South Sudan: Enduring Bentiu

Photography by Peter Bauza, Dominic Nahr and Frédéric Noy

Kuany resembles many of his South Sudanese male compatriots. Appearing to be in his mid-30s, he is tall and built to an image that exudes familiar dichotomies here in the world’s youngest nation; he is lean but muscular, imposing but serene, scarred but resilient. Aside from mere appearances however, he also shares the same story as one out of every three South Sudanese citizens. Along with his wife and nine children, Kuany was forced from his home as he fled amid violent warfare that erupted between government and opposition forces in December 2013. South Sudan, the world's youngest nation, has now been dragged through more than four years of civil war. For Kuany, as for the large majority of the population, the war has left an enormous trail of loss and human suffering in its wake.

“We had a great life,” Kuany recalls. “35 cows, a garden with vegetables and flowers...” he pauses for a moment as his senses wade back through his former life. “...I can still remember their smell,” he adds, his voice distant.

When it first began, the conflict in South Sudan quickly spread along ethnic lines. People like Kuany who feared for their lives faced limited options, and staying behind in their homes wasn't one of them. By early 2018 with no end to war in sight, as many as 2.4 million people had decided to leave the country entirely, making South Sudan the largest refugee crisis in all of Africa, and the third largest worldwide behind only Syria and Afghanistan.

In addition to those who fled to neighboring counties, another two million have been internally displaced within the country. Over 200,000 live in one of six Protection of Civilians (PoC) sites established by the United Nations Mission in South Sudan. The largest of these, housing more than 50% of all PoC residents, is Bentiu, where Kuany and his family now reside.

He remembers well the day they arrived to the Bentiu PoC. As shelling and panic engulfed his community, Kuany and his wife gathered their children and fled.

“Bodies over bodies could be seen on the streets, and we started to run with all of our kids to the camp site.”

Like many of the first PoC residents, Kuany was hopeful that the conflict would come to a swift resolution, allowing him and his family to return home and begin rebuilding their lives. He had good reason to be hopeful; history was on his side. In the past, those that sought shelter at UN bases ended up returning home within weeks or sometimes in even days. But this time proved to be different. Within a few short months, the 5,000 that had originally sought protection in Bentiu had mushroomed to 40,000, and would only continue growing in the months and years to come.

“Now, we are here, under the most awful and miserable conditions,” Kuany says.

Surrounded by trenches and large mounds of earth topped with barbed wire fences and UN watchtowers, the Bentiu PoC appears from above as an incongruent square box framed by a sea of nature that toggles between hues of vibrant green in the rainy season and dusty brown in the dry season.

Today, the Bentiu PoC serves as a place of refuge for nearly 115,000 internally displaced people like Kuany. Along with the other PoC sites, Bentiu was never supposed to house so many people for such a prolonged period of time. Residents live in highly confined temporary shelters made of a combination of corrugated metal, plant stalks, mud, and plastic sheeting. These offer limited protection from outside elements, especially during the rainy season when walkways become uneven lanes of mud.

Despite the presence of UN peacekeeping troops, violence is pervasive both within and outside the PoC. In the evenings, shelters and market stalls are regularly looted and people often find themselves victims of armed robberies. Occasional gunshots are heard within the PoC or in the surrounding bushland areas. Living in such a volatile and conflict-prone setting, Kuany and other residents find little time for rest after sundown.

“At night, you can't sleep. You are always in alert mode. Thieves climb over and under the ridiculous barbed wires with their AK 47s, knives, and spears and steel so many belongings. If you don't give them what they ask, they just kill you. It's a nightmare,” Kuany says.

During the day, other challenges surface. Some residents temporarily exit the PoC to engage in small commercial activities or to search for additional food. Women often tell stories of rape and sexual violence, whereas men risk being forcibly recruited into an armed group.

As a single mother of five and the manager of a small tea shop in one of the PoC's many market areas, Nyalel regularly exits the PoC to collect firewood. Aside from having to leave her children alone for hours at a time, she is fully aware of the risks to herself when leaving the PoC. For Nyalel and others, the risk of sexual violence is a constant risk that hangs over their heads, even within the PoC. Yet the small amount of income Nyalel makes between the tea shop and selling firewood is enough to justify her decision.

"It is worth it to work so hard. I am able to offer all of my kids a simple but private education inside the camp," Nyalel says.

Like Kuany, Nyalel and her children have lived in the Bentiu PoC for several years now, confronting the same realities on a daily basis.

Within the PoC, basic service issues that have plagued the site since its inception continue to present everyday challenges. As a result, residents suffer from avoidable illness, such as those linked to poor water and sanitation conditions. When clean water taps aren't operating properly, residents go in search of drinking water in the same locations where people bath, do laundry, and wash dishes. Latrines are often poorly maintained, with many containing visible feces and no door to provide privacy. Similarly, residents complain that there are not enough areas for hand washing, and that soap tends to be in short supply.

The poor living conditions, violence, and long-term consequences of the war have led to enormous medical needs for the Bentiu PoC population. MSF is responding by providing the only advanced secondary healthcare available within the PoC and the surrounding areas. Malaria, acute watery diarrhea, malnutrition, and conditions linked to poor water and sanitation are the main causes of illness and mortality at MSF's facility in Bentiu. Allieu Tommy, MSF's Medical Team Leader in Bentiu, says that approximately one third of recent emergency room patients have tested positive for malaria.

“We are still very much in the dry season, when malaria cases should be much lower. In many locations, the water is highly contaminated; it’s not suitable for drinking or even bathing, and it encourages breeding of mosquitos,” says Tommy.

Due to the insecurity both within and outside the PoC, violence-related injuries are also common. Throughout 2017, MSF treated an average of 50 violence-related injuries per month at its facility in Bentiu.

Recently, another health concern with potentially devastating consequences for the population relate to a suspected rabies outbreak now occurring within the Bentiu PoC. In the first three months of 2018, 137 suspected rabies cases presented to the MSF hospital. This is nearly three times the number of suspected cases that were received in the last quarter of 2017. In early February, MSF began raising awareness among residents about the importance of seeking medical care following animal bites and scratches. However, the high number of stray dogs that are still present within the PoC mean that rabies remains a very real threat.

Chronic or hard to treat conditions such as HIV and tuberculous (TB) are also present in Bentiu PoC. Due to the highly confined and congested setting, airborne diseases like TB can easily be transmitted to others, making them particularly dangerous.

Originally from South Sudan's former second largest city of Malakal, Gatchar arrived to the PoC in Bentiu after becoming weak and sustaining an injury during one of the many clashes between pro-government and opposition forces. Basic treatment failed to yield any improvement in Gatchar's condition, and after a referral to the MSF hospital, he was diagnosed with a co-infection of HIV and TB.

"I was once a strong, tall man, but as my health got worse, I became skinny and bony," says Gatchar.

Despite being separated from his family and receiving a diagnosis that will follow him for the rest of his life, Gatchar remains optimistic. He even acts as a role model for his fellow patients, encouraging others in the HIV and TB isolation ward to keep up with their treatment regime.

"I have now started a medical treatment, and if I can trust the doctors, I should be better soon. I haven't seen my wife for a long time," he says.

Other Bentiu PoC residents, however, have a hard time remaining optimistic amid such challenging conditions that they have endured far longer than anticipated. At least for now, it's hard to envision a future outside the PoC.

"Living in the camp is not an alternative. We would like to go home and to start a normal life again, but we don't feel safe", Kuany says with a sad look to the musty floor of his dark and overheated tent.

But for his nine children playing outside, he still manages a glimmer of hope.

"I want to see my kids educated, succeed in life, and make a difference. We need a peaceful life and we need to all come together. Is this too much to ask?"

Interested in reading more about Bentiu? Chris McAleer is the Project Coordinator at MSF's hospital in the PoC. In his blog, he reflects on a routine trip from the PoC to the town, as remnants of the past merge with realities of today.

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