Southern Sudan is a region synonymous with war, famine and displacement of people. Its people have been shattered by more than 20 years of conflict.
Four years after the Comprehensive Peace Agreement (CPA) which ended the war between the government in Khartoum and the Sudan People’s Liberation Movement, southern Sudan’s population still faces ongoing violence, disease outbreaks, starvation, and virtually non-existent access to health care in many areas. These people’s struggles and triumphs are never clearer than in the stories of their women.
I gave birth to my third child in the bush. We had no food. We could not wait for me to recover, the fighting was too close.
Rebecca Nyiena Yoak was eight when the second Sudanese civil war began in 1983. Sixteen years later, it was still raging, and at the age of 24, Nyiena Yoak and her young family were forced to flee their home. Her grandmother and uncle were killed, her house was burned and she lost everything she owned.
“The soldiers would come with their guns,” Nyiena Yoak says. “We would run and hide. They shot many people. We were forced to move several times, we kept on moving wherever we could to avoid the fighting.”
Elizabeth Nyapini Khalifa also remembers fleeing around the same time. Both she and Nyiena Yoak were born in Leer, a small town in Unity State, in southern Sudan. They now work as midwives for Doctors Without Borders/Médecins Sans Frontières (MSF) at Leer Hospital.
“I like working for MSF because I am helping our community here” says Nyapini Khalifa. “I am here to support women, to do consultations and to give them encouragement.”
Both women are all too aware of the hardships that women face in southern Sudan. The region has one of the highest maternal mortality rates in the world. One in 50 women die in childbirth, a rate 230 times higher than most developed countries.
“Our patients come from very remote villages where life isn’t easy,” says Nyiena Yoak. “Most of them come to the hospital when they already have major complications. Many come too late. We hope to save the babies, but they often die. Yesterday, I tried to help a mother. She had a double miscarriage. Twins?two boys. She only came to us when she started bleeding heavily, even though she’d been in pain for a month.”
We are the lucky ones. We have work, we are trained and we can continue to look after our children.
Nyapini Khalifa also remembers a recent patient that survived but lost her baby. “The hardest thing is that many women miscarry because they have malaria, sexually transmitted infections, or other curable diseases. Yesterday, a pregnant woman came to us too late. She was a new patient and sick with malaria. We could not save the baby.”
Malaria is endemic in southern Sudan. It is one of the major causes of miscarriage in this region. Women and children die because they do not have access to the simple treatment needed to cure malaria. MSF has been pushing for increased access to Artemesinin Combination Treatment for malaria that the World Health Organization has recommended.
Both Nyapini Khalifa and Nyiena Yoak realize there is a great challenge in encouraging women to come for regular antenatal check-ups. “Many people live so far from here, they have to walk for seven days or more to reach us. And they do not want to leave their other children behind. They are afraid no one will be able to look after them if they are away,” Nyapini Khalifa explains.
Across the road from Leer Hospital is the MSF tuberculosis (TB) treatment village. Patients live there, and receive treatment in a village setting. Elizabeth Nyalok Diu is a community health worker for MSF at the treatment center. She takes care of the patients and gives sessions on health promotion and hygiene.
TB is a major cause of morbidity and mortality in southern Sudan, as many people are unable to access health services like those offered by MSF. The treatment is long and requires six months of consistent adherence to a variety of drugs, making it difficult for patients to follow.
“Some patients start to feel better quickly and want to leave,” says Nyalok Diu. “But they must be encouraged to stay and continue the treatment, because if they stop their treatment, they will not be cured.”
Nyalok Diu began working for MSF in 1989. She and her family were also severely affected by the war. “The soldiers were very harsh with people,” she recalls. “They took our food. We were constantly on the run and had to eat leaves from the trees and lily flowers from the water. We were on the move for many years.”
She truly understands what it means to be caught in a conflict without access to health care. “I gave birth to my third child in the bush”, she says. “We had no food. We could not wait for me to recover, the fighting was too close. I gave birth, tied a cloth around me and ran and ran for two, three days. I kept the baby close to my heart, until we found food. My children all suffered. My three-year-old daughter died of malaria. We had nowhere to take her.”
Nyalok Diu’s story resonates throughout southern Sudan. Like Nyiena Yoak and Nyapini Khalifa, she represents many women who, past and present, struggle to survive and provide for their families.
“We are the lucky ones,” says Nyalok Diu. “We have work, we are trained and we can continue to look after our children. Perhaps one day my children will go to university and then I will be the happiest woman alive.”
“I love my work,” says Nyiena Yoak. “Even if I was free to do anything now, I would choose to be here. I just want to be able to continue to work and help my community, this is my aim. I am a very strong woman. I never give up. I will still be here in this hospital long after MSF leaves.”
“I think what I do is important,” concludes Nyapini Khalifa. “I am happy to have been trained by MSF, I can use my skills to help others. People know me in town, they know I work at the hospital. I am very happy to be here!”