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Local and nimble: getting things done in South Sudan
50 years of experience has taught us that one of the most effective ways to get work done – especially in conflict-affected countries – is to work through local partners. Finding the right partners is key, and helping them to develop and strengthen their own systems is vital.
A painful war
Following a long civil war between the Khartoum government and Southern Sudan, independence was a milestone for the South Sudanese, raising hopes for long-lasting peace and stability, development, and economic growth. But, by early 2014, a fully-fledged conflict had erupted once again in South Sudan, and since then widespread insecurity has caused large scale displacement and hunger.
Concern partners with the South Sudanese NGO Nile Hope here, carrying out nutrition programming, providing therapeutic food, and running stabilization centers for malnourished children and pregnant and breastfeeding women. Nile Hope receives financial support and technical assistance, training, and on-the-job coaching for field staff. Concern also supports the organisation to manage its budget, procurement, transportation, staff security, and welfare systems.
Increasing Nile Hope’s capabilities has been crucial, as they are often the only assistance available to communities that routinely suffer from hunger because of the conflict.
Treating the vulnerable
Last year, a famine was declared in two counties of Unity State, and a World Food Programme report showed that across the country nearly 5 million people were at risk of food insecurity.
In Unity State, people living in Leer and Mayendit counties have been subjected to weeks of fighting and unrest that has led many to take refuge in overcrowded swamp and marsh islands. Though the islands are considered reasonably safe as a hideout for locals, they are also disconnected from basic food supplies and medical facilities.
Since 2014, with funding and support from Concern and USAID, and supplies from UNICEF and World Food Programme, Nile Hope has been able to continuously adapt its nutrition programming to ensure that people still receive the emergency and life-saving treatment they need — despite conflict and uncertainty.
In the past six months, Nile Hope has treated 1,382 malnourished children, along with pregnant and lactating women, through feeding programs in four different sites. Concern also supports a stabilization center run by Nile Hope for children with Severe Acute Malnutrition (SAM) and medical complications in Touch Riak. One key part of the program is providing ready-to-use therapeutic food (RUTF) for children.
Despite helping so many people this past year, it has continued to be extremely difficult to provide treatment while a violent conflict continues unabated throughout the country.
Loss of property and therapeutic supplies is common during periods of unrest. In just the past four months alone, four established field bases in Leer were looted and vandalized. One was burned to the ground. Adapting to the violent climate became crucial.
Getting mobile in the face of violence
Nile Hope has shifted their response from semi-permanent nutrition sites to a mobile nutrition approach. This strategy allows staff on the ground to move with (and treat) displaced and local populations, including those taking refuge on the islands. Once in a secure location, staff contact the base on Kok Island, sharing details of their new location, including population estimates and the situation on the ground. From Kok Island, the project manager and supervisors plan how best to allocate resources among the at-risk population.
“This is particularly important, because safety of the available resources must be guaranteed,” says Nile Hope’s Nutrition Officer Nellie Kuong. “Information also needs to be verified to ensure that additional resources are allocated to the most needy.”
But this operation can be dangerous, and comes with its own set of challenges. Communities in need live in areas where there are no road networks, even during the dry season. The river and swamp routes are often filled with tall weeds and grass that is difficult to navigate. Locals regularly resort to wading through the water on foot. There is also the very real threat to life for beneficiaries and staff.
“It is easier to take services to the communities in the islands,” explains James Gatluak, a Nile Hope outpatient therapy staff member in Touch Riak. “Instead of expecting communities to brave the insecurity, it is easier for us as humanitarians to go to them, as we have some form of immunity. In some instances, women have been raped along the way as they move to seek therapeutic services either for themselves, their children, or both.”
Insecurity on the mainland means that stocks must be dropped at undisclosed locations, with local women then carrying the supplies on their heads for long hours. To distribute stocks to the islands, the use of canoes is common. Sometimes it’s necessary to wade through the marshland on foot. On one occasion, 2 tonnes of food had to be delivered in a convoy of 40 to 50 canoes over a period of 3 days.
Despite these obstacles, the results speak for themselves. Preliminary surveys in Leer show that the Global Acute Malnutrition (GAM) rate has dropped from almost 21% of the population to roughly 12%, partly due to the emergency intervention by Nile Hope, Concern, and other humanitarian agencies in Leer.
Remaining committed
With some help, Nile Hope continues to persevere in conditions that many others would find nearly impossible. As Ignatious Mangwiro, Concern’s Nutrition Technical Coordinator / Programme Manager puts it, “Nile Hope has been faced with repeated attacks and looting, displacement of staff, and challenging operational demands, but have chosen to remain committed to serving the community of Leer since 2014.”
“It is difficult to imagine how the community in Leer would have survived the past four years without such services.”
Story of Recovery from severe acute malnutrition of Nien Gariek in Leer SC
A 12-month boy Nien Gariek was brought by his mother Nyaroun Kuok, a widow with disability and also with mental problem. The family member and the mother said they had lost hope that the child would survive after seeking several medical interventions and even visited the prominent traditional doctor without improvement. Just before coming to the SC, The mother was advised by one of the women whose child had been treated at the NH SC. They came from Adok payam to Nile Hope Stabilization Centre in Tochriak and the child presented with severe watery diarrhea, fever and oral thrush in addition to inability to breastfeed. The child was admitted after the necessary assessments were done. Admission weight was 5.5 Kg and a MUAC of 9.6cm. The child stayed for 2 weeks and recovered fully from diarrhea and fever and appetite regained. The mother and the family members were so happy to see their child recovering day after day, and even though the mother had mental problems, the facility staff observed the happiness and the smile on the mother’s face every step of the journey. The child was discharged with a weight of 7.1kg and MUAC assessment of 11.1cm. The child was discharged from the program and referred to the OTP in Tochriak. The mother with the family members were so happy and grateful to have their child back to normal health.
Picture A showing the child (Nien) during admission to the SC in Tochriak –Leer, and the picture B showing same child after recovery!
Leer Kitchen garden success story.
Nile Hope implemented the kitchen gardens in Leer County as one of the ways of promoting behavior change feeding habits and to help households to diversifying their diets despite years of violence that have destroyed livelihoods and disenfranchised communities. What is possible with further support to local communities is now clear! Before preparing the gardens, Nile Hope engaged the FSL unit within the organization in Leer and Agriculture extension workers from the state ministry of Agriculture based in Leer at the time to support. The project manager and nutrition supervisors were trained together with the Nurses in each of the OTP centers and they in turn trained the mother support groups. There are 8 fully functional demonstration gardens and households were trained to set up their own at home. The endeavor has improved food security by providing variety of vegetables that can be consumed by mother support group families and to sell some for money which can then be used to acquire other materials that would otherwise be out of their reach.
The gardens were fully setup and maintained by the mother support groups and they continue to sell the produce for their own use. In December, each garden was able to produce vegetables worth 4000ssp a day 3-times a week from each of the gardens. Through sensitization, vegetable consumption is becoming a reality in Leer and most families are embracing it. The vegetable gardens were setup near the swamps for sustainability purposes. Mother support groups have full ownership of the farms and they are the change agents in their community. Apart from the seeds and other farm inputs that were sourced by the Nile Hope nutrition unit in Juba and intermittent mentoring, the whole project is being implemented by the mothers in the community under supervision from the Nile Hope nutrition team in Leer.
A local woman, Nyakandey Gatkoi in Tochriak shared her sentiments saying “I used to see my neighbor grow “Sukuma wiki” but I did not know the benefit of Sukuma wiki but now I know it’s good food at home. I initially thought it is Tobacco! When the team taught us about it, I also learnt how to cut it and prepare it so that it is served while still green. I thank Nile Hope team” she said. Nyakandey is a widow in Tharyier Village in Tochriak Boma, Thonyor Payam. She is 32 years old and has 4 children. 2 are under 5 years while the other 2 are 5 and 7 years respectively. In 2007, Nyakandey’s currently, 4 years old was admitted in Nile Hope OTP in then Thonyor OTP and later transitioned to the TSFP program in the same facility. She was a member of the women support group advancing behavior change communication for MIYCN in Tochriak in 2018 and believes Nile Hope and its partners UNICEF and WFP have done a lot for the people in Leer throughout but especially during the Famine response in 2017. Nyakandey hails the food demonstrations and the kitchen gardening campaigns because it has helped her to also setup her own garden where she has managed to get extra vegetables to sell in Tochriak market. Other women also shared their stories on how they have learnt to grow and prepare vegetables and further, how to combine different foods especially vegetables with Meat or Dry fish and eat it with Rice, kop or kisra.
Land clearing by the yang MTMSGs and making ready for plantation.
MTMSGs getting collard green TOUCHRAIK kitchen garden ready for sale in the market
MTMSGs in the market selling the vegetables and a purchasing customer. The Customer gives out the money while the woman gives out the vegetables. Both of them are feeling happy because they met their needs.