Interview conducted  April 15th 2017 by Helena Lindemann. Photo by Barbara Sigge.

Dr Tankred Stoebe is an emergency doctor, member  of  the  International Board of Médecins sans Frontières (‘MSF’)  since   2015 and was President of MSF Germany from  2007-2015. This interview is published as part of the series ‘Voices in the field,’ a joint endeavour by GHLG and IFHHRO.*

Thank you very much for taking the time to conduct this interview with me. Could you briefly explain when the last time was you worked in South Sudan and what projects you worked on there?

I have been to South Sudan four times over the years, two field visits in two different parts and two were project works. The first visit was in the North-West of the country in 2008. The area suffered from a cholera epidemic so we established a cholera treatment center, in a tent town outside the city of Aweil. We were focusing on cholera patients, separating them from the normal hospital and then, of course, treating this life threatening disease. This was one of my earlier projects. The last one was in 2014 when I was doing an Explo mission searching for malnourished children south of the city of Malakal. It was during the rainy season so access was very difficult. Our aim was malnourished children and to propose potential projects in this area. Ever since I am involved with Doctors without Borders/MSF I am interested in South Sudan because it is such a vast country with so many medical-humanitarian challenges and as an organization, we have been there since 1983. South Sudan is one of our main countries with main activities and over 3000 employees and a budget of over € 80 mil annually. The main problem of South Sudan is the civil war which has been going on for decades. The country became independent in 2011, it is the newest country on earth, but the war heritage continues. There was a glimpse of hope and happiness when South Sudan declared itself independent from the North but the suffering of civilians never really stopped. What we see now with severe malnutrition looming is a man-made disaster affecting the population.

You just addressed it. South Sudan is a country that has been affected by these conflicts for a very long period of time. If you compare it to different countries you worked with, with regards to developmental aid and funding: How does aiding a politically disrupted  country  differ from a country that suffers from natural catastrophes for instance?

One big difference in South Sudan if we compare it for example to Syria, a country currently regarded as the main humanitarian crisis on earth,  is that Syria had a well-functioning infrastructure before the conflict, had a health care system which was well developed, had a logistic infrastructure, bridges, streets, railroad system. If you go to South Sudan, none of this you´ll find. You can easily count the miles of paved roads. You have a lot of airports, but mostly these are dirt airstrips. The main channels of transportation are still the rivers. You have very few hospitals; patients have to walk for days to reach hospitals. Pregnant mothers die on their way to a safe delivery in a hospital. They simply have to walk too far. The origin of the conflict has changed over the years. A long time it had to deal with the North; now it is an internal power struggle between the President and the Vice-President. But the effect for the population means violence, internal displacement, no access to health care, malnutrition, mass killing, and mass refugees. All these problems have been existing in South Sudan for many years. The suffering of the civil population is huge and the availability of health care, of humanitarian aid, is extremely limited. Not only because of security, but bad infrastructure and a country that never had the chance to develop like other countries.

Thank you, and actually, you have already answered my next question. Which was why do you think is South Sudan so vulnerable to food insecurity – but with what you just said with displacement, malnutrition, mass killing, the refugees, internal displacements – those are essentially the factors contributing to food insecurity within the country.  Right?

One of the major troubles in South Sudan is, if you look at health indicators, if you look at child mortality, women mortality, life expectancy, coverage of health care, vaccination of children – all these health indicators are among the worst in the world and have been as bad for many years. So even during better times, this country was struggling for survival. The interesting finding last time I was there to do this malnutrition survey, was that during a peaceful period , even if it is lasting only for months; during the rainy season fighting usually goes down because movement for soldiers and militia is reduced; so as soon as the war pauses, people do find food and can feed themselves and their children. So the malnutrition that is hitting the country every so often is due to actual fighting and displacement and lack of access to food.

How big of an issue is corruption in a country like South Sudan?

It truly is a big problem. This country has lots of oil resources and if you see these oil resources but also the aid that comes into the country and how much of this actually reaches the population? Very little. It is a country that is extremely poor. If you also look at the percentage the South Sudan government is spending on health care it is one of the lowest rates in the world. The majority of the budget goes to warfare and corruption is huge and there is a lack of good administration in the country. Becoming a politician in South Sudan means you become wealthy and influential.

In that line of reasoning, how can food insecurity even be counteracted when it is hard to monitor progress? The food and agricultural organization, for instance, says it does not get any really reliable material, data, statistics etc from the country. So if the government can’t even provide this, how is it possible to track change and how does Doctors Without Borders deal with that?

A good question and it is very relevant to look at that – data collection in South Sudan is not reliable. Our advantage is that we act independently; we try to rely as little as possible on the fragile infrastructure or the given resources of the country. Regarding malnutrition, this is a field where MSF has developed quite some experience and with latest developments, ready-made food, that is only available since a few years and helps us to treat even severely malnourished children in a very effective way. So the new feeding-formulas are a great achievement in science that helps us. We are not relying on the national or regional powers but we import the goods, the medicine, and the food and deliver it straight to the people in need. This is also a result that we cannot trust and we cannot rely on the public infrastructure that is there or the lack of it. 

That seems very reasonable. When you look at South Sudan now, what do you think are its biggest issues in development for 2017?

The continuous fighting and the unrest created by the government and the militia fractions that varies quite largely throughout South Sudan. Successful peace negotiations and a factual peace and stability in the country would be the number one request to benefit the population. This is a political dream, and there is nothing on the horizon that gives us hope to believe that anytime soon the fighting will subside. As a humanitarian organization, we act for the needs of the population during the conflict. We cannot stop, we cannot even alter or change the conflict. What we can do is to find access to the most vulnerable people, to have mobile clinics, to run hospitals, to feed malnourished children. This is what we can do. But of course we are also affected and if fighting becomes too intense and our hospitals are attacked as they have been done repeatedly in South Sudan, this affects us as an organization to help but it also affects the people in need and this is our request: stop the fighting, at least stop attacking hospitals, stop attacking medical workers, humanitarian workers so they at least can in the meantime, when there is no peace agreement, that we can at least lower the suffering of the population.

If you had three recommendations in enhancing food security for South Sudan, what would they be? You already mentioned that you can’t end war, displacements, or these refugee issues. But if there were, broadly speaking, any other recommendations, is there anything else apart from a stop to fighting?

A huge challenge, but that is related to the fighting, are the internal displaced people and the refugees. The distinction between those two is basically that refugees cross the borders. Now, hundreds of thousands of South Sudanese people being in Uganda, in Ethiopia, in DRC, the neighboring countries. And theses countries are not wealthy themselves. They are very much stretched to their capacity to host, support, and to feed the South Sudanese refugees. In a similar manner it is very difficult for the internally displaced people and here as well we talk about millions of people. This is something we hardly recognize in Europe, the importance of the millions of South Sudanese people uprooted by the conflict, forced to move to other places in South Sudan or crossing borders into the neighboring countries.

In short, my recommendations for South Sudan would be: ending the conflict, allowing patients free and safe access to medical care and stopping the attacks on hospitals and medical staff.

Do you think signing international agreements such as the International Covenant on Economic, Social and Cultural Rights could potentially enhance food security in South Sudan?

In general, I think it is important to have those agreements. It is probably even more important to hold the political leaders of the country accountable to those agreements. And looking at a country that is much more accustomed to and experienced in being at war than to be at peace, it would take a long time to change that. The international community, and certainly the international political elite, should increase their pressure on South Sudan to find a peace agreement. I am not sure if enough is being done and I am quite skeptical that the international politics, including the German government, is doing its utmost to try to find an end to the conflict in South Sudan.

*Voices in the Field is a multimedia interview series that shares the stories of experienced professionals in the field of health and highlights the role of human rights in their careers. This project is brought to you by Global Health Law Groningen and IFHHRO, and is directed by Jacquelyn Veraldi and Nicole Rusli. Find out more about what inspired Voices in the Field.