Article by Tom Murphy.

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"A ceasefire appears to be holding after four days of intense fighting in South Sudan. As the country approached its fifth anniversary of independence, a tentative unity deal broke down last week, forcing tens of thousands of people to flee their homes, and many were forced to shelter in place.

“There is a lot going downhill,” said Martina Fuchs, founder and CEO of the Real Medicine Foundation in an interview with Humanosphere. “We have told our staff working at the teaching hospital in Juba to stay home.”

The team leader for the Real Medicine Foundation in South Sudan, lost a friend in the fighting. He was shot dead while driving home on Saturday. He traveled to the Ugandan border to attend his friend’s funeral and is stuck there, said Fuchs.

Reports Tuesday indicated that fighting stopped after accelerating on Monday. Most of the fighting and casualties were between troops loyal to President Salva Kiir and Vice President Reik Machar. A unity deal meant to end fighting returned rebel leader Machar to his post as vice president of the country. He said that Kiir loyalists attacked his residence over the weekend, a sign that the already tenuous deal between the two men may be breaking apart.

Over two years of fighting between the two groups has displaced more than 2.5 million South Sudanese from their homes. The economy is in shambles as the oil industry, a primary revenue source, has experienced declining production. Nearly 5 million people live off emergency food rations – about half of the country’s population of 11 million – because of instability and displacement.

The staff for the Real Medicine Foundation in South Sudan is entirely made up of nationals. Most of the 100 person team are in Jonglei State, safely away from the current fighting in Juba. There, the organization is partnering with UNICEF to treat children suffering from malnutrition and provide food for people facing acute hunger.

The staff is dealing with supply delivery disruptions, which are caused by factors from violence to access to money. U.S. dollars are being flown into the country to pay for goods. The South Sudanese pound has lost its value with rapid inflation, and the central banks are holding up money.

Fuchs met the minister of health and other government staff while in the country last week. The country’s health systems were in bad shape when the country was born and have struggled in the five years since. Water and electricity access is spotty, as are basic medical supplies. She said the ministry is struggling in its duties to provide adequate support to existing medical facilities, but those gaps are not deterring South Sudanese health workers.

“The capacity is completely in shambles,” said Fuchs.

The College of Nursing and Midwifery in Juba, co-founded by the Real Medicine Foundation in 2009, has 149 students enrolled in its three-year training program. When the school started there were just four midwives in the entire country, which had one of the world’s worst maternal mortality rates. In December 113 midwives graduated the program, a huge increase in the number of health workers in the country.

Fuchs attributed the high enrollment numbers to the remarkable commitment by young South Sudanese to their country, an idea she repeatedly champions, despite deteriorating conditions in the country. The Real Mecidine Foundation’s team leader, for example, lived most of his youth as a refugee in Uganda. He returned to work in his country of birth to help build its health care system.

“There is an incredible commitment by young people. So many of them would risk their lives for their country,” Fuchs said.

The United States, the United Nations, and other international countries and organizations immediately condemned the latest fighting. Amnesty International said the weekend’s events were evidence of the inability of the region and the African Union to address the human rights violations committed during the conflict. If changes are not made, South Sudan could slide back into full-scale civil war, Amnesty warned.

“We are deeply concerned at reports of civilians being prevented from seeking refuge in the premises of the U.N. Mission in South Sudan and, in some cases, being shot at while trying to do so,” said the spokesperson for the U.N. High Commissioner for Human Rights, in a statement today. “We are also deeply worried at reports that U.N. compounds and ‘protection of civilians’ sites have been directly caught in the fighting and apparently at times directly targeted.” "

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