Q&A: Former MSF South Sudan deputy on providing health services in conflict

The sixth anniversary of South Sudan’s independence passed almost without notice earlier this month, overshadowed by violence, extreme hunger, and instability. Médecins Sans Frontières have become veterans of navigating the relentless cycles of violence that uproot civilians. As people run, MSF runs after them trying to provide medical care, said former country deputy director, Julie Reserve. With more than 10 years experience in war zones, the safety risks in South Sudan were nothing new to Reserve. She has previously worked in hostile environments across Mali, Afghanistan and the Central African Republic. Reserve plans to assume a new role on the MSF Yemen team in the coming days. Her most memorable tour in South Sudan, she told Devex, was in the northwestern town of Wau, situated seven hours outside the capital of Juba, and known for its enduring bouts of conflict. “In South Sudan and especially in Wau, the situation is so volatile, and people are moving all the time. It’s all about being with the people to understand what are the needs, where to go and how they move, which is the main issue today in South Sudan,” Reserve said. In Wau, Reserve was responsible for the overall operation and supervision of mobile clinics that would appear in various locations for a few days before relocating elsewhere. Doctors most commonly treated malaria and respiratory illnesses, often severe, as remote locations in the bush had been blocked from accessing basic services for months prior to MSF’s arrival. The work can be “intense” at times, she recalled. But Reserve said she finds satisfaction in bringing primary medical care to conflict zones such as Wau. After departing South Sudan two months ago, there was “no question” she wanted to continue in this field. She spoke with Devex about her experiences as the second in charge of MSF South Sudan. The conversation has been edited for length and clarity. In Wau, MSF opened mobile clinics. How were you able to keep current on specific security threats while constantly on the move? Because we were there [in Wau] before the last main crisis, we had a pretty expansive network in terms of contacts on both sides. The key for us to run these mobile clinics was to get as much information as we could and “guarantee” our safety before moving, but also during the movements. [There was] a lot of negotiation for the crossing of the frontline, when the frontline was clear, and following its movements. We were ready to be blocked on one side or the other, but that was the way to manage it. We are talking about two different sides of the frontline. It’s difficult to say who is army, because people at the first checkpoint when you left Wau were wearing the national army uniforms, but it didn’t mean they were officially national soldiers. You have a lot of militia in this area, and on the other side. Opposition doesn’t mean anything anymore in South Sudan. As an expatriate, did you have any threats or safety concerns for your own well being? Or were you more focused on the job you were doing? At MSF, we never received any direct threats. Other NGOs did, and the United Nations also, and that’s why they stopped moving. It was key for us to prove to the people — who were sometimes trying to block us — that we are doctors and nothing else. --— Julie Reserve, former MSF South Sudan country deputy director We had clear messages with the army, even if it wasn’t always clear if they were soldiers from the government. There was a lot of pressure. We were searched, we were asked a lot of questions every single day. Sometimes it was a bit of a luck for us to be able to cross [the frontline] with priority and focus on providing healthcare, but to also witness the situation. Impartiality was key, but also showing and proving that we are a medical organization. It was key for us to prove to the people — who were sometimes trying to block us — that we are doctors and nothing else. Almost every day, we treated soldiers at the various checkpoints, because they were also suffering from malaria or syphilis and it was something that was useful for us in terms of access and security. Our most common incidents were malaria and respiratory infections. In terms of combat wounds, we worked with the International Committee of the Red Cross. In the bush, we were running primary health care facilities, and we were referring patients to Wau town in case of need, where MSF was also running a pediatric hospital. What can other health aid workers in conflict regions, or those supporting displaced populations, learn from this field experience? The main problem — and it’s pretty new in South Sudan — is access. Not only in Wau, but also in the west and south of the country, which were more quiet until last year. This access issue is [most] affecting NGOs. I’m afraid there is no magic solution for that. It’s all about negotiation with people on the ground. It’s working at the ground level, usually seeking clearance with high-ranking army civilians. In South Sudan, if you have a national letter of security from the government or the governor, it doesn’t mean you’ll be able to go where you want to go. It’s all about working at the civilian level. Read more international development news online, and subscribe to The Development Newswire to receive the latest from the world’s leading donors and decision-makers — emailed to you free every business day.