Checking malnourished children's weight at a clinic in South Sudan.
Here in South Sudan the level of need across a number of sectors is overwhelming, and the rapidly changing context means timelines for our work are compressed. When I arrived in the country one year ago, I knew that I had signed up for a new challenge, but I wasn’t prepared for the whirlwind that welcomed me to my new assignment. My perspective on my work in Uganda, Tanzania, Zambia and Sierra Leone changed quickly. By comparison this previous work seemed calm and predictable! In South Sudan, while my focus on nutrition programming remains the same, the way we’ve adapted our programs within a very fluid context of violence and displacement means our work can look very different.
In Uganda we were focused on scaling up nutrition (SUN), a global movement spanning 55 countries which focuses on the critical window for nutrition, the first 1000 days of a child’s life. Our approach to SUN involves education and persuading communities to change their behaviours. We share with them about practices to improve nutrition that are low in cost and have a high impact, so that they will be persuaded to make changes in their nutrition practices. We know that sustainable changes in behaviour take time. But in South Sudan, time is a luxury we do not have.
Don’t get me wrong, there is no better way to address chronic malnutrition than this timed and targeted approach. I’ve seen the results from my targeted counselling trainings in Morogoro Tanzania, the infant and young child feeding (IYCF) trainings in Kasama, Zambia or the positive deviance/hearth trainings in the Bothe District of Sierra Leone. In the contexts they were deployed, they were effective. It’s just that in South Sudan everything happens so fast and is so unpredictable.
Conflict almost always means increased levels of malnutrition, especially in children. It’s hard for people to access food when they have had to flee their homes and leave behind crops, farmland and tools. In South Sudan, we also see many children separated from their families making them even more vulnerable. My team sees the devastating effects of this situation, and we know that malnutrition increases the risk that children will die and for those who survive, it hinders their growth and development.
Cruelly, in a context where nutrition programs are so needed, conflict also creates challenges for responders. Like other conflict-affected countries, the response in South Sudan is underfunded, the capacity and resources of government are stretched or unavailable and infrastructure is very poor.
In these conditions, World Vision and other organisations working in South Sudan face huge obstacles in reaching the most vulnerable and maintaining humanitarian access for long enough to complete treatment for malnutrition.
In fact even the model for addressing acute malnutrition in emergencies, the community based management of acute malnutrition (CMAM) is often too slow in South Sudan. We’ve had to make a number of changes and adaptations and, working with our partners, roll out a new, lifesaving, rapid response mechanism (RRM).
The RRM deploys mobile teams – including specialists in nutrition, water, sanitation and hygiene (WASH), health, child protection and education – to hard-to-reach locations where they can rapidly assess and respond to situations on the ground.
Yet even with RRM, nothing is ever straight forward. Unpredictable outbreaks of violence make coordination very difficult. Deciding exactly when to move in, when to evacuate or when to re-deploy can be a matter of life or death and it is an anxious process. It starts with preparing logistics and staff to mobilise in the midst of uncertainty about security clearance for the location. Even once airborne, on the way the location there is still uncertainty whether the plane will be able to land, or whether it will be turned back for reasons of security or weather.
When you do make it, the experience is incomparable. I’ve seen the looks of relief on the faces of women and children when they see us. Knowing that your work may have just saved a life is an incredible feeling. And when you finally take your break after three straight months, you and your boss know that it’s well-deserved, even if it’s only for long enough to remind you what your loved ones look like.
The work of Mercy and her team is profiled in a new case study, Nutrition Programming in Conflict Settings: South Sudan. The study looks in detail at how World Vision South Sudan’s nutrition team worked with the UN Nutrition Cluster to adapt nutrition programming to overcome the contextual challenges.