Southern Sudan. A region synonymous with war, famine and displacement. Its people shattered by more than 20 years of conflict. Who are they? What has become of them?
Rebecca Nyiena Yoak was eight when the second Sudanese civil war began in 1983. 16 years later, it was still raging, and at the age of 24 Rebecca and her young family were forced to flee their home. Her grandmother and uncle were killed, her house was burnt and she lost everything she owned.
“The soldiers would come with their guns,” Rebecca explains. “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 Nyalok Diu and Rebecca Nyiena Yoak both work for MSF in Southern Sudan as a community health worker and a midwife. February 2009 Photo by MSF
Elizabeth Nyapini Khalifa also remembers fleeing around this time. Both she and Rebecca were born in Leer, a small town in Unity State, Southern Sudan. They now work as midwives for Médecins Sans Frontières (MSF) at Leer Hospital.
“I like working for MSF because I am helping our community here” says Elizabeth. “I am here to support women, to do consultations and to give them encouragement.”
Both midwives 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 Rebecca. “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.”
Elizabeth 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.
Across the road from Leer Hospital is the MSF Tuberculosis Treatment village. Patients live here, and receive treatment in a village setting. Here Elizabeth Nyalok Diu is a community health worker for MSF. She takes care of the patients and gives sessions on health promotion and hygiene.
Elizabeth Nyapini is an MSF midwife in Souther Sudan. February 2009
Photo by MSF
Tuberculosis (TB) is a major cause of morbidity and mortality in Southern Sudan and many people are unable to access health services like those offered by MSF. The treatment is long and requires six months of solid 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 Elizabeth Nyalok Diu. “But they must be encouraged to stay, because if they stop their treatment, they will not be cured.”
Elizabeth believes that the success of the MSF’s TB programmes lie in their village approach. “We have children laughing and playing here and women and men are chatting. It is like a village, which makes it more comfortable and easier for our patients. They don’t feel like they are confined to a hospital bed,” she says.
Elizabeth Nyalok 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.”
Elizabeth 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.”
Elizabeth Nyalok’s story resonates throughout Southern Sudan. Like Rebecca and Elizabeth Nyapini, she represents many women who, past and present, struggle to survive and provide for their families.
“We are the lucky ones,” says Elizabeth Nyalok. “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 Rebecca. “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”
All three women like to sing. “I am a very good singer,” Rebecca says, with a big smile. Elizabeth Nyapini blushes: “My singing is not as good, but my friends know I like to talk!” Elizabeth Nyalok says singing and praying help her to hold onto all that is good and forget any negative thoughts.
“I have had many bad things happen in my life,” she reflects. “But I see the good in things. This is how we can all stay proud and look to a better future,” Elizabeth Nyapini smiles. “Let us sing a song for all the women,” she says. “Oh sister, sister, keep me safe – don’t forget me sister – until we meet again.”
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Four years after the Comprehensive Peace Agreement (CPA) was signed (by the government in Khartoum and the Sudan People’s Liberation Movement) Southern Sudan’s population still faces chronic 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.