South Sudan

“We have come to restore hope”: In South Sudan, Action Against Hunger’s emergency team provides last-mile health care in hard-to-reach communities

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By: Susan Martinez

In Pibor County, South Sudan, there is not enough data to officially declare a famine – but some experts believe that it is likely happening. Conflict, climate shocks, and COVID-19 have all contributed to the worsening hunger crisis here. By the time a famine is declared here, it will be too late – many will have died of hunger already.

Maruwo is an isolated area in Pibor County, and it is currently home to an estimated 17,000 people who have fled their communities to seek safety from conflict. In the hills under Mount Maruwo, Action Against Hunger's emergency team has been deployed for several months to address urgent health and nutrition needs.

Our Multisectoral Emergency Team – nicknamed the “MET” – is sent out to help communities facing urgent humanitarian needs. This small team reaches some of the hardest-to-reach areas and, often, they are the only humanitarians for miles. Their role is to get to communities in need as quickly as possible and provide lifesaving aid until more permanent assistance programs can be developed or until a short-term crisis subsides. Sometimes they stay for just a few weeks and other times, for many months.

Witnessing suffering seven days a week, working tirelessly to help those in desperate need, and living in a tent for over a year - this is humanitarian life at its roughest. A year ago, a team of six landed for the first time in Maruwo: Patrick, Moses, Michael, Umary, Queen, and their team leader, Noel.

"Maruwo is an area where access is really a problem. We arrived with a plane because there's no road network," says Noel. The team’s arrival came as a shock to the people living in Maruwo, who had never had access to any health services.

"It was quite challenging for the community to understand what we came to do," explains Noel, who got in touch with the community leaders immediately after the team’s small plane landed. "We explained to the leaders what we're coming to do here, and the services that we're going to provide the people. After that, they welcomed us."

Maruwo presented its first challenges early, as the MET struggled to clear land so they could pitch their tents and dig a pit for their latrine. That first night, the team didn't sleep until very late, under a starry sky and the nearby giggles of hyenas.


A year later, the team is still there. While the team is usually only deployed for weeks or months to a given location, the COVID-19 pandemic has kept them in Maruwo for much longer due to restrictions in movement.

As a red moon rises on the horizon, a guard alerts the team that a medical emergency is at their door. Such midnight emergencies have become the norm.

A group of women and men hurry into the campsite carrying an unconscious woman on their shoulders. Noel and Patrick quickly lay a mat on the ground and set up an IV stand for their patient. Carefully, the group lays the woman on the mat and sit close to her as the team starts their examination.

Asus Alami, 23, was asleep with her family on the bare ground that night. They had travelled from the other side of the hill, and planned to come to the mobile health facility in the morning. They had barely eaten for days. Asus had been experiencing headaches and muscle pain for some time.

But then, in the middle of the night, Asus went into labor and fainted. Her family brought her to the mobile clinic as quickly as they could.

Noel and Patrick immediately stabilized Asus by stopping the bleeding and hooking her up to an IV. As she slowly regained consciousness, they focused on the premature newborn. "Five months premature, at least," they estimated. The mother, still weak, did not have any milk. Patrick diagnosed her with severe malaria. The baby, against all odds, was active and moving.

"He's fighting," said Noel. Inspiration struck, and he asked the family if any of the women had recently had a baby. Asus’ sister had, and was producing “very little” milk. Noel explained that, at this age, the newborn could not breastfeed but could take his aunt's milk through a needleless syringe. The women were skeptical that only the mother's milk could be fed to the baby. But Noel convinced them, and the baby eagerly drank the milk.


For more than a year, MET members have camped out in Maruwo, delivering humanitarian assistance to the community. None of the team has taken leave to visit their families because of the COVID-19 pandemic. Movement restrictions in South Sudan stranded many teams in the field, keeping them from their loved ones for months. On top of the pandemic, Maruwo is so remote that the MET is currently only source of assistance for the community.

"There's no partner able to help this community at the moment, and we cannot just pull out. On a humanitarian basis, we can't do that. Leaving people to go back to the same suffering, we wouldn't be making any difference," explains Noel.

Living in a tent for so long and working in such an intense environment has challenges unlike any others.

"The first time, we arrived one of our team members happened to be sleeping with a snake in the tent. In the morning, we found out, and most snakes in these areas are poisonous, but fortunately nothing happened," says Noel. "Problems with bugs are common. You find scorpions inside the tent often and at least every two months one of the team members gets malaria."

Every day, Noel and Moses, the MET’s nurse, head to the small health center to provide lifesaving treatment to children under five years old. Early in the morning, the health center is already full and has both of them working tirelessly. Just outside the tent, Patrick attends to adults seeking medical attention.

Meanwhile Michael, the team's Water, Sanitation, and Hygiene (WASH) Specialist, travels around the community delivering hygiene and sanitation training as well as ensuring that the community has access to clean water from the borehole.

Queen sits under a tree in a private area where she can talk with people from the community. Slowly, they are turning up in greater numbers for the mental health support and youth health education she provides in a safe space.

Back at the base, Umary, the team's logistician, ensures that all humanitarian supplies are in order and properly organized for distribution. Supplies includes everything from malaria tests to gardening tools, soap to nutrition treatment.

This is the MET, working in an area where there are catastrophic levels of food insecurity and diseases and extremely limited access to health, nutrition, and water. Undaunted, they continue offering their services.

"Never in their lifetime have these people received these services,” says Noel. “Now they can get clean water from the borehole, health services, some seeds to do gardening, and have someone to listen to them. Where there was no hope for survival, we have come to restore hope, and this makes me very grateful."