After years of conflict, the struggle to return home
In the early morning in Kajo Keji, Central Equatoria, what used to be a very busy market slowly opens. A few people set up their stands, while small groups of children in uniforms are walking to school. From the main road, one can still see the scars of the civil war – destroyed buildings, abandoned houses, bullet impacts.
From 2016 to 2018, Kajo Keji was badly affected by violence, forcing most of the population to abandon their home and seek safety in Uganda. A few people remained behind – James Mirye, executive chief of Kangai village in Kajo Keji county, was one of them.
People could not access healthcare and faced unlawful killings, lootings, robbery.
For the people who fled to Uganda, the living conditions in the camps were dire and refugees faced many challenges – no shelter, shortage of food, water, firewood and very bad access to healthcare. Some went back to South Sudan a short time after arriving, preferring to face insecurity than life in the camps. “Today, when you need medical care in the camps, you go to a health centre, and you will get referred to a private clinic. But the clinic is not free. Without money, you cannot survive”, says Mirye.
Yet six years after the peace agreement, families are not yet ready to completely settle back in their homeland. Instability, severe economic inflation and upcoming national elections – expected to be held in December 2024 – add fear and uncertainty among communities.
When healthcare grows, hope mounts
In a region beset by crises, Médecins Sans Frontières (MSF) and the Ministry of Health (MoH) resumed secondary level healthcare services in the Kajo Keji Civil Hospital last year, providing healthcare in maternity, pediatrics, neonates, emergency room, intensive care unit, surgery and internal medicine – encouraging people to come back to seek safe and free healthcare.
Jane Kiden had fled to Uganda and decided to come back when she was pregnant, hearing that MSF was supporting the Mundari County Hospital.
Today, MSF remains the only actor to provide pre-delivery care for pregnant women presenting with complications, delivery and obstetrical surgeries in case of complications, medical care for sick newborn babies, ante-natal and post-natal care.
Beatrice Cosmas is MSF midwife supervisor in Kajo Keji County Civil Hospital. Every day, she sees pregnant women like Jane Kiden reaching the facility after days of suffering, either because labour has started or because of complications, putting their lives and the lives of their babies at high risk.
“Most women are still living in the refugee camps, but they come all the way to Kajo Keji because they heard that MSF is here”, explains Cosmas.
After the operating theatre and the emergency room, the hospital’s maternity will be entirely rehabilitated by June 2024, with a capacity of twelve beds for mothers and four beds in the Newborns Intensive Care Unit. From February 2023 to 2024, our teams provided life-saving care to 272 mothers and 281 babies. Yet, the community’s needs are huge and remain insufficiently addressed.
“We used to have other organisations that were supporting Primary Health Care Centers in the county. Midwives would receive pregnant women and could identify the need for specialized medical care. They could call an ambulance and send the patients to us. Now, pregnant women fully rely on themselves, their relatives or their community to reach our facility”, says Cosmas.
Following the withdrawal of partners and humanitarian actors in the region, MSF is now supporting five Primary Health Care Centers (PHCC). Our teams provide medicines, training and incentives for healthcare workers, and ensure referrals by ambulance to the County hospital.
Post-conflict mental health needs
In Kajo Keji, women suffer stress, anxiety and depression among other mental health difficulties.
With national elections coming up and the phasing out of partner organisations, a lot of uncertainty remains for people considering settling back in Kajo Keji. Even if the situation has slightly improved in recent years, communities still face many challenges, such as access to food, education and sustainable, quality healthcare.
