Episode: "Into The Crisis Zone"

WESTERN UPPER NILE: SUDAN

Country Background - Sudan

Since Sudan gained independence from Britain in 1956, it has been a nation divided, plagued by religious, ethnic, and economic tensions between the primarily Muslim north and the predominantly Christian and animist south. The nation saw its first civil war soon after independence, and peace did not return until 1972.

In 1983, the Sudanese government imposed Islamic law throughout the country, and partitioned the south into three administrative territories, sparking a second devastating civil war. For the last 20 years, the Sudan People’s Liberation Army, or SPLA, and shifting alliances of other rebel groups have engaged in fierce combat against the Sudanese government and government-backed militia. Civilians have paid the overwhelming price.

In 1997, oil exploration and growing inter-factional rivalries among armed groups in the south led to an escalation in the conflict and a disastrous new phase in the humanitarian crisis.

When Medical Aid is Not Enough: Fourteen Years in Western Upper Nile

In this episode, filmed in early 2002, Leslie Lefkow, a human rights specialist, researches human rights abuses inflicted upon civilians in the Nuba Mountains and in the western Upper Nile region of south Sudan – areas especially hard-hit by the country’s two-decade civil war. The purpose of Leslie’s research is to collect testimony demonstrating the war’s effects on the civilian population of western Upper Nile.

Drawing on interviews with patients and medical staff from MSF’s projects, her subsequent report reveals a civilian population subjected to atrocities from all sides and ravaged by a vicious circle of forced displacement, malnutrition and spiraling disease. Western Upper Nile is a region in which violence, malnutrition and infectious disease go hand-in-hand. Cattle, the lifeblood of the south Sudanese economy and diet, are looted by roving soldiers, and the severity and reach of epidemics is intensified by displacement and the destruction of public health structures and supply lines.

“More than 100,000 people are known to have died from one war-related disease alone – kala azar,” the report concludes. “[But] the total mortality from violence, disease and hunger in western Upper Nile will never be known…Each individual has a story. What is clear is that the war is inexorably killing off the people of the area.”

For MSF, this bleak assessment is the result of 14 years struggling to bring medical aid to a population living through one of the longest and most destructive African wars of the twentieth century.

Violence, Health, and Access to Aid

MSF first opened a project in western Upper Nile in 1988, at first providing basic health care, then gradually expanding infectious disease treatment throughout the early 90s. Although lack of infrastructure and war have historically made western Upper Nile an extremely remote place, even by south Sudanese standards, MSF managed to have 15 rural health clinics up and running by 1996.

In late 1997, tension between the commanders of two government-backed militias brought fierce conflict directly into western Upper Nile. Wave after wave of fighting swept through communities that were already prone to malnutrition and disease. During this new phase of the war, which has lasted the last six years, violence against civilians has been commonplace in western Upper Nile. Looting, forced recruitment and rape have been widespread. Famine and disease have been ubiquitous. And the humanitarian response to these tragedies has been hindered and threatened by the deliberate targeting of relief personnel and aid centers.

In the last 10 years of the conflict, there have been 10 separate attacks on MSF health facilities, and in this same period, 10 of MSF’s Sudanese health workers have been killed. Each attack forced MSF to evacuate its staff and suspend activities in a given health clinic, taking a harsh toll on a local population for whom MSF provides the only health care.

The clinic at Thonyor, for example, where Dr. Kate Doan is seen working in this episode, serves an estimated population of 12,200. From October 2001 to January 2002, the clinic received 120 hospitalizations – people whose medical conditions were serious enough that they would die without treatment. The clinic also treated 67 kala azar patients. Given these enormous health needs, a temporary disruption in aid due to insecurity can be devastating to local people.

Even when humanitarian relief is uninterrupted, there are clear limitations to what it can accomplish. When violence is directed at civilians, the health care that MSF provides can treat only the effects of such violence – it cannot address the cause.

On these occasions, MSF speaks out in an attempt to benefit and give justice to the populations it serves. Frustrated by 14 years of witnessing violence, deprivation and disease in western Upper Nile, and concerned that a new even more harmful stage of the war was on the horizon, MSF released Leslie’s report, “Violence, Health, and Access to Aid in Unity State/Western Upper Nile” in April, 2002:

“MSF calls on all of the warring parties to respect their obligations to protect civilians. Current peace negotiations must recognize the gravity of the violence, and agreements must ensure that the warring parties commit to a robust process whereby monitoring and investigation of abuses, and accountability of armed groups, is ensured.”

Project Update: Western Upper Nile

Since this episode was filmed, a current attempt at forging a peace agreement in Sudan has progressed further than its predecessors. Despite the hope that this gives, neither the ongoing peace-process, nor a year-old agreement between the SPLA and the government to “protect non-combatant civilians and civil facilities from military attack,” have prevented savage combat from being waged in western Upper Nile.

Starting in December, a fierce wave of fighting swept through the oil-bearing regions of western Upper Nile, driving people in several communities from their homes to avoid forced recruitment and looting.

In late January, MSF was forced to evacuate the clinic at Thonyor, along with a nearby project in Dablual. Fortunately, both teams were able to return to work within a week. The team at Bentiu, however, has been less fortunate. In mid June, the Bentiu clinic, the only health center serving a large local population, was evacuated – as of early July, the team has not been able to return.