This is what it's like to deliver aid in South Sudan

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TAYAR ISLAND, South Sudan — Kiden Loice steps into the narrow canoe, careful not to rock the boat and fall into the murky swamp below. Slowly inching toward the bow, Oxfam’s emergency response team leader takes a seat before the rest of her crew settles in and braces for the journey ahead. Two and a half hours of navigating muddy waters in a rickety coconut tree canoe awaits. 

This is Loice’s second trip in less than a week to Tayar Island in South Sudan’s Unity State — the epicenter for the region’s most recent cholera outbreak.

What used to be a trading site and home to just a few hundred people, Tayar Island has become a refuge to more than 2,300 internally displaced South Sudanese who have fled their homes during the country’s three-year civil war. Without toilets or access to clean water, people defecate where they bathe and use the same soiled waters to cook. The actions have resulted in an extremely rare dry season cholera epidemic. 

Since October, 10 people have died from the disease on Tayar alone. The community is in dire need of help and supplies, such as water treatment pills, hygiene kits and clean buckets. Yet Oxfam has been the only humanitarian group to set foot on the island in 2017.

For aid agencies working in this war-torn country, the lack of response on Tayar doesn’t come as a shock.

“Emergency teams are stretched,” said Dorothy Sang, Oxfam’s humanitarian campaigns manager in South Sudan. “With food and security, cholera and mass displacement, it’s hard to move across the board.”

Emergency teams are stretched in one of the world's most expensive countries to deliver aid, where 7.5 million of 12 million people are reliant on it and another 2 million are displaced.

The recent famine announcement, which declares that over 100,000 people are facing starvation, means the humanitarian community’s resources — both human and financial — will be further strained in coming months due to a particularly challenging mix of geographical, logistical and bureaucratic factors.

Although Tayar is technically one of the easier islands for aid workers to access, it’s still a challenging commute for the few organizations based on the mainland nearby.

Each time Loice and her team want to visit Tayar’s community, they walk for 25 minutes from the center of Ganyiel — Panyijiar County’s main town — to the makeshift port. This is followed by a two- to three-hour canoe ride through swamplands to reach the island’s muddy shores. On occasion, canoes have been known to capsize, leaving people to wade through water until they reach land or are picked up by a passing boat.

Organizations without a presence in Ganyiel have an even longer journey. For Sang, who came to visit her team from Oxfam’s head office in the country’s capital of Juba, it was a two-day trek and $270 worth of plane tickets. This included a 45-minute flight, a few hours’ delay in another city’s airport, followed by a 20-minute helicopter ride. Flights to Ganyiel only operate from Juba twice a week, and each has limited seating.

For humanitarian agencies without a presence on the ground, it’s timely, costly and inefficient to attempt to deliver aid at all.

In response to the cholera outbreak, Oxfam decided to dispatch Loice and her emergency crew to be based in Ganyiel for a few months. Charged with eradicating the epidemic on the island and the surrounding areas, Loice admits that if the problem isn’t brought under control before South Sudan’s rainy season from May to September, 120,000 people could be at risk of sickness or death.

After three weeks in the field, however, she says getting help to those in need is exceptionally draining.

“It’s exhausting,” said the South Sudan native. “You have to go by foot or by canoe to give [informational] sessions. You wake up at 6 a.m., walk for four hours, give a two-hour talk and walk four hours back.”

Sprawled outside the three-man tent she shares with her two Oxfam colleagues in Mercy Corps’ campsite, Loice lays on a mat, snacking on crackers and attempting to decompress after a long day.

Oxfam is one of only three nongovernmental organizations based in Ganyiel. The plan was to be there for three months in order to get the cholera situation under control. Yet Loice is convinced the mission will be extended — something she’s mentally preparing for. The campsite they’re staying in is extremely basic, with no running water, minimal electricity and little privacy.

Loice finds it best to stay focused on the mission. Right now, she’s preoccupied with the difficulty of accessing vulnerable populations.

Not only is it hard reaching remote islands like Tayar that are only accessible by boat, but due to the conflict, Loice and her team often don’t know where to look in order to find people. When fighting breaks out in villages, civilians hide in swamps or in the bush and are sometimes too afraid to emerge for fear of being killed.

“What worries me is who we’re missing,” Sang said. “The people we see have come to us but some are too weak and we can’t get to those people.”

Since being in the field, Loice has been waiting for three weeks for supplies to arrive. These include water treatments pills, buckets and hygiene kits, all of which are necessary in order to combat the outbreak. However, due to the conflict, aid is often delayed by weeks and sometimes months. 

It’s usually held up due to access negotiation talks between aid groups and whichever armed faction is in charge of the given region. In January, the government prohibited humanitarians from delivering supplies to Ganyiel for several weeks due to an issue between government and opposition forces. 

These delays and interruptions create an inconsistent flow of supplies, making it harder for NGOs to deliver it to those in need.

“There’s a repeated cycle of people being displaced due to fighting and constant renegotiating of access,” said George Fominyen, communications officer for the World Food Programme’s South Sudan program.

Compounded with the access challenges are the high operating costs. A recent study published by Oxfam found that South Sudan is one of the world’s most expensive contexts in which to function.

Even though South Sudan has a road network of over 10,000 miles, only 125 miles are paved, which means it can takes days rather than hours for a convoy of aid to reach its destination. According to the United Nations Humanitarian Air Service, the going rate for an MI8 MTV — the standard model truck used for delivering aid on the road — is approximately $18,000 for an average trip of three hours and delivering 2.5 to 3 tons of supplies. 

The country’s vast terrain and crippled infrastructure mean that much of it can’t be accessed by road at all. Aid must therefore be delivered via plane or helicopter, especially during rainy season.

The average cost to operate a plane is based on weight — approximately $2,000 per metric ton and $7,000 to $8,000 per metric ton for a helicopter, according to World Food Programme Logistics Cluster Coordinator Fiona Lithgow. Even though planes have a greater capacity, many places in the country don’t have anywhere for them to land.

Ganyiel’s landing strip — which also acts as soccer field and cattle market — is not big enough to support a cargo plane. Consequently, the World Food Programme has to conduct food airdrops on a regular basis. 

Unsurprisingly, these costs add up quickly. According to South Sudan’s 2016 Humanitarian Response Plan, the same amount of money used for a standard road vehicle could instead be used to feed 165 people. However, NGOs say that these additional costs aren’t directly taking money away from assisting the local population.

“These costs are already factored in when speaking with donors,” Sang said. “It’s the reality of working in South Sudan.”

As the country continues to spiral, challenges for humanitarian workers in delivering aid will only increase. As frustrating as it might be, the aid community needs to continue delivering a coordinated response, Sang said.

“It’s a necessity here to coordinate,” Sang said. “The humanitarian community works well together to cover gaps and share information.”

For Loice and her team on the ground, she says that no matter how hopeless it can sometimes feel, she’s not giving up: “I’ll continue working for the people who are really in need,” she said. “With your heart, you feel inspired to do your work.”