It's not easy when it's a question of who lives and who dies

A place to call home

I opened my eyes before sunrise and saw the mosquito net hanging over me. South Sudan, I thought, immediately recalling where I was, where mosquito nets save lives. I stepped out of my metal shipping container and into my muddy gum boots.

Hesco barriers – oversized boxes filled with sand -- surrounded the crammed camp. Over 24,000 people were corralled here, a small city worth of people no bigger than a few square kilometers. A base initially built for the UN peacekeeping operation in Malakal - the major city in the northern end of South Sudan - thousands of South Sudanese civilians fled here when the civil war began in December 2013. They still call it home years later.

The South Sudan civil war continues to affect millions

More than 2.4 million people have fled the country, and 1.9 million people still in South Sudan have been displaced from their homes.

I was in Malakal with the International Committee of the Red Cross team providing medical care in isolated areas. The seasonal rains isolated many villages and the war had debilitated government medical facilities residents may have previously had access to.

Thrust onto the world stage with its independence in 2011, South Sudan has been in the throes of civil war since late 2013. More than 2.4 million people have fled the country, and 1.9 million people still in South Sudan have been displaced from their homes.

Getting the needed food, medicine, and material aid to South Sudan is hard enough, but getting it to those in need can be much harder. Roughly the size of France, South Sudan has only 300 kilometres of paved roads. The rest of the country is accessible only by air or connected by dirt roads that the seven-month rainy season makes impassable. A million others have fled the country entirely. Since the country’s inception outside aid has provided significant support, and is struggling now more than ever to fill the growing gaps.

Off to a muddy start

Roads? Where we were going, we didn’t need roads. The White Nile River runs through Malakal, and the ICRC had a boat. The team packed it up quickly and we headed north.

Skirting along the flat morning water, we wove through green corridors of elephant grass in pursuit of a far-flung village. Two hours later we gently ran the bow into the dense underbrush until we touched land.

One problem: we saw no one. Word usually spreads quickly when the ICRC visits, and even people living outside the village often walk in for aid. As we finished unloading we learned that the surrounding flatlands had been flooded, and badly. That meant a long, difficult walk for us. Lugging the foldable desks, medical equipment and medicine on our backs and heads, we walked toward the village. After only a few steps off the boat, the brown silty water had already reached our waists.

Not enough time

The trip had taken more than four hours in all and in order to make it back before dark we had to leave.

After an hour’s wet hike, we saw the village perched atop a hill. Within minutes the team arranged tables and supplies and dozens of villagers lined up for treatment.

Thankful to have finally reached the patients, the medical team moved quickly and efficiently. Malaria symptoms were common among the residents. I thought back to the first moment of my morning; there are evidently not enough mosquito nets here. The team also treated symptoms of diarrheal diseases and respiratory tract infections, common ailments in remote villages.

Within an hour the team had treated 18 patients, but it was already time to go. The trip had taken more than four hours in all and in order to make it back before dark we had to leave.

“Can we do 15 more minutes?” the head doctor asked as he finished pulling fluid from a woman’s injured knee. Caroline, the team leader, looked at her watch and then at the row of patients. “OK, we can do 15 more but then we need to leave,” she said.

A South Sudan humanitarian crisis with difficult decisions

Out of a day’s journey the medical specialists saw 22 patients. Yet in a more accessible place the team could have treated 50. These ground realities raised difficult, uncomfortable questions.

The day was soon over and we had spent only 90 minutes with the patients. So many others left untended still waited back in the village. We could see angry thunderheads rolling quickly towards us as we hurried back down through the woods to the lowlands.

Making another visit seemed untenable. Out of a day’s journey the medical specialists saw 22 patients. Yet in a more accessible place the team could have treated 50. These ground realities raised difficult, uncomfortable questions: How do you choose who to treat?

Cutting through that marshland, we grappled for moral footing. The drone of the motor again created the backdrop for private thoughts that wondered over life’s big questions as the dark clouds chased us back to Malakal.