Napere refugee camp

In the CAR. No passport required.

Some young boys fetching water at the
hand-pump in Makpandu refugee camp.

Napere refugee camp hosts several thousand men, women and children from the neighboring countries of the Democratic Republic of the Congo and the Central African Republic. In fact, in the adjacent town, there is a market that straddles all three countries. There’s no actual border to speak of, just dusty roads and jungle. The same tribe (the Azande) lives in all three countries, so linguistically and culturally there isn’t a difference. On the left-hand side of the main road between Dabio and Ezo is the Congo, on the right side, South Sudan. For some time, a rebel group, called the Lord’s Resistance Army (LRA) has been active in these areas. Tens of thousands of people have been forced to flee their homes because they’re afraid of violence. Those who flee across an international border are refugees (and therefore under the protection of UNHCR); those who flee within their own country are called internally displaced people (IDP’s).

The WFP warehouse where we store
the food that we distribute to refugees

Bags of lentils, donated by
the US government to support
refugees in Sudan.

In addition to spreading violence and fear, these attacks have created a situation of food insecurity. Western Equatoria should be an incredibly fertile place. Enough food can be grown here to feed the whole of South Sudan. Yet, the World Food Program (WFP) and many other multi-lateral and non-governmental organizations have had to step in and provide food aid to the population. The reason for this is that farmers are fleeing their homes and aren’t planting. Even those who are planting are not planning as much for fear of the risk of having to flee before harvest and losing their investment. So, as families flee to peri-urban centers,

 there is less cultivation and higher 

population density in towns. All of this leads to higher malnutrition among children, poorer sanitation, worse health outcomes, higher maternal mortality, the spread of STD’s including HIV, and a greater pressure on schools—not to mention the incredible toll such conditions have on people’s mental health.

In the refugee camps, organizations such as the one that I work for, are trying to alleviate these negative consequences. We support health clinics and a primary school, distribute food and do some activities around water and sanitation. This is an effort that involves a lot of people and a lot of money… and it’s woefully insufficient. Yet, without international assistance, things would be far, far worse.

A baby girl waiting with her mother at the refugee health clinic

I took this photo in the camp.
This little boy is infected with intestinal worms.
When you see a kid with a tummy like this, you know its worms.

To me, the most striking thing about these camps is the number and state of children. There are so, so many of them and most of them are obviously sick. Because of a lack of family planning knowledge, contraceptives and a very traditional culture the birth rates are very, very high. I can’t tell you exactly how high. (As a public health person, a relief worker and someone who is supposed to monitoring these things, this is very frustrating) Babies are born at home, and a skilled birth attendant attends only about 20% of births. None are attended by a nurse or doctor. Babies are not registered at birth. If you are a refugee mother, you can register your child at the UN, and it is in your interest to do this since your family receives a larger food ration with an increase in household members. However, not all babies survive until its time for them to be registered. With the highest infant mortality rate in South Sudan, and one of the highest in the world, there are a significant number of babies whose time on our planet goes completely undocumented.

Those who do survive will be exposed to intestinal worms, malaria, respiratory infections, malnutrition and a good amount of neglect. The issue of intestinal worms is one of the most troubling to me. Intestinal worms leech the vitamins and minerals as well as calories from a child. It is estimated that these worms take up to 20% of a child’s nutritional intake every day. They are often home sick, have trouble concentrating at school, and don’t develop physically or mentally as well as they would otherwise. In high prevalence areas, like the refugee camps, it is recommended that children be dewormed at least 2x a year. It costs 50 cents to deworm a child.

These boys were getting water in the yard of the Primary School. The little one in the teal t-shirt and his brother both have worms.