For the first two months of her life, Mary James slept with no blanket on a steel bedframe inside a small, damp shelter in the middle of an overcrowded displaced persons camp. Now, she’s sleeping in an MSF hospital bed, fighting for her life.
Each time the three-month-old exhales, her breath rasps in her tiny, infected lungs. When the infant cries, her body contorts with the effort of breathing. Until recently, she’s been connected to an oxygen machine.
Mary lives in the United Nations Protection of Civilians Camp (PoC) in Malakal, South Sudan. As the cold season sets in, children like Mary suffering from pneumonia and other respiratory tract infections make up over half of the admissions to the pediatric ward in the Doctors Without Borders/Médecins Sans Frontières (MSF) hospital, which is the main provider of inpatient secondary health care in the camp. Recently, a malaria outbreak filled the hospital with convulsing children. As beds were taken, many patients slept on mattresses on the floor.
"The root cause of these illnesses is overcrowding and substandard living conditions," says MSF medical doctor Yasser Sharaf as he makes the morning rounds. Outside the hospital gate, nearly 50,000 people are living in thousands of tents and shelters packed so tightly together that residents must walk sideways through some of the narrowest passages.
Fleeing an Upsurge of Conflict
The families living in the worst areas arrived three months ago, part of a wave of 16,000 people who fled conflict, violence, and malnutrition. Most of them traveled at night in small canoes from nearby Wau Shilluk, across the White Nile River, where humanitarian assistance had been cut off for months. They arrived to the camp with almost nothing.
Forty-year-old Nya Gaw was among them. Formerly a midwife with a career and middle-class home, she is now almost completely reliant on humanitarian assistance. In the PoC she lives with 55 other people in a dirt-floored communal tent.
Sitting in her tiny living space, she removes the stems from a pile of leafy greens known as lum. It’s a food-of-last-resort foraged from outside the camp to supplement her meager monthly food rations.
Nya arrived with two sons but her family has grown bigger since she came here. In spite of her difficult circumstances, Nya has taken in four other children who were separated from their parents during the conflict. Nobody knows where they are. Together, Nya’s expanded family shares a single cot and a couple plastic mats on the floor for sleeping. Their living space is the size of a single bedroom.
At night, it is getting increasingly damp and chilly, and the air buzzes with mosquitos. The narrow ditches and alleys that separate Nya’s tent from the others around it are filled with mud and stagnant water. There are barely more than four square meters of space per person in this area of the camp—less than one seventh the minimum space required by international humanitarian standards.
Put simply, Nya’s living conditions are a recipe for disease. She says that two children living in her tent have been admitted to the MSF hospital recently, gesturing to their families’ equally cramped living areas. "At night, everyone is coughing and sickness is spreading," says Nya, a comment echoed by many mothers in the camp. "We need more space."
Cramped Quarters, Few Resources
Only about half a square kilometer of the camp has been allocated by the United Nations for families like Nya’s. More room is urgently needed. Currently, there is not enough space to expand life-sustaining services like water points, bathing areas, and latrines—never mind adequate schools, recreational spaces, or markets.
About 200 meters from Nya’s tent, a set of taps is surrounded by winding lines of jerry cans. The taps are connected to a bladder that is filled with water twice a day, but never stays full. A group of women has been waiting in line for hours, but they don’t always get the water they need. Latrines are a bigger problem. With less than one latrine for every 70 people in the largest section of the camp, one woman complains people are defecating in the few showers available for hygiene.
In these conditions, it is no surprise that queues for the few primary health care centers in the camp often form before sunrise. The clinics close at 5:00 p.m. and every second Sunday there is no primary health care available at all. When those tent clinics are closed, long lineups form at the emergency room in the MSF hospital. Too many of those patients, like young Mary James, arrive in serious condition.
Back at the MSF hospital, it is now evening time and Mary is doing much better. She is sleeping under a mosquito net for her last night in the hospital. Sadly, when she leaves, she’ll return to the same cold shelter in the same crowded cramp, where she is likely to get sick again.