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In the far-flung corners of South Sudan, health care is all but impossible to find. People often walk for days to get the care they need to survive. Hope comes in the shape of the Red Cross’ surgical unit in a hospital in the remote town of Kodok. Oxford nurse Robbie Gray is part of the team and is no stranger to South Sudan, but that doesn’t make medical care in the world’s newest nation any easier.

Working in South Sudan is totally different from a modern well-staffed hospital in the UK.

We are working in a conflict zone where people are suffering from horrendous wounds and injuries. We only have basic equipment and supplies. It’s a sad fact that we simply cannot help everyone.

For starters, we don’t always have electricity at the hospital. We have two large generators, but due to the paucity of fuel available, we can’t run them all the time. This inevitably impacts upon the treatment we’re able to administer.

Our sterilisation area used to be a store room. We sterilise equipment in an autoclave – essentially a large pressure cooker heated on a charcoal burner.

Then there’s the heat – it can reach 40 degrees in the shade. Many patients come to us dehydrated and we depend on treated water pumped from the Nile.

None of this is new to me. This is my fifth mission to South Sudan with the Red Cross. I guess I keep coming back because I get a lot of satisfaction out of the job. I feel like we’re making a difference every day.

Space in the wards was scarce because of the influx of the wounded. ©Alyona Synenko / ICRC

Space in the wards can become scarce when there is an influx of wounded people. © Alyona Synenko / ICRC

Normal people caught up in conflict

We’re currently based in a hospital in Kodok, a town in the north-east of the country. Our remit is war surgery: treating any combatant or civilian affected by the fighting in our area.

The people we treat have lost everything. They often arrive bewildered and traumatised with a wide range of injuries and illnesses.

Most injuries we see are to arms and legs. They range from muscle and tissue damage to fracturing or extensive damage to bones. We do get abdominal and chest trauma as well as explosive amputation.

People have to travel for days to get to the hospital. They can be in a pretty bad shape when they get to us.

I remember one particular young man who’d walked in with a gunshot wound. His wound was about ten days old and needed to be thoroughly disinfected.

We grafted some skin from his arm as the wound was too wide to stitch up. He stayed in the hospital for a while after and we got to know each other quite well.

He was a farmer really. He was just trying to defend his family and his tribe. Before that he was just living a normal life raising his cattle. He just got swept up in everything and was shot. You see a lot of people like him, normal people caught up in this extraordinary situation.

Sometimes we see other cases. I remember one time I was called in along with the midwife for an emergency caesarean section at 2am. The woman had been trying to deliver at home but the baby wasn’t in the right position. Our midwife knew instantly that a natural birth wasn’t going to happen.

Afterwards the mother and baby stayed in the hospital for a few days recovering. That was nice – a happy story and we don’t always see many of those. Without our help, I’m pretty sure she and the baby would have died.

"My hands were trembling as I was helping out with the triage. This hospital was hit by fighting in the past and we were scared this might happen again," said Dianne, an ICRC health assistant. ©Alyona Synenko / ICRC

“My hands were trembling as I was helping out with the triage. This hospital was hit by fighting in the past,” said Dianne, an ICRC health assistant. © Alyona Synenko / ICRC

The threat of starvation

Famine was declared in South Sudan in February. 100,000 people are facing the very real threat of starvation.

While I’m not working in the area worst affected by food shortages, it’s noticeable how the quantity of food available in local markets is going down, and prices keep going up. The situation for people in town is getting desperate.

How different it was when I first came to South Sudan back in 2012; one year after it gained independence, the mood was so positive. Everyone was hoping for a change and a better life.

Yet here we are. More than three years of conflict has left people in the world’s newest nation on their knees.

We work closely with volunteers and staff from the South Sudan Red Cross. Their families are among the thousands of people crossing the border into Uganda – 1.5 million people have fled South Sudan to neighbouring countries – but still they stay.

I’ve been working with the same translator for three years now. He’s a smart guy and we’ve taken to getting him scrubbed up for smaller operations.

I’m there to talk him through it. This is the only medical training he’s had. But we know that if we have to leave, there will still be a group of people who know what to do.

Most South Sudanese aren’t at all squeamish. Our translator has seen things that most people would run away from pretty quickly. I guess coming from this country, people are used to the consequences of fighting.

The bravery of the local Red Cross workers is humbling, and one of the reasons why I keep coming back to this country, despite the endless suffering.

The suffering can take its toll on your mind. Everyone needs a way to relax, to disengage from the trauma. I play trumpet.

I live in a small, mud hut in a compound not far from the hospital. On the calmer evenings, you can hear me playing Miles Davis as the sun sets over the compound.

Perhaps there is no more incongruous sound given the setting. But it helps me to unwind and reflect on why I keep coming back to the far-flung corners of this war-torn country.