Southern Sudan fighting famine

The road leading into Tonj forks at the market-place and merges again on the other side. This small town in the Bahr el Ghazal region of southern Sudan has seen its normal population of around 600 swell in the last few months to between 8,000 and 12,000, as the famine that is ravaging the region drives people here in search of food.

The market offers little in the way of sustenance, mainly soap, cigarettes and other dry goods, but the two streets on either side of it are crowded. Many people have found shelter in abandoned stone buildings in the centre of town. Others are huddled on the wide verandas or camped around small cooking fires.

At one end of town, in a mission compound, the ICRC has set up a feeding centre for Tonj’s most vulnerable residents, such as the blind, the disabled and lepers. Here, 468 people are served two meals a day consisting of maize flour, beans, oil and salt.

At the far end of the compound, an old dispensary has been turned into another kitchen, this one for severely malnourished children and adults. Behind the main building, plastic tarpaulins tied to the top of wooden poles protect the kitchen from sun and rain. Beneath them, five large pots of maize porridge and two of beans simmer over the fire.

All around the courtyard, people sit on the ground in well-ordered groups and rows. Most have their plastic ICRC registration cards dangling on strings around their necks. Lines of ashes on the ground mark out the various sections of the compound. Since the most urgent priority was to make food rapidly available, there was no time to build fences or other methods of crowd control, but the symbolic perimeters are scrupulously respected.

As each group is called, they form a queue and wait their turn to receive a bowl of food. Each card is checked, and if the description does not match the person, the card is confiscated so as to discourage theft and other forms of preying on the weak.

Once all 468 people are served, the staff look around for the weakest of the new arrivals not yet registered at the kitchen. The remaining food is divided amongst them. ICRC nurse Corinne Borloz says that now the meal distribution system has been set up they can start to diagnose and treat common ailments, such as worms, while people wait for their food.

A new arrival

In the centre of Tonj is a third ICRC facility, this one providing therapeutic milk and meals to children and breast-feeding mothers. A large crowd is gathered outside the one-metre stone wall surrounding the building. Inside, on one side of the building, are twelve groups of children, each forming a circle. ICRC staff stand in the middle of each circle handing out mugfuls of Nutriset, an enriched milk formula. The 670 children receive four feedings of milk and one meal of sorghum and beans each day. They range in age from three to their early teens. Many have no clothes, others are clad in a tattered shirt or piece of cloth tied at the shoulder.

The area around the gate clears to reveal the naked and motionless body of a teenage boy lying on the ground. Every bone and joint stands out. The ICRC nutritionist in charge of the centre, Jenny McMahon, spots him and runs over, waving urgently to staff and shouting: “Who brought him here? How did he get here?” She requisitions two men to carry the boy to the shade of the veranda, where they prop him up against a wall. He opens his eyes, but his stare is vacant. One of the local staff estimates his age to be about 13 or 14. They feed him a mug of the enriched milk. Between sips, he answers questions in a barely audible voice.

His name is Marar and he has been walking for three days from the town of Thiet, a distance, the Sudanese interpreter adds, that a healthy adult would cover in eight hours. The boy explains that he had started out from Warrap, walking for 15 days to reach Thiet, where there is a feeding centre run by a relief agency. It is only for children under ten, however, and Marar was turned away, so he continued on to Tonj.

Marar left Warrap after several members of his family died.First his father succumbed to illness, then his mother and sister. “There was hunger in Warrap,” he says. He didn’t know what had become of the rest of his extended family.

After finishing the milk, he is given a bowl of maize flour mixed with water, as well as beans and oil. Jenny McMahon cautions him to eat slowly, saying he can take all afternoon. Later, she fetches him a second serving of beans to add more flavour and encourages him to finish the maize porridge. Marar is returning to life now and his eyes have brightened.

“They recover very quickly once they start to eat,” explains McMahon. “It’s a sure sign of extreme starvation.” Marar is not only becoming more alert but also more demanding. He wants lodging and a blanket, says an interpreter. But tarpaulins and blankets have still to be delivered to Tonj, and the centre is not organized or equipped to shelter people. Marar’s case is serious, but he is far from unique amongst the centre’s 670 children.

The boy is told he will have to find shelter in one of the large stone buildings housing other displaced people across the street. Marar is now strong enough to make his way slowly over there, after being told he can come back to the centre for more food in the morning.

Back in action

After an absence of 19 months following a serious security incident, the ICRC was able to relaunch its field operations in southern Sudan on 1 June 1998. During the stand-by period, the ICRC maintained its 500-bed surgical hospital in Lokichokio, in northern Kenya near the border with Sudan, as well as other core activities such as cooperation with the Sudanese Red Crescent, tracing and detention. Since it resumed its operations inside southern Sudan, the number of locally hired and expatriate staff has increased to over 500. Every week, six ICRC planes transport an average of 100 tonnes of food, water and sanitation as well as medical assistance items on 25 flights. In the Bahr el Ghazal locations of Wau and Tonj, the ICRC is feeding over 5,000 people, by serving over 63,300 meals per week. As part of its integrated approach, the ICRC is also providing medical assistance to the local health facilities and restoring wells and bore holes to allow people access to clean water.

Building up strength

Back at the feeding centre, more circles have formed, this time composed of 180 women, each holding an infant or small child. The mothers receive two meals a day plus milk and are encouraged to continue breast-feeding. One woman gently places a small package on the ground next to her. She unwraps the cloth to expose a tiny new born weighing less than one kilogram. The mother says the delivery was not premature. With the help of a Dinka translator, Jenny McMahon exhorts the mother to eat and drink more. “You must consume more to provide more milk or the baby will die,” she pleads.

At a staff meeting, some members suggest that the ration is too generous and that it should be reduced to include more people. McMahon disagrees. “We need to restore these people to an acceptable level as quickly as possible,” she counters, “so that they can move to the other kitchens, and room can be made at the feeding centre for the new cases of severe malnutrition that are surely on the way.”

“The people arriving now,” she says, “are walking for six to ten miles to get here, but as word spreads, more will come from further and further away.”
Later, she confides that an additional kitchen will soon be required in Tonj, but she worries that other kitchens should also be set up in the surrounding communities to avoid encouraging even more people to converge on the town.