In South Sudan, Oxfam races the rains to save lives

By Tim Bierley

In the middle of war, even the simple solutions to staying healthy can feel impossible, but education and resources at the community level are saving lives every day.

Nyawal is a community heath volunteer, helping to educate her community about the importance of keeping their community clean, using clean water and practicing good sanitation to avoid diseases like cholera and diarrhea. Right now, Oxfam and volunteers like Nyawal are racing to educate and provide resources before the rainy season starts. Photo: Tim Bierley/Oxfam You can do many simple things to keep control of cholera and diarrhoea, 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 diarrhoea. 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 pointy-topped 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 wet 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, those 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 supplies 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 unnecessary deaths. It can be hard to persuade people that it’s possible to stop the slide, when it is clear the 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.”

Children are the common denominator

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 almost 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 neighbours 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 pangas 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 tells 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.

Yoal 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. It makes a huge difference to have access to clean water and to the utensils needed to be thorough in hygiene practices, but simple bad luck is also an inevitable factor. The awful fortune of being surrounded by chattering guns is compounded by the resulting destruction of water sources, of trade, of whole ways of life. People continue to be forced from their homes, their routines, and their means of looking after themselves.

As long as this keeps going, thousands of people will continue to suffer from entirely preventable diseases. Oxfam will continue to help people access clean water, maintain their dignity and keep their communities alive. That is something we can at least control.