By Tim Rice By mid-March, an aid convoy managed to reach an extremely remote, war-torn area of the Nuba Mountains in Sudan: Kau-Nyaro and Werni counties. Effectively cut off from the outside world due to conflict, the UN estimates around 45,000 people living in these counties are considered the most affected by the six-year conflict in the Nuba Mountains.
The South Kordofan-Blue Nile Coordination Unit, an organization that monitors food security and displacement in the two areas, reported last February that 242 people – including 24 children —had died of hunger-related illness in the two counties. Now, for the first time, vital medicine provided by Persecution Project Foundation (PPF) reached one of the most isolated areas in Sudan, if not the world.
“We’ve been trying for years to penetrate every community in the Nuba with our medical outreaches,” said PPF President, Brad Phillips. “We thank God we managed to bring some hope and encouragement to another dark corner of this conflict.”
But no area of the restive Nuba Mountains is easily reachable, and the Sudan government wants to keep it this way. The central Khartoum government effectively blocks any aid from reaching the rebel-controlled areas of the Nuba. The government’s blockage follows their military strategy -- a war of attrition against the Nuba people -- since the conflict began in 2011.
“In the wars of Sudan, food and medicine have been more effective weapons of genocide for Khartoum than bombs and bullets,” said Phillips.
Despite these challenges, PPF managed to deliver 44.5 tons of medicine and medical supplies to the Nuba Mountains in 2016, making it the single largest supplier to the region, according to PPF Field Coordinator Kuti Rajab.
Assisting 175 localities in the Nuba Mountains, a large amount supports Mother of Mercy Hospital, and two other smaller hospitals where PPF also covers staff salaries, says Phillips. “One of the first people we met in the Nuba in 2011 was Dr. Tom Catena at Mother of Mercy Hospital. We knew then we wanted to do whatever we could to help him in the area of medical needs.”
While the support is great, the need is still greater, Phillips concedes. There still remains a 25% gap in available medicine for the region, and health facilities are few and far between. The UN estimates there are 70 active health facilities functioning in the rebel-controlled areas of the Nuba Mountains – that means one facility per 12,600 people. There are four hospitals serving roughly 1.5 million – and one of these hospitals, Gigeba Hospital, is still being built.
PPF is providing the bulk of the medicine and much of the construction materials for the upcoming facility. The hospital is designed by a local Nuba doctor, Dr. Ahmed Zakaria, who, incredibly, managed to pick up a degree in architecture while completing his studies in medicine. Already, many patients are being treated there despite the fact the floor is only partially complete, and most window-panes are missing, Dr. Zakaria said back in December, 2016.
“It’s really helping people in Western Jebel,” says Tutu Turkash, Secretary of Health for the rebel-controlled areas, speaking about the new hospital. “Now it is able to provide services for the people there and reduces the number walking two to three days to reach Gidel [Mother of Mercy Hospital] – our main facility.” Out of 52 clinics in the area, Turkash added, Gigeba is the only hospital.
The secretary of health believes thousands of lives are saved each year through PPF’s support, especially children and mothers. Child mortality rates, particularly during the rainy season when malaria thrives, used to be very high prior to the organization's involvement. “It was not uncommon for clinics to report 40 – 50 cases per month, sometimes reaching hundreds,” Turkash said. “When you compare these rates to now with better equipped health facilities, clinics report two to five mortality cases. It’s a huge impact, beyond words.”
Hussein Adam, a long-time farmer and former soldier during the previous war in the Nuba Mountains has experienced the change in medical access firsthand. “Before, finding any medicine was difficult,” Adam recalls. “Most of the time you had to rely on traditional remedies that sometimes worked but sometimes failed.” Adam’s brother died of a leg wound that he feels could have been treated if only basic medical care was available. “If he was here now, we could have saved him.”
But getting this medicine to the Nuba Mountains is no easy task. Kuti Rajab recalls a time in 2014 when it took the PPF team two weeks drudging through mud to get two trucks of supplies delivered. A medical consignment was delayed forcing PPF to deliver supplies during the onset of the rainy season where roads become intractable and the rebel-controlled areas of Nuba are effectively cut off from the outside world. “We really struggled, but in the end succeeded to get the shipment up there, pushing the trucks through mud for days on end,” Rajab remembers.
But in many ways, mud is the least of their worries. The Antonov, a lumbering but deadly warplane used by the Sudanese government, is a common bane for the Nuba people. Since 2012, the Sudan government has dropped over 4,000 bombs against civilian targets in the Nuba Mountains. One of these planes hovered above PPF’s medical-supply convoy. “When we see them flying above we stop all movement since, if you move, they will spot you,” Rajab explained. “Since we were on the road there was nowhere to hide, we just had to stop while the plane flew overhead and pray they don’t bomb us.” Fortunately for Rajab, their prayers were answered on that journey.
Once in Nuba, local partners often have to find secure and creative ways to deliver the medicine. To reach Western Jebel, a restive area in the Nuba Mountains, a convoy of 20 motorbikes was used to deliver medical supplies, Phillips said. The roads were so poor, only motorbikes could make the journey – a journey that was done partially at night to avoid detection by enemy combatants.
And once medical supplies reach health facilities, there is still a chance of an attack. Since 2012, Sudan warplanes have targeted hospitals at least five times, according to Nuba Reports, a media house that documents the conflict.
According to Turkash, Sudan forces have attacked 24 clinics in three counties of the rebel-controlled Nuba Mountains since the war began in 2011.
One of the most crucial medicines PPF provides local health facilities in the Nuba Mountains is anti-malarial drugs. “This is the one that always runs out,” Rajab said, “especially during the rainy season.” Turkash agrees. “It is the biggest challenge we have, especially considering the fact that roads are impassable during the rainy season so even distributing malarial drugs becomes a challenge, sometimes vehicles simply cannot reach certain locations.”
Relatively new challenges for the Secretary of Health in the Nuba Mountains are hunger-related illnesses. Harvest rates for the Nuba Mountains were less than half their average production, according to the Secretary of Agriculture in the rebel-controlled areas, Hafsa Idriss. This, coupled with displacement from the conflict, has led to skyrocketing prices for staple commodities, reaching ten times their normal market prices.
“Although maybe not noticeable at first, many people in Nuba are suffering growth retardation from malnourishment,” said the Director-General of Health Joseph Konda. “This can only get worse in the current situation we are facing.” To address this problem, PPF added another commodity to its support: the high-nutrient BP-5 biscuit.
“BP-5 is expensive, but a great resource for getting high-nutrient food to the severely wasted or malnourished in our hospitals or clinics,” said Phillips. “We don't currently have the capacity to feed everyone, so we are focusing on the greatest needs — mostly children and IDPs [Internally Displaced Persons].
Besides delivering medicine to a remote war zone, providing materials and upkeep to hospitals, among other projects, PPF hopes to provide even more holistic medical support to the Nuba people: care for the caregivers.
Everyone in the Nuba Mountains has witnessed and contended with death due to the war, especially those in the medical field. “We see nurses and doctors saving lives every day,” Phillips said, “but they are also seeing death every day.” For this reason, PPF plans to provide trauma counseling for medical staff. “It vexes your soul, it makes you angry and then sad – you can’t help but be affected,” said Philips, reflecting on some of the tragedies he has personally seen while working in the field. But the stress will not slow the organization down as it plans to expand its health programs across the region.
“To be honest, I cannot even imagine how we coped before PPF came,” Turkash said. “Having them with us here, where few others will come, it’s a game changer.”