Fear and Loathing on the Sudanese Border

There has been a noticeable increase in tension across this entire region since last weeks Lords Resistance Army (LRA) attack in Southern Sudan and movement towards the Ugandan border. The restaurants and shops are full of rumors of ‘sleeper cells’ and potential rebel incursions. Worries of fears of attacks inside Uganda are already impacting activities aimed to contain the growing Hepatitis E (HEV) outbreak. Village Health Teams are starting to become reluctant to travel to the areas where they are needed the most. New cases continue to rapidly climb, and we’ve now passed 50 confirmed deaths in this district alone (although the true number is much higher).


Thursday afternoon, I went back to the Agoro IDP camp with a small team from UNICEF Kitgum to run a host of tests using the Rapid SMS System being developed by NY Headquarters. With the security situation in limbo, my boss here first checked if we needed an armed escort. We were told that this was not yet necessary, but we needed to be careful and keep our eyes open. The hills around Agoro were one of the primary staging points for LRA attacks in the past; this is one of the more likely areas for any new outbreak of hostilities. It is a significant distance past the Ugandan border post in Madi Opei. Parts of the Agoro camps sprawls into the mountains of Southern Sudan, which is historically LRA country.


On the way, nearly everybody we passed were military heading toward the border. Many were on foot, carrying heavy rifles and machine guns. Others were on bikes (some two at a time), with guns slung over their shoulders. It felt like the entire Ugandan Army was being mobilized. In operations near the border, the military doesn’t often travel in vehicles, as they are too easy to ambush. Instead, they have adopted guerilla tactics and fan out on foot, covering wide swatches of the country side while limiting risk of a direct attack.

We arrived at Agoro around lunchtime without incident and headed straight to the Health Clinic. There was a long line of very sick people silently waiting to be seen by the resident nurse. With limited staff, many would have to come back tomorrow and try again. We sent a young man to fetch Patrick, the Health Assistant who, despite his unimpressive title, is responsible for a quite substantial sub-district that includes tens of thousands of people.


Under a tree a short distance from the clinic, we discussed the challenges Patrick is facing. Much of the monitoring is done by himself and the Village Health Teams. He said that it was difficult to travel to some resettled villages, a few of which were nestled high into the hills in very inaccessible areas. He described constraints such the NGO community’s inability to harmonize messages, gaps in monitoring, and inexcusable technical blunders (ie latrine construction) that were putting the lives of the IDPs at risk. Patrick even noted that the borehole in the clinic was contaminated with fecal matter and could no longer be used.


In the past week, 11 stances (the equivalent of 22 latrines) in Agoro have collapsed. One occurred with an old man inside. Patrick explained that due to high quantities of alluvial deposits, soil erosion is a major problem in the area. The latrines holes are being dug too wide and not reinforced with cement or limestone. When heavy rains fall, the base around the slaps tumbles into the hold and the entire structure plummets into the hole. There are currently over a 100 of these stances in the village. Many more will collapse in the months to come.


What was most frustrating is that the NGO (name redacted) continues to build stances with the same, or very similar, technical specs right next to the collapsed latrines wasting literally hundreds of thousands of dollars. Patrick complained that locals were not only never consulted, but actively ignored when they raised objections to the types of latrines being dug. Later in the day, an old man nearly in tears asked me why nobody asked the community what they wanted, while continuing to build these ticking time bombs.


The primary areas Patrick felt the Rapid SMS System might prove useful were conducting quick surveys (as we were about to do with the latrines), qualitative or open ended queries that would allow them to expand on the surveys, urgent messages (such as the collapsing latrines), notifying authorities about depleted supplies at the clinic, and recording audio messages for expressing frustration with problems that they felt were being ignored.


Patrick affirmed that recorded audio should be used on the radio, which he said even women in the camps listened to during the evenings, to promote frank discussion and create accountability within the community. Patrick also felt that there should be better utilization of the schools, using pupils as an entry point into the community (“Normally when a child tells parents something, they tend to listen more”.) During the next couple of hours, we attempted to mimic all these possible scenarios using the Rapid SMS System.


Because Agoro is so densely populated, there is no room within the camp to put latrines. Instead, the camp is completely encircled by these festering, disease ridden death traps. As they collapse, they are forming a revolting moat of human waste, besieging the IDPs. Many camp inhabitants, duly worried about their safety, are now defecating around the latrines, exasperating the situation. The children, never sold on the latrines to begin with, continue to use the entire camp as a toilet.


There was no mobile reception at the clinic, so we drove to the primary school where we could get a signal. As I started to show Patrick how a mobile phone might fill many of the gaps in monitoring and communication that he previously highlighted, a middle aged man staggered up to us. Blasted out of his mind on local sorghum booze, he incoherently shouted something about Europeans. As I was showing Patrick how to conduct a simple SMS survey, he tottered up, put his face next to mine and started repeating everything I said. His breath reeked of alcohol and sickness.

I couldn’t concentrate, so I suggested to Patrick that we move and attempt to record audio messages instead. The blasted man started yelling “United Nations… United Nations is the Children’s Emergency Fund”. He must have shouted this line verbatim at least a hundred times, laughing to himself after each time. A small crowd started to gather. Curious children nearby pointed at him and giggled under their breaths. We gave them some distance and a recorded couple of audio messages, before deciding to head towards the camp latrines to mimic the scenarios that Patrick felt the Rapid SMS System would be useful.


We were at the latrines for a long time. The camp started to become suffocating. Irene, my UNICEF counterpart, joked about navigating a fecal minefield while pointing to all the fresh logs on the ground. I tried not to laugh, primarily because I didn’t want the swarming disease carrying flies in my mouth. The whole area stunk of human waste, mingled with the noxious odor of fermenting sorghum. Malnourished kids were playing everywhere. I peered into a collapsed latrine and nearly vomited. The midday heat, amplifying the stench, started to take its toll. We had lingered too long in this area of the camp and I was becoming thoroughly disgusted. We jumped into the land cruiser, dropped Patrick off at the clinic, and headed back to Kitgum.

Hours later, as I finish typing, I am still unable to completely rid myself of the stench.