Conflict in South Sudan has driven a massive displacement crisis—with more than two million people forced to seek safety across borders and another two million uprooted within the country. During some of the most intense periods of the conflict, which began in late 2013, thousands of people fled to existing United Nations (UN) bases for protection. As the conflict ground on, these bases transitioned into Protection of Civilians (PoC) sites guarded by forces from the UN Mission in South Sudan (UNMISS).
Since the signing of an agreement between warring parties in September 2018, there have been discussions about the possible return of displaced people and the future of the PoC sites. Currently around 180,000 people are seeking safety in six of these camps in South Sudan. Médecins Sans Frontières/Doctors Without Borders (MSF) is present in two of these camps, in Bentiu and Malakal. Despite the challenging conditions within the PoC sites, for many people the alternative of living outside is worse.
“When my village was attacked, many people were separated, and children even ran with different families wherever they were. Everyone was scattered or killed,” says Teresa, a mother of three from Mayendit now living in Bentiu camp. “When we got here, we were only hearing things like, ‘This one was killed, this one is here, or this one is looking for you.’ ”
Distraction and disease
Across from Teresa, two plastic chairs have been occupied, and music is blaring from a speaker tied up with chicken wire. The speaker breathes rhythm into the camp, music falling on teenage ears that are perhaps listening for hope, love, or just distraction. For the more than 100,000 people living here in Bentiu PoC, the challenges include finding safety, shelter, food, water, and health care.
“Gatherings of big populations in one place is not good in terms of health. People are not housed properly,” says Peter, a father of five from neighboring Rubkona who has been living in Bentiu camp for five years. “The way they construct the houses is by putting five shelters together without being separated. If a person in shelter 1 is infected by TB and does not know his symptoms, we fear this guy will infect all five shelters.”
MSF has repeatedly called for conditions and services within the sites to be improved beyond current levels, in particular, water and sanitation. Overflow from the latrines oozes down banks to form a stagnant thick sludge, which often draws young children to investigate and play, and risk catching disease. The statistics are alarming: almost half of all patients seen in the outpatient department or admitted to MSF’s 160-bed hospital in Bentiu are children under five. Many of these children suffer from illnesses like severe acute diarrhea, skin diseases, eye infections, and worms, which can be avoided by improved water and sanitation.
The relative safety found within the camp comes with the risk of exposure to life-threatening diseases and undignified living conditions.
Not enough of anything
In Malakal, which was the second most populous city in South Sudan before the war and one of the worst affected areas during it, MSF also runs a hospital inside the PoC. Around 30,000 people are seeking protection here. Control over Malakal has passed from one armed group to another several times. Destruction from the fighting is still visible everywhere. Twisted wreckages, burnt out cars, and empty neighborhoods serve as constant reminders of the recent past.
“We still face many challenges—one is hunger. You may have sorghum grain, but you don’t know where to grind it, or you may not have money to take it to the grinding mill. Even if you have money to grind the sorghum, you may not have water to cook it,” says Martha*, a 27-year-old woman from east Malakal county. “There is not enough water. The community is too big here.”
These camps came into existence so that people could survive situations of extreme violence and be less exposed to armed groups. More than five years on, however, merely surviving in the camps is not enough. In 2018, the MSF hospital in Malakal admitted 51 people who had attempted suicide—an average of one person per week. MSF teams provided more than 2,400 mental health consultations, including in both individual and group sessions—in response to a combination of factors, including extreme levels of violence suffered throughout the conflict and feelings of despair due to their current conditions in the camps.
“Life for everyone, but especially for women, is very difficult,” says Achol, a 32-year-old woman from Obai, a village south of Malakal. “These five years have affected people. They are unhappy, they lost many things when they had to flee their homes, and there have been so many deaths in the community. Some people are mentally ill and even say it would be better to kill themselves.”
Based on what MSF teams are hearing from our patients, temporary movement in and out of both Bentiu and Malakal camps is happening. However, people are hesitant to relocate prematurely or permanently due to uncertainty about their safety in a context that can quickly shift.
“The most difficult moment I have faced is when I first came to the PoC. It was also very difficult when the compound was attacked and burned in 2016,” says Achol, in Malakal camp. “My shelter and everything I had inside it, including my clothes, was destroyed.”
Security within the sites is not guaranteed, with robberies, looting, and sexual violence common concerns raised by residents. For those with jobs or a source of income, the risk of being attacked is even greater.
One MSF driver says he has never left the camp unless in an MSF vehicle. “There is no safety in the place where we came from,” he says. “We are waiting until the situation calms before we go, but even then, there may not be services for people to be able to survive in their places of origin.”
David, one of MSF’s health promotion staff living in one of the PoCs, says he feels particularly at risk. “Even me, because I have a job, we are the most targeted people in the PoC. Where can I run though? We don’t have the choice to leave [the camp], it’s still better than outside.”
Hope for peace
Despite the many challenges people face within the camps, and despite feelings of uncertainty about what their future might look like outside of them, there is undeniable hope for what could be.
“If we witness it, the peace, then we can go outside. If not, better to be here,” says Teresa. “But what I want to add is that all the women from South Sudan, all the people of South Sudan, hope for peace. "
Until then, the rhythm of life in the camps continues: chitchat, hands scrubbing, children playing. The people living in these camps are struggling but resilient, surviving in some of the most undignified conditions imaginable.