In the middle of war, even the simple solutions to staying healthy can feel impossible. In South Sudan, Oxfam is bringing education and resources to communities to help save lives - every day.
"You can do many simple things to keep control of cholera and diarrhea," explains Yoal, an Oxfam health volunteer in Pading, South Sudan. But it gets more complicated when your town’s water pumps break down and people are forced to drink swamp water. When animals drink and defecate in the same water sources. When there are no toilets. When you only have one container for bathing, collecting water, and washing clothes and dishes. When conflict cuts off your town from almost all trade and the price of soap is more than many people earn in a week. When sick people must walk 30 miles through blistering heat to reach the nearest hospital.
“It is hard for people to keep healthy here,” Yoal sighs. “In 2017, we had so many cases of cholera and diarrhea. We lost 27 people.”
Yoal, an Oxfam community health volunteer, teaches the importance of keeping water containers clean in Lankien. Photo: Tim Bierley/Oxfam
Yoal’s home town of Pading is a small cluster of cone shaped huts in Nyirol County in the northeast of South Sudan. It is extremely remote – surrounded by huge stretches of almost completely flat land, compressed into uniformity by the swamps which swell in the rainy season between May and October. The swamps make delivering aid to places like Pading extremely difficult and they also increase the risk of cholera, as the expanding waters soak and mix up everything in their path.
Soon, rains will thunder down on Pading again. With lives at stake, Oxfam is racing to make sure communities like this one are prepared with the means to fight off another outbreak during the wet season.
Oxfam and local leaders respond ahead of the rains
Last month, engineers from our mobile emergency response team repaired the town’s two water pumps, so Pading will have clean water this year. Now we’re working with volunteers like Yoal to teach people practical ways to keep disease at bay, as well as handing out ustensils like water buckets, containers for bathing, soap and drinking cups.
The key to surviving in extremely risky situations like this, Yoal says, is being completely thorough.
“Sometimes, everyone within the family has to rely on the same containers for lots of different uses,” he says. “You have to be extremely careful about how you use your resources.”
He explains that as the war has dragged on, people have grown increasingly tired. They have seen friends and family die. It can be hard to persuade people that it’s possible to stop the slide, when it is clear that the country's relentless conflict is forcing people into ever worsening positions.
“You have to give really practical support like telling people that even if they cannot afford soap for washing, they can use ash. They should boil water if they are drinking it from the swamp. We explain exactly how each thing can affect them.”
Family's health is most important
Convincing people that change is possible is not still not always easy, but Yoal says there is one thing that unites everyone: “It’s when people see the impact on their children’s health that they are really affected by what I say. Everyone just wants to keep their family safe.”
Nyawal, who volunteers for Oxfam in Lankien, a town nine hours walk from Pading, knows too well the impact cholera can have on a family. She lost two children to the disease last year. Like so many mothers in South Sudan, she felt that their lives were out of her control.
Nyawal, smiling with one of her children whose health has improved, is an Oxfam volunteer in Lankien helping with water and sanitation work. Photo: Tim Bierley/Oxfam
“I have always kept things clean and done everything I can to look after my family,” she says, but adds that people across the community do not realise the constant level of vigilance needed to prevent the spread of cholera.
Cholera can spread extremely quickly and through the most innocuous-seeming sources. Nyawal says she always knew that you should wave flies away from your food, for example. It’s instinctive. But she hadn’t seen it as a life and death matter. She doesn’t know what it was that caused her children to fall to cholera, but she wants to make sure her neighbors don’t suffer the same fate.
“As someone who went through this experience I have to keep telling people to take care of themselves and their children – how to help stop these diseases. We’ve brought tools, including rakes and other types of tools to help people clean up the areas around their houses and we’re telling them how to ensure their food is safe.”
Clean water isn't always an option in a warzone
Just as it is impossible to keep every fly from infecting food, sometimes the conflict takes health completely out of people’s control. Just outside Lankien, William a village elder explains how fighting in the area forced him and his community to flee deep into the bush, fearing attacks on civilians. The priority was to hide, so it was not possible for people to use functioning boreholes in the area: most were close to the road and therefore considered to be too exposed.
William and his family were forced to flee violence and were too afraid to seek out clean water or boil water where they were hiding. Photo: Tim Bierley/Oxfam
“During this time, we had to drink swamp water,” he says. “It was hot and dirty.”
He and his family could not even treat the water by boiling it, as demonstrated by Oxfam’s health volunteers, for fear that the smoke would give away their position. And almost inevitably disease spread.
“A lot of us got sick at this time,” says William. “People lost their lives.”
In a country at conflict, it is extremely hard for communities to eradicate the risk of disease completely. Having access to clean water and the utensils needed to be thorough in hygiene practices makes a huge difference, but even then, war stacks the odds against people and their health. Regular bouts of gunfire force people to prioritise physical safety over health; immediate survival over longevity. The effects of these choiceless decisions are then compounded by the resulting destruction of water sources, of trade, of whole ways of life. People continue to be forced from the homes, their routines, and their means of looking after themselves.
As long as there is fighting, thousands will continue to suffer from entirely preventable diseases. For now, Oxfam will continue to help people access clean water, maintain their dignity and keep their communities alive. Together, that is something we can at least control.
This entry posted by Tim Bierley, Information & Communications Officer, Oxfam in South Sudan, on 4 April 2018. All photos: Tim Bierley/Oxfam.
Oxfam and our partners are working across South Sudan to provide life-saving clean water and promote awareness of the key ways in which disease can be stopped from spreading. Oxfam's work described in this article is carried out with the support of Disasters Emergency Committee and European Civil Protection and Humanitarian Aid Operations (ECHO). In 2017 we reached over 500,000 people with emergency and longer-term support -- please help us reach more people.
Read the new report: Hungry for peace: exploring the links between conflict and hunger in South Sudan - recommendations for the international community and warring parties on what they can do to stop the violence, increase access to humanitarian aid and allow the people of South Sudan to recover.