A hard return to peace in Sudan

The sound of drums and hundreds of voices singing fills the air by the banks of the White Nile. An enormous barge has carried 311 Sudanese refugees and displaced people down the river to the town of Bor. They are finally returning to their homes. For some, more than 20 years have passed since they last were here.

For decades, Sudan was a country at war with itself. Conflict still prevails in the western Darfur region, but the civil war between the government in the north and rebels in the south officially ended with the signing of a peace agreement in January 2005.

The town of Bor in southern Sudan's Jonglei state was the cradle of the uprising against the government in Khartoum. It is the home town of the late John Garang, who led the Sudan People's Liberation Movement (SPLM) during the war.

Forced to flee

Like other major towns in southern Sudan, Bor was a garrison town fought over and controlled by the government for over a decade during the war. As in many other places in southern Sudan, thousands were forced to flee. The population of Bor had shrunk from 85,000 to just 2,000. Many sought refuge in neighbouring countries like Kenya and Uganda. Others remained displaced in Sudan itself.

"They are returning to places that in many cases have been completely devastated," says MSF's former Head of Mission David Veldeman. "It takes a lot of courage to return to these areas. The people coming back there are starting from zero."

Now that peace has returned, the refugees and internally displaced people are returning. Bor is currently home to an estimated 47,000 people, and regaining a central place in this reshaped environment where boundaries have opened again.
But the town is also an important way station for returnees on their way to homes in other parts of southern Sudan.

A camp has been set up along the White Nile to temporarily house these returnees. As people are disembarking the barge, residents of the camp and Bor proper warmly welcome the new arrivals.

Starting from zero

The returnees disembarking the barge at the Bor way station may be coming home, but they are returning to a country facing enormous humanitarian needs. In terms of health care, agriculture, housing and security, the situation is extremely dire.

"They are returning to places that in many cases have been completely devastated," says MSF's former Head of Mission David Veldeman. "It takes a lot of courage to return to these areas. The people coming back there are starting from zero."

The war has left Bor in deplorable sanitary conditions. The population's main source of water is the polluted Nile River, where they must wash, do laundry and fetch drinking water. The conditions are ideal for the disease to spread, especially with people travelling.

Last spring, a cholera outbreak occurred in the city.

The MSF cholera treatment centre was a small camp of white tents demarcated by a bright orange plastic fence. Everyone entering or exiting the camp had to wash their hands and the soles of their shoes in a chlorine solution in order to keep the disease contained.

Due to the oppressive heat, the patients would spend their days outside the tents, in the relatively cool shade of a tree. Next to each bed, one would find a bucket for vomiting; underneath, a bucket for diarrhoea. Some patients were receiving intravenous drips suspended from the tree.

Monday Frances was one of them. The 11-month old baby boy had diarrhoea and was severely dehydrated. Rakel Ludviksen, the nurse, recalls: "He had lost a lot of fluid. Even his eyes were completely dry. I strongly suspected that it was cholera."

The treatment consisting of a re-hydrating solution containing sugar and salt is very efficient and quickly shows results. Dehydrated patients who arrive at the facility unable to walk and with skin like dry parchment can be discharged quickly.

After three days of treatment, Monday Frances was re-hydrated and the cholera cured. Monday's mother could take him home alive.

Health care in ruins

Right next to MSF's cholera treatment centre is Bor General Hospital, or what is left of it.

An earthquake destroyed large parts of the structure in 1971. Side-stepping casually discarded syringes and needles in the yard or walking beneath the bats which have made their home in the asbestos-filled ceiling, it is hard to see this as anything more than a ruin.

Through two decades of intense warfare, Sudanese health workers have kept the hospital running. But lack of qualified staff and virtually all necessary resources has made the job incredibly difficult.

"When I first arrived here, I could not believe that this was a hospital," says MSF's logistics coordinator Mulla John. Now he is in charge of rehabilitating the structure. It finally has electric lights and access to clean water - essential preconditions for meeting the health care needs of Bor's population and the returning refugees.

MSF is taking over the responsibility for Bor General Hospital and the patient load is increasing. Now that the town has re-opened its doors and people can move freely, the hospital is regaining a central position. Notably as a referral structure for the surrounding smaller health facilities, adding to the already high number of patients in need of medical care in Bor alone. Among the recent arrivals include a woman who had a miscarriage, several children with malaria, and nine soldiers injured in a gunfight.

Lion or flames

Though miscarriages, malaria and gunshot wounds are sadly frequent here, some of the patients in Bor General Hospital have stories that are anything but commonplace.

Cattle herders were burning off vegetation to provide grazing lands for their livestock when 14-year old Mayen was set upon by a lion. His only options were to be attacked by the animal or to brave the fire. Mayen chose the fire.

We meet Mayen in Bor General Hospital. He is alive, but his legs are covered by extremely painful second degree burns. Mayen's father watches over him day and night as the hospital staff treat his wounds.

Mayen made the right choice. It will take time, but he is going to be okay. In the hospital, Mayen receives proper care, which is still all too rare in southern Sudan.