In South Sudan, rapid response brings aid to remote locations

With small teams of specialists deployed to remote areas of South Sudan, UNICEF is helping to bring desperately needed assistance to communities coping with conflict, displacement and malnutrition.

At first glance, this village in South Sudan looks like a place of relative plenty. There is fertile soil, strong sunlight and regular rainfall, but fighting forced people to flee, leaving their seeds rotting and tools looted. There is a clinic, with health staff and solar-powered vaccine fridges, but there are no medicines. There is a road and an airstrip, but they are falling into ruin after months without maintenance. And there is a school, with teachers and keen pupils, but no blackboards, furniture, books or pens.

Kiech Kuon, in Upper Nile State in the country’s north-east, could stand for many villages across the three northern states of South Sudan worst affected by the conflict that flared up in December 2013. Since then, the basics that kept people fed, healthy, educated and safe have disappeared. In their absence, hunger, illness and insecurity have taken hold.

Nearly a million South Sudanese children age 5 or under will need treatment for acute malnutrition before the end of 2014, UNICEF estimates. As many as 50,000 could die if international funding appeals fail.

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To accelerate its help, UNICEF, together with partner the World Food Programme (WFP), has taken a new approach. Alongside major interventions that typically take weeks of preparation time and face huge logistical difficulties, small specialist teams are running nimble operations far into remote rural locations. Using helicopters and planes, they bring in food and life-saving supplies and reach as many children and mothers as possible in 10-day expeditions.

These Rapid Response Missions (RRMs) are designed so that children can also get vaccinated against polio and measles, checked for malnutrition and treated with special protein-rich, high-energy foods. Mothers are reminded of the importance of breastfeeding and good hygiene, both of which help babies and children avoid illness.

Nyakuoch Keat, holding her sick 9-month-old son, Bhan Ruei, meets with Dr. Thomas Lyimo, a health specialist for UNICEF, at an abandoned health centre in Kiech Kon.

“Villages like this have been entirely cut off from routine services, sometimes for up to nine months,” says Simon Bol, UNICEF’s team leader for the Kiech Kuon RRM. “There is no other opportunity to reach people in these very remote places.”

Even with their small teams –usually eight UNICEF specialists and 10 from WFP – these undertakings are difficult. Staff must be flown in with enough food and water to last them the trip. There are very few comforts, and the team sleeps in tents often pitched near snake-infested swamps that flood during frequent heavy rainstorms.

All supplies must brought in by air. During each RRM, the United Nations Humanitarian Air Service rotates in at least one helicopter a day from logistics bases in faraway Rumbek or the capital, Juba. Aircraft fuel is often scarce, disrupting flights and delaying operations.

But the need for even the limited help offered by such missions was clear in Kiech Kuon, where UNICEF expected to reach up to 30,000 mothers and children during a fortnight’s visit in mid-August.

Everything was lost

Over several days, hundreds of families arrived at the site where the UN teams set up their temporary screening centre. One after another, women talked of how with no decent food and with the health centre closed, their children were falling sicker and sicker. Families were surviving on wild plants, fish bought at steep prices from swamp fishermen, or cows’ milk and blood. Precious livestock was being bartered for sacks of sorghum.

“One good cow now only fetches four sacks,” said Nyayian Lul, 32, queuing with her six children at the screening site. “That’s a quarter of what it was before.”

A health worker administers vitamin A drops, which help boost immunity, to a child held by a woman, during a rapid response mission to the town of Kiech Kon.

“Everything was lost. When the fighting came, we fled with only our clothes,” Ms. Lul said. “When we returned, our pots and pans, even our bedsheets and blankets, had been stolen. It’s not just food, we have nothing now. And no one has been here to help us for more than six months.”

Further back in the queue, temporary health workers hired from the local population and trained by UNICEF for the RRM found Nyabel Wal’s 18-month-old son, Goaner.

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With a measuring tape wrapped around his upper arm to check his nutrition status, the reading showed red, the danger zone. He was pulled from the line for special attention, including therapeutic feeding and a dose of antibiotics to knock out any underlying infection that might worsen his condition.

“He has had chest pains and diarrhea and a cough, for many weeks,” says Ms. Wal, 34. “I have no cereals, no grains, no vegetables and no fish to give them. We are suffering in this crisis – we planted a lot of food, but it got ruined when we had to run. Now there is nothing.”

Nyater Gatdet, 24, walked for half a day to get here. “This is our only chance to be assisted,” she said. Other families arrived later who had walked for two days. Nyathor Teny’s daughter Nyachuol had a persistent cough that could have been tuberculosis or pneumonia, but Thomas Lyimo, the UNICEF RRM health specialist, could not make a diagnosis without lab tests. Nyachuol was given antibiotics and a small dose of painkiller.

Nyaruach Del, 30, told how she suffered a miscarriage when seven months pregnant only a day before the UNICEF team arrived. “All of my other children were born in the health centre when there were doctors there,” she said. “If this war had not come, and the clinic was still open, this baby could have survived.”

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More needed

On the other side of the village, Nhial Ojulu, 35, an English teacher at Kiech Kuon Primary School, surveyed the two classrooms where, until December 2013, he taught 300 pupils. “We need blackboards, exercise and text books, chairs for the children to sit on, uniforms, playing materials,” he said, ticking off his list on his fingers. “I am ready to teach even without pay. We need only the materials.”

Each person was given advice, medicines, special food or vaccinations. A “school in a box” – a temporary tented classroom and materials – was due to arrive by helicopter soon. The problem, of course, is that for every person helped in Kiech Kuon, there are 100 more elsewhere in South Sudan still beyond the reach of humanitarian agencies.

Children and women watch as a World Food Programme (WFP) aircraft drops food aid in Kiech Kon.

“This approach is working very well where we have already carried it out,” said Mr. Bol, the Team Leader, as he and his colleagues opted to stay extra days to continue helping the still-arriving families. “What we need are more and more RRMs, to be able to go to more and more places. It is the best way to help for now.”