By Dr. Sam Agbo
Mother of three Achok Deng woke up suddenly around midnight to rapid gunfire around the Tompin area of Juba, South Sudan's ramshackle capital. This was Friday the 8th of July; her husband, a soldier with the presidential guard, had left for duty the preceding evening. She was confused as to what was happening, what to do and where to go.
South Sudan is widely believed to be on the brink of a renewed civil war, and the gunfire was ominous. She mustered courage and gathered her three children, all younger than four, to quietly slip to her neighbor's house to seek company till the early hours of the morning.
After discussing their plight, the two families decided to try to reach the United Nations compound, just a few hundred meters way. Neither woman could reach her husband because they had no cellphone airtime left. And both secretly feared that their husbands may have been caught up in the conflict, being part of the presidential guard.
Achok, whose story was relayed to me by her cousin Dr. Jane Juma, finally made it to the UN compound where many other families were taking shelter. But it was unclear how long they would be allowed to stay; and if asked to return home, how she would obtain food and clean water for the family.
Since achieving independence in 2011 from the Khartoum government, South Sudan has seen repeated outbreaks of conflict driven by ethnicity and the struggle for power. The inclusive transitional government of 2015 and the recent reconciliation with one rebel faction have done little to buttress the peace agreement or create an enabling environment for nation building.
In the meantime, the country has spiraled further into disaster. The United States this week pledged a further $138 million in humanitarian aid to South Sudan, but also warned its leaders that they need to fully implement plans for peace or face a U.N. arms embargo and sanctions.
Pregnant woman and newborns are the first to pay the price. South Sudan's Millennium Development Goals (MDG) score card at the end of 2015 showed that death rates for mothers is estimated at 730 per 100,000 live births, almost twice the rates in neighboring Sudan and Kenya. The successive conflicts - when mothers such as Achok are unable to access health care - only retard any progress towards improving these baseline indicators.
For anyone who has worked in South Sudan, as I have done off and on for more than 15 years with organizations ranging from UNICEF to Save The Children, the news is unbearably grim.
An ongoing cholera outbreak clearly reflects the fragility of the health system. Essential commodities such as drugs are unavailable, medical personnel are thin on the ground and clinics are hard to access. Cholera was confirmed by the Ministry of Health in Juba in July, and thus far 1,160 cases including 23 deaths have been reported nationwide, with the majority reported in Juba County. The incessant rain is exacerbating the situation, undermining sanitation efforts and threatening to further the spread of the disease. Achok has to ensure safe and portable water for her young children which remains a serious challenge.
The threat of vaccine-preventable disease outbreaks like pertussis and measles remain very high, with estimated immunization rates of just 31 and 20 percent respectively. The increasing disease burden for common childhood diseases such as malaria, diarrhea and pneumonia is directly attributable to the low coverage of common childhood interventions and the weak status of the health services.
South Sudan's conflict has displaced about a million people who have fled to neighboring states. An estimated more than 4.8 million are people facing chronic food shortages and famine which has led directly to increasing caseloads of malnutrition.
The new U.S. aid, and increased involvement by regional governments, is a good first step toward stabilizing the situation. But for South Sudan to really change course, belligerent parties to the conflict have to commit to peace. A political solution can only work in a true democracy with peace; and having empowered community systems; fully functional basic primary health care services that are appropriate, acceptable, enjoys people's full participation and at their level of development.
No tribe nor ethnic group can have the interest and well-being of South Sudan more at heart than the peoples of South Sudan. The political leadership need to give back power to the people and let them decide who leads them, as was the case in the during the independence referendum.
For Achok and her children the future remains bleak. She eventually left the U.N. compound, and returned to the uncertainty that is life in South Sudan. Yet she dreams for peace and opportunity a better life and future for her children - if only the country's political leaders would make that possible.
Dr Sam Agbo is UNICEF Chief of Survival and development, UNICEF Angola, and an Aspen New Voices Fellow. Follow him on Twitter @soboche