© James Lorenz/MSF Click for larger view June 14: Starvation takes hold in southern Sudan where leaves are the only food This crisis has come in the wake of the January peace accord that ended 21 years of civil war. So far over 2,100 children under five years of age have been given life saving nutritional treatment, in a therapeutic feeding centre, a supplementary feeding centre and three ambulatory centres.

For the first time in months, nearly 50 children are in the Medecins Sans Frontieres (MSF) therapeutic feeding centre in the village of Akuem, in the southern Sudanese state of Bahr El Ghazal. At the height of the nutritional crisis from June to late August, when malnutrition rates were at twice the emergency threshold, the centre was almost constantly at its capacity of 250 children.

So far over 2,100 children under five years of age have been given life saving nutritional treatment, in a therapeutic feeding centre, a supplementary feeding centre and three ambulatory centres. To prevent a further deterioration of the situation MSF decided to undertake a blanket feeding operation. Mid-August, the team conducted two rounds of food distribution for 15,000 children each time.

Nybol Bol sits on a grass mat cradling her one-year old twins Ngor and Achang. She had walked for 14 hours to bring them here in August when they were admitted with severe acute malnutrition. Without intensive and specialised nutritional care, they would have died. Today, like the other children laughing and playing while their mothers weave colourful baskets or chat under the tarpaulin shelter, they are out of danger. For now.

This crisis has come in the wake of the January peace accord that ended 21 years of civil war. As a homeland for the rebel Southern Peoples' Liberation Movement (SPLM), Akuem and the surrounding Aweil East County had been particularly badly hit by the conflict.

Over 30,000 people have now returned to the County and they are facing the reality that the end of war does not signal an end to struggle. Welcomed back to their home villages and supported as far as possible by relatives, the returnees have received virtually no aid and their numbers have served to further destabilise an already impoverished and battered community.

Akual is one of those who have returned to the region since the January 2005. Many fled the war in this frontline area, finding refuge in the north of the country or in refugee camps outside the Sudanese border. Others, like Akual, were abducted into servitude.

"I came back in March this year," she explains, "I feel at home here. I am with my people and I can no longer be mistreated."

But the joy of returning home is tempered. Newly found freedom from violence and of movement may be important, but as she sits, clad in rags in front of her tiny and ramshackle mud-walled home, she explains, "the only other real difference between here and the north is the lack of food and the poor shelter. But this is our homeland."

Those who have come back to Akuem have returned to nothing but scarcity.

Despite the peace and handsome pledges of bounty from the international community, life for the swelling population is bleak. MSF runs the only accessible and free medical facility for literally hundreds of kilometres in every direction and there are no roads, no schools and no infrastructure of any kind.

"The only change since the comprehensive peace was signed in January is that we are treating more patients. In August alone we carried out 7,000 medical consultations. The nutritional crisis may have abated for now, but in medical terms we have reached the absolute limit of our capacity and worryingly, there is little sign that help is on its way," explains Claire Magone, MSF head of mission for southern Sudan.

Dressed in the ragged remains of a t-shirt emblazoned with slogans from a long-completed vaccination campaign, Dut expressed the frustrated fatalism that is so common in this area following the January 9 agreement.

"Every 9th of the month we hope change will come," he says with a wry smile. While there are signs of improvement - such as the increasing number of women coming to the MSF hospital to give birth - thousands of returnees are expected to further swell the population of Aweil East in the coming months.

"The onset of peace should have heralded a new era of development in Akuem. But despite the huge unfulfilled needs, in the last eight months, change has been conspicuous in its absence," concludes Magone. Without change, Ngor and Achang Bol may only have survived to face another year of misery.