Welcome home: to a land ruined by war

April 3, 2005 (The Sunday Times)

The people of Nuba paid a high price during the 20-year civil conflict in Sudan: murder, rape and exile. Now that a fragile peace has been restored, they are rebuilding their shattered lives. But is their homecoming turning into a horror story?

Sunday afternoon at the Limun basic health-care clinic, in the Nuba mountains of Sudan, and a group of men are gathering beneath the shade of a baobab tree: a guard, a health worker, the fathers of children staying in the wards. They fetch picks and shovels from the guardhouse, waiting a moment to see if anyone will join them in their work. Their children sit quietly on rope beds in the shadowed mud-brick wards, or play outside in the softening afternoon light. The children's mothers keep an eye on them, crouching by small cooking fires, talking, carrying plastic jerry cans of water back from the well on their heads, coaxing pale-haired babies to their breasts, watching the men from a distance. Chickens scratch around the sandy compound, looking for spilt scraps of food.
The men turn and walk out along a narrow path between fields of sorghum and maize, down to the stream. A woman washing her family's clothes glances up in greeting as the men cross over the stepping stones. "Salam," she murmurs. "Assalamualaikum," they reply. "Ahlamdulillah."

Following the line of the stream, wading through the long grasses still wet from yesterday's rain, the men walk quickly, silently, their tools slung over their shoulders. A boy herding his father's goats stops to watch the procession, staring, calling out to ask the men where they're going. "Kwes?" he asks — "How is it?" — but gets no reply. Striding on, the men reach a low hillock at the far end of the valley, and climb up to a patch of ground scraped clear of grass. One of the men, Ismail, reaches the spot first and starts to dig. The others watch as he lifts the shovel over his head and brings it down hard into the stony ground, swinging it with something almost like fury, quickly working up a sweat as the damp soil sprays across his face and his green hospital scrubs. After a few minutes he straightens, rubbing his back, passing the shovel to another man, catching his breath. The others take turns to break up the solid ground, working with bare feet and broken sandals as the afternoon light colours with the expectation of thunder and rain.

Our journey through the Nuba mountains began in Tangal, a well-populated village to the south, where Médecins Sans Frontières (MSF) runs one of four health outreach units. As we walked from the airstrip to the clinic in the late afternoon, we passed lines of people coming back from their fields and from the market: children bringing their goats in for the evening, old men standing and talking at the crossroads. But despite seeing so many people, and despite passing a school, a church, and a busy mill, we never arrived at a recognisable village; the one-room houses were scattered across the valley and up the sides of the hill in groups of no more than two or three, their stone walls shielded by ripening sorghum stems. They looked like houses that were trying to hide. I asked Carbino, our translator, why the village was so spread out like this; perhaps it was traditional, I suggested, or a result of the distribution of farmland? He thought for a moment, and waved his hand at the sky. "Yuh," he said, "actually, it's safer like this. This way they are not a target."

A clustered group of houses is easier to see from the air, he explained — and to bomb. A traditional village, grouped around the well, mill and meeting square, can be surrounded, and once one roof is set alight the rest will quickly burn. The villagers of Tangal had scattered in the early days of the Sudanese civil war, as villagers all over Nuba had done, hiding their homes high in hills, looking for a safety that wasn't always there. They weren't yet ready to regroup and rebuild.

Not far from the MSF compound, we met a woman walking back from her field on crutches. Half of one leg was missing, and after Carbino had greeted her and introduced us, he asked Lenda our obvious questions. She paused a long time before answering, puckering her mouth around the words in distaste, as if she'd eaten one of the locally grown sour oranges. "She says she walked on a mine," Carbino told us. "Over there, when she was tending her crops." He pointed to a field on the other side of the stream, 5 or 10 minutes' walk away. "She lost her husband and children in the war. She is all on her own here," he said. She told him she was 80, though she looked no more than 45. Does her leg still hurt, we asked, and she turned away, shaking her head, as if the question was foolishness itself.

Sudan is a vast and complicated nation. Created almost as a cartographer's convenience from a shifting collection of tribal lands and alliances — Dinka, Nuer, Nuba, Arab, Fur — by the colonial powers of Egypt and Britain, Sudan has experienced peace for an all too brief 11 years since gaining independence in 1956. The most recent war, which started in 1983 and finally seems to have ground to a bloody halt — Darfur notwithstanding — can broadly be described as pitting the ruling Arabic and Islamic government of Sudan (GoS) in the north against the predominantly Christian and black Sudanese People's Liberation Army (SPLA) in the south. It's been a war fought over land, resources, the right to self-determination and the personal vengeances that gather their own malevolent momentum in any civil war. And oil, the poisonous treasure buried beneath so many of the world's conflicts, has had a role to play as well; particularly in the Nuba mountains, which lie directly between the oilfields and the main export route of Port Sudan.

The war came to Nuba with a particularly relentless brutality, bringing suffering that has been described by African Rights, the human-rights organisation, as a policy of slow genocide. In an attempt to clear the Nuba Mountains region of its population, the government forces destroyed food sources and infrastructure, carried out extrajudicial killings, and intimidated or forced villagers into specially established camps away from their own areas. The suffering of the Nuban people was heightened by being hidden from the world — outsiders were barred, and not even the UN's Operation Lifeline was allowed access to fulfil its mission of feeding the starving. It took a long time for the rumours of what was happening in Nuba to reach the outside world, and even longer for the suffering to come to an end.

The geography of the conflict in Nuba was complex, with front lines shifting between the rainy season and the dry, with GoS garrisons planted like hostile outposts in the middle of SPLA territory, with houses, churches and mosques (Nuba, crucially, being both Christian and Muslim, refuting the simplistic claim that this has been an exclusively religious war) burnt and rebuilt several times over the years. I lost track, as we walked from one MSF clinic to another, of where exactly the front lines had been, whose territory we were on at any one time, why a particular mountain range had been such a vital battlefield. But one factor is key to understanding the war — and the Nuban landscape. When the GoS attacks began — aerial bombardments, cattle-raiding, kidnap and forcible relocation, the burning of homes and food stocks, summary executions, rape — the Nuban people, who have traditionally lived on the fertile plains and valley floors, ran for the hills and stayed there.

Cut off from their homes and their farmland, they built new houses in small, isolated groups, carved steep terraces out of the rocky hillside, and searched — often fruitlessly — for adequate grazing for the few goats and cattle they had left. And now, with a two-year-old ceasefire, and a peace process beginning to take hold, people have tentatively started moving down to the plains and valleys again, and coming back from their self-imposed exiles in Khartoum and elsewhere; returning to their homes, rebuilding their villages, replanting the fields their families have worked for innumerable generations. The geography of the Nuba mountains, I began to understand, can be read as a geography of hope — albeit a hope with deep scars of hardship, pain and irrevocable loss.

That first evening, camping in the MSF compound, we heard what sounded like gunshots echoing down from the hills. Carbino assured us that it was boys playing with sorghum sticks. "They heat them up in the fire," he said, "and then hit them against a rock — bang! It's the war-traumatised children," he added, casually. "They remember things, and they want to be soldiers."

After a few days' stay in Tangal we walked out, following the route taken by patients who get referred from the basic outreach units to the better-equipped clinic at Limun. The outreach units are able to deal with only the simplest of life-threatening diseases: the more easily diagnosed strains of malaria, the diarrhoea and vomiting to which children are so fatally prone, chest infections, wounds. Anything more complicated — TB, other strains of malaria, malnutrition, anything that might warrant a blood test or admission to the wards — means that patients have to be referred to Limun, and have to make their own way there on foot.

I asked Carbino how far it was, and since there are no surfaced roads in Nuba, and very few vehicles, he gave me the distance not in miles or kilometres but in walking time. "It's not far," he said. "Maybe 10 hours." He paused, looked at me again, and corrected himself. "Yuh, for
you, Jon?" he said, grinning, "I think two days."

They were two of the toughest days' walking I've done in a long time. Striding out at a remorseless pace across dusty, shadeless plains, up steep mountainsides, down narrow paths treacherous with shale and loose rocks, we had no time either to enjoy the magnificent scenery or to stop and catch our breath. Long before we'd crested the final ridge and looked down over the valley of Limun, glimpsing the white MSF flag in the distance, I'd started to realise how difficult the journey must be for someone carrying the weakness of malaria, the breathlessness of TB, the fearful burden of a sick child. I wondered how many people were unable to make the journey.

The medical clinic at Limun is the nearest thing the area has to a hospital. There are no surgical facilities, but there are inpatient wards, a pharmacy, a laboratory, a therapeutic feeding centre, and about 80 staff. Dozens of people arrive each day, waiting patiently on narrow benches for medicine, for treatment, sometimes for miracles that can't be performed. Without a surgery, even appendicitis can be fatal here.

I accompanied Sook Lin Yap, one of the MSF nurses, on her morning tour of the wards. Each ward, a low mud-brick building with a grass roof and a packed-earth floor, has seven or eight beds squeezed into it, and we had to pick our way carefully between cooking pots and jugs of milk, ducking under mosquito nets strung from the roof like washing, as Lin introduced me to the first patient. "This boy's 2½; he's been here for six days," she said, taking him from his mother, asking in Arabic if the child was eating well, as she smiled and pulled faces, looking at his tongue and the whites of his eyes, feeling his skin. "When I first spoke to her, she knew I was worried," she said, passing him back to his mother, "because I really thought I was going to lose him. But he's gained weight nicely, huh?"

She moved on to the next bed, crouching beside a pale three-year-old boy lying across his father's lap. "This child I was very concerned about," she said. "He had malaria and became very anaemic, and what he needed was blood. But I haven't got it. So I put a tube down instead, and gave him good nutrition and, hopefully, you know, his body will make his own blood."

"Hopefully" was a word I heard a lot from the MSF staff in Nuba, a secular version of the Arabic insha'Allah, "God willing". Hopefully, he'll pull through. Hopefully, the family will give the medication properly. Hopefully, the ceasefire will become permanent and the people here can start to rebuild their lives.

She worked her way around the ward, discharging a girl who'd had swollen knees, a girl with a chest infection, a boy who'd recovered from malnutrition. She showed another nurse a boy with a kidney disorder, nephrotic syndrome, explaining how to look for the symptoms, and the limited treatment available. "Basically, we can give him steroids, and drugs to make him pee," she murmured, "but this child won't get better."

In the last bed in the ward, she came across a young mother with a very underweight-looking child. "This is Bethlehem!" she announced, recognising the child who had been carried in during a rainstorm a few days earlier. "And she gained 100 grams, and she's eating and drinking well, and she looks happy, huh?" Bethlehem's mother, Nafisa, smiled at Lin's obvious delight. She looked a lot more relaxed than when she'd first arrived with her husband, Isaiah. Then, they'd watched helplessly as Lin and others had gathered around the wailing Bethlehem, taking blood, preparing a tube, asking questions, both of them exhausted after walking for two days to bring their first-born to safety. Now, they shone with relief as Lin explained she was ready for home food, and they could feed her on demand until she was ready for the journey home.

I asked Lin about malnutrition, about its effects and its causes. She told me that very few children die of lack of food alone, that usually it's combined with something else: with malaria, vomiting, diarrhoea. Hygiene is often poor, she said, and the diet is already limited, lacking in fresh fruit or vegetables, meat or eggs, in anything much beyond a thick sweetened porridge made from sorghum. The treatment is simple, though, she explained, if the parents are able to bring the children to the clinic in time. Rehydration and high-calorie food supplements, combined with hygiene education, are usually enough. When the children first arrive they are weighed — invariably bursting into tears as they're put into a bucket slung from a set of grocer's scales — and measured, and are then not discharged until they regain a height-to-weight ratio of at least 80%.

"Really, they should be 100%," she said, "but nobody's ever 100% around here. Bethlehem was 74% when she came in, and that's low, that's ill. I was surprised she could drink for herself. I've got a child in ward three with a height-to-weight ratio of 57%, and if he makes it he'll only be my second one who made it from less than 60%." She looked at the floor, faltering, and I recalled asking why she was working in Limun, asking what had brought her all the way from Malaysia via London to the scarred heart of Africa, and being struck by the simple sincerity of her response: that she loved having the opportunity to make a real difference to people's lives.

"He's only four years old and he's in a bad way," she said about the boy in ward three, Mustafa Phillis. "Mostly when they're that low it's too late. Their bodily systems have been too badly damaged." Do many children die here, I asked. "Yes," she said, lowering her eyes again. "Lots do. Especially now, during the malaria season. But this child will make it," she added, brightening, smoothing down the brittle hair on Bethlehem's head. "I can guarantee that, 100%." Nafisa and Isaiah sat on the bed with their baby, looking at us, wondering what we were saying.

Mustafa died three days later, in the early afternoon. It's his grave the men are digging now, barely an hour after his death, out at the far end of the valley with the other small and freshly dug graves. There are eight others where they are digging; low, gravelled mounds ringed with rocks. These are only from this month, one of the men says. The rest are there. And he gestures up and over the low hillock to where the long, wet grass hides numerous other small and unmarked mounds of earth. The men dig, and rest, and glance anxiously at the darkening sky.

Ismail has brought a short stick with him, to measure the length of the hole they must dig, and he lays it out along the ground occasionally, muttering instructions to whomever is wielding a pick at the time. The man in the pale-brown kurta, the father of the boy with nephrotic syndrome, kneels in the hole and scoops out loose soil in his clenched fists. Four of the other men return from the hillside with large slabs of stone on their shoulders: heavy graveside rocks, which make them move with a funereal swagger. Another man fetches a jerry can of water from the stream. Thunder crackles in the near distance; storms pour down onto other valleys.

Carrying rocks, in this heavily gender-divided society, is something that men do, for building materials, or for land clearance. Men build and rebuild houses, work the land, dig the graves and fight the wars. Women fetch the water, collect the firewood, cook, bear children, and lead the mourning at funerals. But Mustafa's mother will have to wait until she gets home before she can begin to mourn his death; she has no relatives here with her, and she will stay away from the graveside — relatives don't attend the burial by custom — gathering her few things together and preparing for the long and stunned walk home, a journey of 2½ days.

When the neat rectangular hole is little more than a foot deep, the men concentrate on digging a smaller, deeper hole, a grave within a grave, hacking away at the stony ground with an axe to straighten the sides. A man in a striped shirt, the father of the anaemic boy, stands in the deeper hole to scoop out the last of the soil. The new inner grave is barely as wide as his two feet pressed together. Ismail picks out loose stones and measures the length again, checking everything over one last time before the tools are laid to one side and the men turn to face Limun, the sky clouded darkly over now, the rain starting to fall. The whole job has taken about an hour, but it's such a small, small grave. It must be these fathers' wish — it must be every parent's wish — never to have to do this for one of their own.

Another man appears down by the stream, walking quickly through the long, wet grass. He is carrying the child, Mustafa, wrapped in a printed blue sheet. The boy's body looks light and limp in the man's arms. His head falls down from the man's forearm, out of proportion with the rest of his body, his bound feet pointing away to one side. Together, the men hold Mustafa's body over the grave, unwinding the blue sheet, laying him into the ground wrapped only in thin white gauze. The grave is well measured, and he fits snugly into the hole. They place small round stones onto his body and lay the flat rocks across to form a lid. They mix the water with soil to form a clay, plastering it over the rocks, and heap dry soil on top. The measuring stick is snapped in two and stuck into the ground at either end, the head and the foot. They crouch around the grave, tidying the mound, picking out stones and grass, patting it smooth. They wash their hands and sprinkle water onto the soil.

They stand back quietly, and Ismail mutters some words, almost inaudibly, the other men murmuring in agreement, briefly lifting their palms to the bruised and impassive sky before turning and walking away, ignoring the writer and the photographer intruding on this small scene of ordinary sadness. They wash their hands again in the stream, hurrying to get back to the clinic before the clouds burst open.

MSF will be leaving Limun soon. Their role here has been as specialists in emergency health care, and as hard as life in Nuba still undoubtedly is, it can no longer be described as an emergency. The clinics will be handed over to an organisation more focused on development, training and education, while MSF focuses its resources on the many ongoing emergencies elsewhere (Darfur, Chad, Angola, Somalia, Congo . . . the list is not a short one). The people of Nuba have come through many difficult years, and although food is still short and children are still dying, they at last — hopefully, or insha'Allah — have reason to look to the future. People are returning from long exiles, rebuilding their homes, replanting their fields, resurrecting the gatherings and markets and festivals that they have been afraid to hold for so long.

Anil Osman had a story typical of many. Born in Limun in 1975, he left as an 11-year-old — "because the situation was a little bit severe at that time" — and travelled with his brothers and sister to El Obeid, in the north. I asked him what he meant by the situation being a little bit severe, and he shrugged: "If they suspect you are a rebel they will come and take you, and if you are not lucky they will kill you. And if you are lucky, and you have cows, they will rather take cows."

He lived in El Obeid with his brothers and sister, without word from their parents, finishing school, finding work and marrying a childhood friend from Limun who had also gone there; until, with the first peace agreement being signed in 2002, he began to think about going back to Limun. "I told my brother," he said, "now it look a little bit safe, I have to go and see my mother and father, because we have been here a long time without seeing them. It will be better to see them if they are alive, or where they live."

He came alone, first, leaving his wife and two children in El Obeid, wary of whether the fragile ceasefire would hold. "Peace is like oxygen for life here," he said. "We want to live, and without peace there is not life." He found his parents still living in the village, survivors of the war's worst years. He rebuilt a house near the clinic, and watched the ceasefire being renewed two, three, four times. Soon, he said, he will send for his family, and bring them home to live in Limun.

I walked up to his home with him, and he showed me where he will build another one for his wife and children, explaining how he will carry the stones to the site, cut the branches, dry the grasses for the roof. The end of the year is a good time for people to come back to Nuba, he said, because the building materials are in good supply. I stood by his doorway, looking down into the valley. I could just see, beyond the clinic and the MSF staff compound, the evening's football match being played out; and beyond that, women washing clothes at the stream. In the distance, I could see the small hillock where Mustafa had been buried. I asked Anil what he thought the valley would look like in the future.

"I think there will be a lot of changes here," he said. "People will move from up hills to down, and they will receive a lot of development they don't have before. They will have hospital, they will have more schools, they will have tarmac roads. I am happy to be here the rest of my life," he added. "That's why I want to bring my family back here in Nuba mountains."

I recalled Mahamud, an MSF nurse, describing his return to Nuba after a 15-year absence. "It was a very big party," he said. "I was feeling very happy. Really very happy. It was as if someone was lost or was dead and had come again."

AUTHORS IN THE FRONT LINE

In The Sunday Times Magazine's continuing series, renowned writers and artists bring a fresh perspective to the world's trouble spots. The international medical-aid organisation MSF has helped our correspondents reach some of these inhospitable areas. To donate to MSF, visit www.uk.msf.org, or call 0800 200 222

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