Displaced children gather at a cooking fire in the town of Mingkaman, South Sudan.

Interview: On the Ground in South Sudan with Kent Page

As unrelenting fighting continues in South Sudan, UNICEF is warning that famine could claim up to 50,000 children’s lives. Months of violence have kept farmers from planting crops. Now, for so many South Sudanese, there is little left to eat other than grass, leaves and roots. The possibility of the worst famine since the 1980s could leave millions on the edge of starvation in just a few months.

 

In this exclusive, never-before published interview, UNICEF emergency communications specialist Kent Page tells stories from the ground and shares first hand what’s truly happening to children in South Sudan as the situation deteriorates.

Q: How long were you in South Sudan, and where were you?

KENT: I was in South Sudan on an emergency communication mission for six weeks. Most of my time was spent in Juba and the surrounding areas, but I also traveled to Minkaman, which is in Lakes state, and Bentiu, which is in Unity state. While I was in Juba, UNICEF was leading an emergency response to a cholera outbreak, and there are a couple of protection sites where internally displaced people are seeking refuge. In Minkaman and Bentiu, the focus was also on the emergency response for internally-displaced people.

Q: Describe what you saw in the South Sudan and the children that you met there.

KENT: Physically, South Sudan is very beautiful, and the people are wonderful. They're people just like you and I who want to go to work to create the best life for themselves, for their family, for their children. The children, all they want to do is go to school. These people are victims of a senseless conflict they really have no part in. They all want peace to return, to go home, to have a normal life, to create the same opportunities for their kids that everybody around the world wants to have.

It’s almost a perfect storm in South Sudan for ... malnutrition and eventual famine.

 

It’s so sad—given that South Sudan just gained independence, that because of the conflict, millions of people are suffering on a daily basis. They just want to build South Sudan up to its full potential. They deserve that opportunity.

 

Children in South Sudan call for peace in their country.

HELP SAVE LIVES

 

Q: Could you put the current crisis in South Sudan in context?

KENT: Since December 2013, there has been conflict. Right now, there are 1.3 million people who are displaced – and amongst those 1.3 million, more than 550,000 are children. A massive amount of people have fled the conflict, carrying the clothes on their backs, afraid for their lives. Many have sought safety at United Nations bases, or they’re in internally-displaced persons camps.

Because of the massive displacement, people are not able to plant food. They won’t have a harvest, and the food pipelines – from grower to seller to consumer – are terribly disrupted. Markets don’t have the amount of food they would normally have, so prices go up. At the same time, people aren’t working. They don’t have an income and can’t buy food.

Q: How did this become such a dire emergency?

KENT: Before the crisis, South Sudan already had high rates of child malnutrition. These rates are exacerbated by the conflict – and then there’s an added layer of disease. Children who are weak from hunger are at greater risk for measles, cholera and malaria, and there have already been a number of outbreaks of disease spreading death throughout the country.

Unless nutrition treatment is scaled up immediately, up to 50,000 children will die ...

 

It’s almost a perfect storm in South Sudan for the terrible potential of malnutrition and eventual famine. UNICEF is very concerned. Unless nutrition treatment is scaled up immediately, up to 50,000 children will die of malnutrition. In addition, there are about 3.7 million people in South Sudan who are currently at very high risk of food insecurity. Among them are 740,000 are children under the age of five.

Families gather at a UNICEF water collection point in Bentiu, South Sudan.

Q: What does the situation look like for children?

KENT: I was at a nutrition treatment tent about two weeks ago in Bentiu where severely malnourished children are being treated. I happened to be there when a mother was told her child had passed away. This woman was completely devastated, as you can imagine, anguished beyond belief. That’s a horrible thing to see. The very next day, at about 4:00 in the afternoon, I saw another woman told her child had also just died. These are the children that are able to get treatment – that can give you an idea of just how desperate the situation is.

Q: Is there any food in these camps? What are people eating? We have reports of people eating famine foods like grasses and roots already.

KENT: People are eating whatever they can find, wild vegetables and fruit, as well as roots and grasses. That’s definitely happening. In the camps, there’s food available, but the food there might not give you all the nutrients that people need for a healthy diet. As I mentioned before, the prices of food, because it’s so limited in supply, are very high. For displaced people, it’s very difficult. They have no employment and therefore no income.

People are eating whatever they can find, wild vegetables and fruit, as well as roots and grasses.

 

The food markets that do exist are over-burdened with demand. Supply routes have been impacted severely by the conflict and by the rainy season. Transporting food is very difficult on dirt roads that are quick to turn to mud and are virtually impassable during the rainy season.

Q: Could you talk a bit more about the coming rainy season?

KENT: The rainy season is both a curse and a blessing. It’s a curse, because water-borne diseases like malaria and cholera increase, and we’ve already seen a cholera outbreak. On the other hand, if there’s not enough rain—and that, in fact, is the predicted situation for the rest of this year—any harvest that may have been planted won’t get adequate rainfall. There won’t really be a harvest in the coming months and FuseNet, which issues food security alerts, is warning of famine

Many of the 1.3 million South Sudanese who have fled the conflict do not even have shoes.

HELP SAVE LIVES

 

Q: What are some of the signs and symptoms of malnutrition and severe acute malnutrition?

KENT: Low body weight for height ratio. A child will be very thin. The child’s skin may sag. I took a picture of a child where there are hollows in the back of his neck. Malnourished children are also lethargic. Their eyes are dull; they just look exhausted and tired. When you look at them, you just want to help them so badly. Edema can strike them on the feet or on the upper body, when fluid builds up in the skin and then it bursts. It’s pretty horrible. These children don’t show a lot of emotion, except for exhaustion and anguish, and they also have a loss of appetite, which is not good.

Q: With everything going on in South Sudan, how is UNICEF able to reach children who need relief? What are the greatest challenges UNICEF faces in caring for children?

KENT: In terms of reaching children with relief, our partners on the ground are key. UNICEF works with partners to supply ready-to-use therapeutic food and nutritional screening for children. This includes the MUAC screening—a MUAC tape is a measuring tape for mid- & upper-arm circumference. It’s a quick, efficient way to screen children for malnutrition

UNICEF works with partners to supply ready-to-use therapeutic food and nutritional screening for children.

 

We also provide micronutrients, support feeding centers and work to raise awareness of the importance of breastfeeding for new mothers. For the first six months, breast milk is definitely the best food mothers can give their children. Even before the conflict, there were issues with insufficient breast feeding.

The challenges? Well, the violence, the terrible roads, reaching the isolated populations. The major issue, though is funding. We’re facing a huge gap in the funding that’s needed to continue these lifesaving interventions for malnutrition.

A health worker uses a MUAC arm measurement tape to screen a South Sudanese child for malnutrition.

Q: Tell me about the therapeutic food used to treat children with severe acute malnutrition. How is it different from regular food?

KENT: Therapeutic food is really palatable food that has a high energy content and high amounts of vitamins and minerals. Ready-to-use therapeutic food comes in a package. It’s soft food, and basically you just need to squeeze it out of the package directly into the child’s mouth. This is really great stuff, very nutritious, and what’s extremely important is that you don’t need to mix that food with water. You avoid the risk of contamination that could come with mixing food with unclean water.

With therapeutic food ... you can see the positive results in a matter of days.

 

I’ve seen kids across South Sudan eating ready-to-use therapeutic food, and I’m certain that I’ve never seen a kid who didn’t sort of look like he was enjoying eating it. I can’t tell you that it tastes good, but I’ve not seen a kid pushing it away. They are eating it – the kids have got their little hands on the package, and the mother is there helping them, squeezing it right into their mouth. You can see the positive results in a matter of days for a child who’s severely malnourished.

A South Sudanese mother feeds her malnourished child ready-to-use therapeutic food.

HELP SAVE LIVES

 

Q: Is the continued violence a threat to UNICEF’s ability to reach children in remote locations?

KENT: The fighting is very much impacting our work. UNICEF works wherever UNICEF can work, and we work in a lot of places across South Sudan. but at the same time, there are sections of the population that we have little humanitarian access to, so we are doing our best to reach them.

Conflict and insecurity are the main obstacles. What is needed in South Sudan, not just for nutrition, but for every aspect of people’s lives, is that there be peace, that there is security, and that humanitarian actors like UNICEF have access to all the populations that we need.

Q: A lot of organizations are trying to respond to the South Sudan crisis. How is UNICEF’s work different?. How does UNICEF work to coordinate efforts across organizations?

KENT: UNICEF is a cluster lead on nutrition, which means we take the lead on work that combines all the different partners that work in this sector. UNICEF has very good contacts and coordination with the government of South Sudan, and with community leaders in IDP (internally displaced persons) sites, so we lead on that as well. There’s a lot of trust placed in UNICEF, a lot of knowledge, a lot of emergency experience that UNICEF has, but we don’t work alone. We work with partners across the board, and our partners are excellent, doing terrific work in nutritional treatment for children.

UNICEF supplies micronutrients, ready-to-use therapeutic food, the MUAC measuring tape, the long measuring boards to get the height of children, the scales that weigh the children to find out their nutritional status, their state of health. We also do a lot of social mobilization, community awareness about the importance of breastfeeding, the importance of making sure that diets include different kinds of food, so people are not just eating sorghum, for example, and not getting all the nutrients they need.

Long queues under the hot sun at UNICEF health tents for displaced people in Bentiu, South Sudan. @UNICEF

We also provide a lot of tents, very important at IDP (internally displaced persons) sites where people forced from their homes are seeking safety. During the time I was there the weather was, on a daily basis, about 40 degrees Celsius (104 Fahrenheit), with very, very hot, blinding sun. These IDP sites have virtually no trees, no shelter from the sun. UNICEF also provides tents to our partners to use as nutritional treatment centers. The difference between being out in the sun and inside a huge white UNICEF tent is incredible. It’s clean. Desks can be set up. Medicine can be stored. Doctors and nurses can treat children. Children are out of the sun, laying on beds, even sitting on mats on the floor.

UNICEF is very well-placed to work with our partners, to work with the government on nutritional treatment for children, but, as I said, unless treatment is scaled up very quickly in South Sudan, 50,000 children will die of malnutrition. We have to do everything and anything possible to keep that from happening.

HELP SAVE LIVES

© UNICEF/NYHQ2014-0413/Holt