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Sudanese refugees carrying supplies on their heads walk to southeren Sudan

If you’ve read anything in the news about problems or violence related to South Sudan recently, there’s almost no chance that it was near Raja. Rest easy grandma. The retributive inter-tribal cattle clashes in Jonglei, the ongoing violence around Abyei and in South Kordofan, and the newest clashes in a border state between South Sudan and Sudan are reminders that the independence gained on July 9 didn’t mean an immediate end to decades of violence and strife.

Some of the consequences of those years of violence, forced migration, and the population’s inability to live a normal life pursuing its own livelihood are found in the damning health statistics for the new nation:

  • Three out of four people do not have access to basic health care
  • Malaria is considered hyper-endemic in Southern Sudan, accounting for more than 40% of all health facility visits. (MDG Report 2005, UNDP 2006)
  • One out of seven women who become pregnant in Southern Sudan will die. (WHO 2008)
  • 92% of women in Southern Sudan cannot read or write. (MDG Report 2005, UNDP 2006)
  • A 15-year-old girl has a higher chance of dying in childbirth than completing school
  • Only 6.4% of the population use improved sanitation facilities.

Add this to the estimated tally of the war: 2 million dead, 4 million internally displaced, 1 million refugees. This is only South Sudan by the way; these numbers have nothing to do with Darfur. It’s dire. It’s hard to comprehend.

MSF health staff preparing to screen a child for malnutrition in South Sudan

Looking forward, so much needs to be done. Where to begin? Who should do what? How? What’s MSF’s role?

MSF is a medical humanitarian organization that, let me nerd it up and quote the Charter, “offers assistance to populations in distress, to victims of natural or man-made disasters and to victims of armed conflict, irrespective of race, religion, creed or political affiliation.” To oversimplify things, aid is divided into two categories: relief and development. MSF was founded on relief action and now does it (if I can say so) really well: we are in the middle of civil wars and famines; we are on the scene following natural disasters. What we don’t do is development, which is short for long-term development, sustainable development, bi-lateral aid based development, etc.

So as I mentioned, we’re luckily nowhere near the current violence, but does that also mean that we’re not responding to an acute emergency? Or do the statistics above show that we are? Should a more development-orientated organization be the one here? Or does the lack of medical infrastructure justify our intervention in Raja? It’s true that what we are seeing here is a population in distress that would otherwise have a much more limited access to medical care. The last few weeks has seen an explosion in malaria, which has jammed the pediatric ward to capacity. Lives are on the line. But wouldn’t this justify our opening projects in many other places? What happens if and when we leave Raja?

One thing that I like about MSF is the fact that there’s an ongoing discussion and debate about who we are, what we should be doing and how we should be doing it. So the questions above are open. There’s no shortage of self-criticism and organizational introspection.

Emmett Kearney, water and sanitation logisitcian for MSF in Raja, South Sudan

For example, my previous mission in Zambia was for a cholera prevention project. After responding annually to the outbreak in Lusaka’s slums for years, it was decided to take preventitive action (mostly chlorinating shallow/dirty wells and undertaking a hygiene education campaign) and then advocate for the government and other actors to follow the actions that we used. Why treat the symptoms and not the cause? It seems logical, but prevention and the activities involved aren’t what MSF does, so we faced some pushback from some MSF members. There was a lot of debate about the project as a whole as well as what activities should be allowed to be undertaken. While at times frustrating, I found it healthy and worthwhile to discuss and compare our proposed actions against the organzational philosophy.

Meanwhile, in South Sudan, things are still hanging in the balance. Things are calm in our neighborhood, sure, but at the moment there’s no shortage of places that aren’t. The reality is much improved, but still precarious. Raja, population 26,000, is reportedly made up of 90% returnees. 90%!? That means that only 10% of the people now living here were also here during the worst years of violence. What would this town look and feel like with only 2,600 people in it?

It’s hard to imagine. Maybe the same way that it’s hard to imagine us not being here and not treating the women and children that so desperately need us.


Emmett writes for MSF Field Blogs.  You can leave a question or comment for Emmett by visiting his blog here.