MSF has been running the hospital in Marial Lou since 1997 and has set up five feeding centres to deal with the dramatic rates of malnutrition. The centres provide food for the moderately malnourished, with severe cases referred to a therapeutic centre situated in the hospital itself. Southern Sudan is no stranger to starvation. In 1998, over 60,000 people died as a result of famine. While 2005 is unlikely to reach this level, the hunger is devastating and the first victims are the youngest children. © James Lorenz/MSF Click for larger view "The situation is very bad," Anindo said. "Dying is a matter of days, not months."
The physical effects on the young children are striking. "The malnourished babies have sunken eyes and thin discoloured hair," explained Desma Anindo, an MSF nurse at the Paliang feeding centre. "They look like old men." Anindo runs the centre which weighs and measures children to check their nutritional status, providing them with supplements when required. They usually are. A long line of mothers and their children, listless with hunger, wait to be seen. Many have walked for miles in search of food. One child lies naked in the dust, barely able to move. Another mother cradling her baby squeezes at her barren nipple, showing the MSF team that she has no milk. Her body is too weak to produce any. "The situation is very bad," Anindo said. "Dying is a matter of days, not months." But once inside the Marial Lou therapeutic feeding centre, the recovery of the severely malnourished children is nothing short of miraculous. "Within a week they go from being on the verge of dying to behaving like normal healthy children again," explains Patrick Murphy. Violence over cattle There is scarce pasture for the cattle which are as precious as life itself in southern Sudan. Cattle are the heartbeat of the country, serving as currency, as well as a vital source of nutrition. Now they are dying or ghostly thin, unable to provide milk. Some lie dead on the edge of villages. Cattle are at the root of violence that is exacerbating the situation. With failed rains increasing the pressure on scarce pasture, clashes have flared up between the two main ethnic groups in southern Sudan - the Dinka and the Nuer. Cattle-raiding has also been on the increase, serving only to add to the impoverished state of the inhabitants of Tonj. Violence is not limited to clashes between Dinka and Nuer. Around three hours drive to the north of Marial Lou, regular outbreaks of fighting have occurred in recent months between two Dinka clans, the Aliek and the Langkap. With a fragmented state unable to intervene, the violence has spiraled, forcing people to head south into the already impoverished regions around Marial Lou. The violence has also blocked off important grazing and fishing areas, further adding to the crisis. "The people here are desperate," explained Dr. Murphy. "They need food aid urgently or many more people will die." At the moment though, despite the many promises from the international community, nowhere near enough assistance is forthcoming. A region on the edge In the province of Upper Nile the situation is little better. Again, failed rains compounded by continuing violence are leaving thousands starving in the region. In the town of Leer where MSF runs a further TFC, 80 children were admitted in the first two weeks of May, nearly three times the number for the corresponding periods of 2003 and 2004. "And we are expecting this to get worse over the next few months," explains head of mission Tom Roth. The "official" peace in the South is hardly transforming the lives of the people who have already suffered so much in twenty years of war.