A HOSPITAL AT THE END OF THE WORLD

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The Economist's Africa correspondent observes the Médicins sans Frontières surgical hospital in South Sudan ...

From ECONOMIST.COM

This week is about medicine, or more specifically about how to attend births, gunshot wounds and tuberculosis at the end of the world. I'm hoping it will be about healing, but expect it to be more about patching up the poor and sending them back to the wastes from whence they came.

I am in Juba, the capital of South Sudan, and heading for a remote bit of Nuerland, hard up against the bandit border with Ethiopia. I am due to spend a few days at the Médicins sans Frontières (MSF) surgical hospital in the town of Nasir, on the Sobat river. MSF divides itself into country chapters. The Nasir hospital is run by the Dutch chapter.

MSF is doctrinally neutral. Patients are treated regardless of tribal or religious origins; MSF-Netherlands attends to the wounded on both sides of a conflict between the Jikany and the Lou. Both groups are Nuer, but hate each other with a grimness that has come to characterise relations between many pastoralist peoples in Africa. A scarcity of resources and an easy access to guns frequently blows old enmities white hot.

The Jikany and the Lou share the Nuer language and dress—and of course, they share a common love for cows. The cows are the problem. They need water, grazing, and sperm for insemination—all of which are in short supply. Tensions over grazing set the Jikany against the Lou for whole passages of the civil war in South Sudan. Now the hatreds have spilled over again. The Lou slaughtered 71 Jikany under a full moon during a recent cattle raid. Most of the dead were women and children. The adults were shot at point blank, many of the children were driven into the river, where they drowned. After an hour of shooting, the Lou made off with the Jikany's cattle and their meagre possessions. Fifty-seven wounded made it on a boat down the river to MSF's hospital in Nasir. Fifty-six of them were saved.

The wider story is about the stability of South Sudan and of how the country may go to war with Khartoum before a referendum on full independence in 2011. The war between the Christian black African south and the mostly Muslim Arab north lasted on and off for decades and killed some 2m people. I also want to see if climate change has exacerbated the fighting between the Lou or the Jikany, or whether it is sinister night flights of weapons and cash on Antonov cargo planes from the north that has upset the balance.

But first I need to get there.

I am spending the night at a camp by the Nile. The river is wide here and flows strongly and smoothly. The swiftness of the waters and their imagined depth reminds me of the Danube where it flows through Bratislava. But of course everything else about the Nile is different, like a scene from the Babar children’s books. It has not been tampered with. The river banks here are overhung with palms. Is it the artery of Africa? The backbone? The descriptions slip away with the water, into the night. It is simply the Nile. It has flowed from Lake Victoria. It will flow on to Alexandria.

The air is still. The rains have not come. There is grit in my teeth from the dust on Juba's dirt roads. I use a motorbike here to get around. No helmet, stupidly, but the speeds are never great. The kerosene lantern lets out a butter yellow light, illuminating the tiny mosquitoes. I've learned a long time ago that it is the small ones you have to watch out for. My companion, a Kenyan Asian trader, takes another slug of warm beer—Nile beer from Uganda, appropriately, and maybe it’s the softness of the heat, or again the grit, or the sound of the insects and the water flowing, but there is a sense of being in the back of a scene in a V.S. Naipaul essay.

The conversation is hardly revelatory. The trader runs a logistics company in Juba. He has been coming back and forward to South Sudan for years. He has seen this most dreary of capitals in bad times. Even with the decline in oil prices, on which South Sudan depends to pay its salaries, the times are good, and in his opinion they have rotted out the South Sudanese elite. “They've gone soft. Mad for money,” he says. The conversation trails off. He gazes out over the Nile. After all this time, he is still dominated by it.

Picture credit: Nite_Owl (via Flickr)

(This is part of a week-long correspondent's diary about a surgical hospital in South Sudan, published on Economist.com.)