People living in South Sudan's largest displacement camp, in Bentiu, face an uncertain future after the United Nations Mission in South Sudan (UNMISS) announced earlier this year that it would begin withdrawing peacekeeping troops who have been responsible for security.
Ever since armed conflict broke out in South Sudan in December 2013, thousands of people have taken refuge near the international peacekeeping troops on UNMISS bases in different parts of the country. These camps became known as Protection of Civilians sites.
Doctors Without Borders/Médecins Sans Frontières (MSF) runs a 116-bed hospital in Bentiu, where conditions in the camp remain very concerning. In 2019 and early 2020, MSF conducted a survey showing that fewer than 60 percent of families had their own water jug to clean up after using the toilet. The risks to health posed by poor water and sanitation services and substandard living conditions include diarrheal diseases, hepatitis E, cholera, typhoid fever, trachoma, and skin infections.
While conditions inside the camp are miserable, people also fear the threat of violence and insecurity outside. Patients and other community members express concerns about safety and security conditions once the UN is no longer there. Nyakuoth*, a 50-year-old woman from the nearby town of Rubkona, said: "The UN gathered people here and told us they will leave this site. We told them that if they leave there will be harm. They didn't explain how they will do it or when it's going to happen. I don't know if we will be protected."
A peace agreement in 2018 renewed questions about whether displaced people would return to their home areas. UNMISS announced that the camps will remain for people who choose to stay, but camp management and security responsibilities will be transferred to the national government. Displaced people in Protection of Civilians sites in Bor and Juba have already reacted negatively to the transition, saying they were not informed of the UN troop withdrawal and that they now live in fear.
Parents cannot take care of the children full-time because they spend hours collecting firewood outside the camp or carrying out other manual labor to earn a living.
Children under five years old are most vulnerable. Among those admitted to the MSF hospital in 2020, 562 children were severely acutely malnourished, while many also had other preventable illnesses. Our teams see children who were born prematurely because their mothers were sick.
"These kids often never had a clean place to sleep or play," said Philippe Manengo, MSF hospital coordinator in Bentiu. "The long-term exposure to chronic diseases, coupled with malnutrition, decreases their immunity, making them more susceptible to other illnesses. Despite all our efforts, this year we have lost nine percent of the malnourished children in our hospital. It's very distressful and concerning."
Nyakoang*, a 30-year-old woman, lives in a one-room shelter shared by eight people from multiple families. She told MSF: "This is not the kind of life I want for my children and myself. I want to be able to go to a place where I can study while my children are safe and that they can go to school. Education is what can change their lives."
Nyamal*, age 43, showed MSF staff how her dwelling has no toilet, shower, or light. She cooks a traditional dish of porridge over embers on the ground, while watching her children playing outside. "We could not stay in a war zone," she said of her decision to come to the camp in 2014. In the camp, however, she has not always felt safe, even while it was supposed to be protected by the UN. In 2018, a group of armed men broke into her shelter, threatening the family and taking their belongings. "Since then, I never slept well again. I always imagine that somebody else could come," she said.
MSF's hospital in the Bentiu Protection of Civilians site includes an inpatient department, emergency room and an operating theater for surgery. Surgical patients are sometimes referred to the hospital from elsewhere in South Sudan, such as people wounded earlier this year in violent clashes in Jonglei state. The hospital also provides maternal care, including for complicated deliveries, as well as care for survivors of sexual violence, mental health care, treatment for HIV/AIDS, tuberculosis, and malnutrition. In 2019, more than 49,000 people from inside and outside the camp received care in the facility. From January to October 2020, MSF teams treated more than 80,000 people, with malaria and respiratory tract infections among the most common medical conditions. MSF also manages a well for the community to use and distributes soap and other hygiene items.
*Names have been changed to protect anonymity.