THE CONDITIONS OF PROTECTION

In South Sudan, 180,000 people shelter in UN camps to escape ongoing violence - but life inside is not without risks

A woman carries a bucket of water at Malakal POC camp in South Sudan © MSF/Igor Barbero

A woman carries a bucket of water at Malakal POC camp in South Sudan © MSF/Igor Barbero

A woman carries a bucket of water at Malakal POC camp in South Sudan © MSF/Igor Barbero

Since 2013, four million people have been displaced by conflict in South Sudan.

Two million sought safety across borders, while another two million remain displaced within the country.

During some of the most extreme periods of violence, thousands of people fled in unprecedented numbers to existing United Nations (UN) bases for protection.

As the conflict continued, these bases transitioned into Protection of Civilians (PoC) sites, guarded by forces from the UN Mission in South Sudan.

Women and children queue at a water point in Malakal POC site where over 29,000 internally displaced people live © MSF/Igor Barbero

Women and children queue at a water point in Malakal POC site where over 29,000 internally displaced people live © MSF/Igor Barbero

Women and children queue at a water point in Malakal POC site where over 29,000 internally displaced people live © MSF/Igor Barbero

"THIS ONE WAS KILLED... THIS ONE IS LOOKING FOR YOU"

Since the signing of an agreement between warring parties last September, discussions on the return of displaced people and the future of the PoC sites are emerging.

Currently, around 180,000 people are seeking safety in six of these camps in South Sudan. MSF is present in two - Bentiu and Malakal. 

Map of PoC sites in South Sudan © MSF

Despite the challenging conditions within, for many, the alternative of being outside is worse.

“When my village was attacked, many people were separated and children even ran with different families wherever they were," says Teresa from Mayendit, a mother of three at Bentiu PoC.

"Everyone was scattered or killed. 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'."

People washing their clothes in a nearby river at Bentiu PoC © Emin Ozmen/Magnum Photos

People washing their clothes in a nearby river at Bentiu PoC © Emin Ozmen/Magnum Photos

People washing their clothes in a nearby river at Bentiu PoC © Emin Ozmen/Magnum Photos

An MSF medic treats a patient suffering from tuberculosis (TB) in Malakal PoC © Alex McBride/MSF

An MSF medic treats a patient suffering from tuberculosis (TB) in Malakal PoC © Alex McBride/MSF

An MSF medic treats a patient suffering from tuberculosis (TB) in Malakal PoC © Alex McBride/MSF

EXPOSURE TO DISEASE

In Bentiu PoC, for more than 100,000 people living here, the challenges are many; safety, food, water, health and shelter.

“Gatherings of big populations in one place is not good in terms of health," says Peter, a father of five who has been living in the PoC for five years.

People washing their clothes in a nearby river at Bentiu PoC © Emin Ozmen/Magnum Photos

"People are not housed properly. The way they construct the houses is by putting five shelters together without being separated. So, 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.

"Without shelters being separated, there is a greater risk of being contaminated."

"The relative safety found within the camp comes at the expense of unnecessary exposure to life-threatening diseases and undignified living conditions"

MSF has repeatedly called for conditions and services within the sites to be improved beyond current levels, in particular, water and sanitation.

In places, overflow from latrines oozes down banks and into stagnant thick sludge, putting children playing nearby at risk of preventable disease. This leads to alarming statistics in the PoC camps.

An MSF medic treats a patient suffering from tuberculosis (TB) in Malakal PoC © Alex McBride/MSF

Almost half of all patients seen in the outpatient department or admitted to MSF’s 160-bed hospital in Bentiu PoC are children under five. Many suffer from illnesses like severe acute diarrhoea, skin diseases, eye infections and worms, all of which can be avoided with improved water and sanitation.

The relative safety found within the camp comes at the expense of unnecessary exposure to life-threatening diseases and undignified living conditions.

They are both factors which should not drive a person’s decision to return home.  

NOT ENOUGH OF ANYTHING

In Malakal, which was the second most populated city before the war and one of the worst affected areas during it, MSF also runs a hospital inside the PoC where around 30,000 people are seeking protection.

"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."
Achol | Malakal PoC resident

Malakal passed hands between one group to another several times. The destruction is still visible as if new. Twisted wreckages, burnt out cars and empty neighbourhoods serve as a constant reminder of the recent past.

“We still face many challenges," says Martha (not her real name), a 27-year-old woman from east Malakal county.

"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. There is not enough water; the community is too big here."

EXISTING TO SURVIVE

These camps came into existence so that people could escape the violence that they would otherwise be exposed to outside.

More than five years on, for some people, existing to merely survive is causing psychological harm.

Throughout 2018, 51 people who had attempted suicide were admitted to the MSF hospital in Malakal PoC, marking an average of one person per week.

The MSF teams provided more than 2,400 mental health consultations including both individual and group sessions.

People’s conditions are often triggered by a combination of experiencing extreme levels of violence throughout the conflict, and feelings of despair that are exacerbated by, or a direct consequence of, their current environment.

Achol and her child Timothy at MSF's hospital in Malakal PoC © MSF/Igor Barbero

Achol and her child Timothy at MSF's hospital in Malakal PoC © MSF/Igor Barbero

Achol and her child Timothy at MSF's hospital in Malakal PoC © MSF/Igor Barbero

“The 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."

The remains of Asosa - south of Malakal city - an area that was very populated before the war started in 2013 © MSF/Igor Barbero
Veronica and her child Angelo live in Bentiu PoC © Emin Ozmen/Magnum Photos

UNCERTAINTY

Based on what we hear from our patients, temporary movement in and out of both camps is happening. However, people are hesitant to relocate prematurely or definitely due to fears about their safety in an environment that can quickly shift.

“The most difficult moment I have faced is when I first came to the PoC," says Achol.

"It was also very difficult when the compound was attacked and burned in 2016. My shelter and everything I had inside it, including my clothes, were destroyed."

Security within the sites is not absolute, 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 of MSF’s drivers, who has never left the camp unless in an MSF vehicle, says:

“There is no safety in the place where we came from.

"We are waiting until the situation calms before we go back, but even then, there may not be services for people to be able to survive."

Similarly, David, one of MSF’s health promoters who lives in a PoC site, says:

“Because we 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, and it’s still better than outside.”

A market inside Malakal PoC © MSF/Igor Barbero

A market inside Malakal PoC © MSF/Igor Barbero

A market inside Malakal PoC © MSF/Igor Barbero

"WE HOPE FOR PEACE"

People’s coping mechanisms have been stretched, but 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.

"[They are] surviving in the most dignified way they can, in some of the most undignified conditions imaginable"

“If we witness it, the peace, then we can go outside," says Teresa.

"If not, better to be here, 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; chitter-chatter, hands scrubbing, hearts praying, women fetching, children playing, all struggling, but all resilient - surviving in the most dignified way they can, in some of the most undignified conditions imaginable.

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