Obstacles and Initiatives to the Protection and Recovery of Internally Displaced Civilians
In South Sudan, the number of civilians fleeing conflict zones and destroyed areas grows by the day. In a previous blog article, we identified armed conflict, inter-communal disputes, and flooding as the leading factors of internal displacement in South Sudan. This blog article aims to better understand the consequences of such forced migration on civilians by examining the living conditions of internally displaced persons (IDPs) in protected camps. Most camps do not offer adequate protection, housing, or health and sanitary facilities, leaving IDPs confronted with problems similar to, or worse than those they fled from in the first place.
As survivors or witnesses of serious violations including rape, torture, lootings, and even killings, most displaced civilians suffer not only from injuries or diseases requiring medical treatment, but also from mental health issues such
as anxiety, grief, and post-traumatic stress disorder (PTSD).
Most camps lack the facilities or support systems to provide medical and psychosocial help to victims. This article will further discuss the current situation inside South Sudanese refugee camps and point out the challenges IDPs face in such environments, including in relation to security, health, hygiene, access to medical treatment, and economic opportunities.
Water-related issues, lack of infrastructure, and health consequences for IDPs
In most camps, clean water provided by humanitarian actors or sold at an inflated rate by private actors fails to cover the needs of the thousands of IDPs who take refuge in those structures. To improve camp residents’ access to treated water and address the disastrous consequences resulting from the use of contaminated water (malnutrition, diseases, etc.), initiatives such as the International Organization for Migration (IOM) Core Pipeline program have been launched.
Pipeline construction and management projects aim to provide free treated water to individuals who previously had to walk to remote streams or spend most of their income to buy enough water to fulfill their family’s needs. Facilitating access to water allows IDPs to save money and allocate
more time to their personal lives (studying, farming, developing small businesses, etc.).
The lack of enough pipeline structures to meet communities’ drinking, cleaning, and cooking needs is not the only waterrelated issue in camps. River floods and heavy rain contaminate water supplies by flooding boreholes and latrin es, often resulting in waterborne infection outbreaks. These infections (cholera, typhoid fever, hepatitis E, gastrointestinal diseases, diarrhea, etc.) have high mortality rates, particularly when targeting vulnerable groups such as pregnant women, children, and newborn babies.
In addition, many camps are surrounded by large, submerged areas, and others are built below the waterline. For instance, in Bentiu where floods have been particularly ravaging, the water overwhelms the dikes, threatening to inundate IDPs’ shelters and destroy the few farmlands that residents can maintain around the camp. Dikes are extremely fragile, and local communities, with the support of humanitarian actors, must work daily to reinforce them with sandbags and mud piles to protect them and ensure the camp will stay above water.
Furthermore, the limited access to basic sanitary and hygiene products such as soap or sanitizer further exposes IDPs to diseases by accelerating the risk of hepatitis E and diarrheal disease outbreaks. Women and girls are at high risk of suffering from urinary tract infections and toxic shock due to the camps' lack of menstrual materials and clean water. Most women and girls in camps do not benefit from “dignified, private and safe menstrual management.” Indeed, they often lack safe spaces or hygiene facilities necessary to bathe, clean, or change, which increases their risk of being subjected to sexual violence, harassment, and social exclusion.
Moreover, the numbers of toilets and sanitation facilities are insufficient for the number of camp residents relying on them. Finally, the lack of a sewage system leads to water contamination by feces, which tends to leak into water areas where people bathe and fish. This contributes to the development of stagnant water holes, which attract flies and mosquitoes and heavily contribute to the spread of diseases.
Humanitarian efforts, accessibility and other challenges
Humanitarian actors experience difficulties in forwarding necessary items and aid to the camps, as roads are submerged or constantly need to be cleared from water. Planes are also struggling to land and transport items near camp sites due to unpaved and muddy landing strips. In Bentiu, the very few items that external sources manage to bring into the camps are overpriced and force communities to find new income sources to afford them.
In order to survive, displaced populations are fishing, collecting wood and burning it to make charcoal, collecting and selling used items in landfills, walking long distances to bring back goods from remote cities, cooking “moonshine” (homemade distilled alcohol), sewing, repairing objects, and managing small shops.
Many of these activities involve walking and swimming in submerged areas or working close to stagnant water. Incidents related to venomous snake bites, drownings, or infections resulting from exposure to contaminated water are common in those areas. The limited medical infrastructures and treatment opportunities in IDPs camps further aggravate the situation of sick and injured civilians.
Flooded areas generate important risks for civilians, including infections resulting from exposure to contaminated water, snake bites, water-related diseases, etc.
Children and newborns are heavily exposed to diseases and often severely malnourished. In Bentiu’s Protection of Civilian site (PoC), one of the largest in South Sudan, children suffering from acute malnutrition are fed with ready-to-use-therapeutic food (RUTF) by local volunteers and UNICEF staff.
Although they can drastically improve children's health when taken regularly for a few weeks, RUTF supplies remain insufficient.
Recent data from the Integrated Food Security Phase Classification (IPC) warn that “between July 2022 and June 2023, an estimated 1.4 million children under five are expected to suffer from acute malnutrition” in South Sudan due to the rising prices of food (particularly rare and expensive in camps), lack of funding, and difficulties to access populations in need.
Psychosocial support and security risks to aid workers
The role of humanitarian and aid workers is not limited to medical and material support. Camps should be equipped with adequate mental health facilities to treat the important psychosocial needs of IDPs, considering the high rates of depression, PTSD, trauma, and anxiety recorded within displaced communities. The trauma and suffering associated with the environment they had to flee, combined with the sense of fear and uncertainty caused by the challenging living conditions or abuses experienced in camps, severely impact IDPs’ psychological well-being.
In many cases, the hardships experienced by men, women and children are such that they trigger suicidal thoughts or attempts. Stories of survivors illustrate the widespread mental health emergency taking place across displacement camps. This crisis has been exacerbated by the COVID-19 pandemic, which prevented therapy sessions, as well as one-to-one counseling therapy for many survivors.
To alleviate traumatic disorders, different initiatives have been engaged, including programs of Cognitive Behavioral Treatment (CBT) designed to medically guide survivors in the process of confronting their own experiences and starting to heal. Unfortunately, those assistance programs are not accessible to all those in need. Mental care services struggle to meet demand due to lack of resources and funding.
In September 2022, twenty-four incidents related to “violence or threats against humanitarian personnel and assets” were recorded.
Other wide-range initiatives are indeed available for more displaced people, like psychosocial group sessions that involve different activities of social connection and occupation. Nevertheless, camp residents are innovative in their attempts to alleviate the suffering of others, organizing activities within the camps, including musical, religious or sportive events, as a way to gather, heal from past trauma, and share experiences.
Humanitarian and aid workers, local volunteers, and many other professionals work hard to alleviate the situation of IDPs, despite the life-threatening risks faced in this field. In September 2022 alone, three aid workers were killed while on duty, and twenty-four incidents related to “violence or threats against humanitarian personnel and assets” were recorded by the UN Office for the Coordination of Humanitarian Affairs (OCHA). The frequent targeting of medical teams, aid convoys, and organizations’ offices is highly concerning, as it directly impacts vulnerable populations who depend on humanitarian relief. An eventual suspension of humanitarian aid operations therefore threatens these populations.
Basic needs and “objects indispensable to the survival” of civilians are under menace, with a critical number of “humanitarian access incidents” in the country (including obstruction of humanitarian aid, killings of workers, or looting of emergency items). In Bentiu’s PoC site, external actors sometimes attempt to break down the dikes in an attempt to flood civilian shelters, thus requiring the surveillance and protection of UN peacekeepers.
Security concerns are not exclusive to humanitarian personnel working on-site. Indeed, in several PoC camps, the responsibility to protect IDPs has shifted from United Nations Peacekeepers (UNPK) to government troops. This has raised serious concerns for civilians who fled their homes because soldiers of those troops had targeted them. There are also many concerns regarding the safety and integrity of women and girls, who are heavily at risk of sexual and gender-based violence (SGBV) and marginalization within those camps.
In an attempt to tackle such security issues, UNMISS is currently coordinating workshops and strategic efforts designed to raise awareness on SGBV issues and help survivors, including those within IDPs populations. Governmental forces have yet to make an effort to organize these workshops, especially in the context of the transition of UN Protection Sites into conventional camps for displaced people. Lately, security concerns have been growing by the day, especially in the Upper Nile State, where refugee camps are being caught up in armed confrontations, resulting in deathly tolls for the IDPs and civilians living in the region.
The path forward
It is still unclear what path South Sudan will take in the near future. Although numerous projects have been implemented to improve life conditions in the refugee camps, many South Sudanese, and particularly IDPs, are still struggling to survive and are bound to find new ways of earning a livelihood in unstable environments. Most refugees face safety and health challenges, suffer from a lack of humanitarian aid, and witness floods destroy the few infrastructures that serve them.
Due to the significant risks of attacks and abuses outside the camps, IDPs have almost no opportunities to leave those protected areas and even fewer chances to return to their homes. The question of what constitutes sustainable reintegration is of the utmost importance for the peacebuilding and reconciliation process of the country, but has not yet been sufficiently addressed by the authorities. Indeed, despite the “adoption of a National Framework on Return, Resettlement and Reintegration in South Sudan”, the legal framework to adequately protect returning IDPs is still missing.
Sustainable and viable solutions must urgently be implemented based on thorough assessments of IDPs and vulnerable communities’ needs to build better infrastructure and alleviate the consequences of displacement. In such a process, the participation of local actors and communities will be crucial.
While neighboring countries, international stakeholders, and civil society should take part in this effort, South Sudan must urgently take action. Only through effective implementation of the peace agreements can South Sudan redress its path and develop a sustainable healthcare system, functional infrastructure, justice, accountability, and reconciliation.
Refugees in camps and local communities may also hold the key to advancing these goals, and the solution to end violence and provide justice, as is the case of some former rival communities, is particularly deserving of attention. Human lives, basic human rights, and universal access to humanitarian relief are all at stake when assessing the current situation of the refugee camps in South Sudan.