Into the Sudd

An emergency response in the swamps of South Sudan

Humanitarian aid workers in a canoe arrive at a remote village in the swamp of South Sudan

fter 2.5 hours in the canoe, Medair’s Emergency Response team arrives at a remote village in the swamps of Nyal Payam. ©Medair/Stefan Kewitz


“The whole community was sure I was going to die”, Gabriel remembers with fright in his eyes. It was in early September 2022 when malaria made him collapse and he fell into coma. In the midst of the rainy season, the female anopheles mosquitoes that transmit the deadly infection through a parasite are wide-spread and always on the prowl for human blood. After Gabriel was bitten, he had a very high fever and pain throughout his body. “It got worse every minute”, he shares.

A male patient after malaria treatment in South Sudan

Gabriel, the local community leader in Meer village, recovered from malaria thanks to Medair’s treatment in September 2022. Just days before, his family was sure he would not survive. ©Medair/Stefan Kewitz

Gabriel is 52 and is the chief of one of the many small remote villages located in the banks of the Sudd. Africa’s largest swamp stretches from the north to the centre of South Sudan. It used to be a safe space for people displaced by conflict. Hard to reach for attackers, offering ample resources for both, humans and their cattle. Since the seasonal flooding constantly increased and ravaged the infrastructure, life changed dramatically for the communities in a place there, called Nyal Payam. The cattle died in the water, traditional cultivating became almost impossible and the floods cut access to safe drinking water and even the most basic health services.

A boy in a canoe in a swamp in South Sudan

Increased flooding over the past years has ravaged the infrastructure in Nyal. Canoes remain the only way to move, but they are rare and expensive in the swamp. ©Medair/Stefan Kewitz

The situation worsened as reduced international funding for the crisis in South Sudan led to the closure of some of the only health facilities reachable for remote communities in the swamp. “My family wanted to bring me to the next health facility, but it was way too far and I was too weak for the long journey in the canoe”, Gabriel laments. Many people are like him in the Sudd. With no help available nearby and nowhere to go, the number of people dying increased dramatically over the past months in villages like Meer, where Gabriel lives.

“Our assessment revealed a high number of deadly malaria cases in all age groups, Medair’s Health Manager Emelda explains. “What concerned us the most was the high number of child deaths that were reported”, she adds. “It is triggers like these that make our Emergency Response Team (ERT) waste no time to bring help immediately.”

Humanitarian aid workers during a supervision visit in South Sudan

Community health worker James is happy to support his village with medical services. ERT managers Emelda and Gatmai are guiding him with regular supervision visits. ©Medair/Stefan Kewitz

Emelda and her team work tireless to save as many lives as possible in this emergency. For all of them, being part of Medair’s ERT is more than just a job. It is a calling, a mission to bring help and hope to the neediest and most neglected crisis-affected people. It is a faithful commitment which for them means countless hours in scorching heat in small and shaky canoes to reach communities, needing to balance their own body weight all the time to prevent falling into the swamp. It means walking or footing, as the South Sudanese call it, through the swamp in overgrown slippery waterways, wherever canoes cannot pass. It means adapting to a very low-resource and often insecure environment, living under most basic conditions for months, far away from their own families. But seeing children recover from disease, seeing communities gaining confidence that better days are coming through their help makes them forget all the difficult circumstances they are working in.

Even in time-critical health emergencies, Medair staff involve and engage affected communities as much as possible to ensure sustainable aid and to build local capacities to help communities cope with future shocks. “Here in Nyal, we train and supply local Community Based Distributors to support and enable them to serve their own community members. We teach them how to diagnose and treat diseases like malaria, pneumonia or diarrhoea, and we distribute medicines. Our role here is supervising. We show them how to protect their people. It makes them proud to become a proactive part of the solution, it boosts their confidence to act and be less dependent on aid. This brings hope and new strength to the people that lasts much longer than our intervention here.”

Humanitarian aid workers talking to each other in South Sudan

Community Health Worker John shows his latest report to ERT Health Manager Emelda during a supervision visit in Yup Village. ©Medair/Stefan Kewitz

In Yup village, not far from Meer, Community Based Distributor John is one of the temporary local Medair staff who is serving his own community. “I have been working with Medair since August”, he shares. “I test the patients that come with symptoms and I give them medicines, for example, when they are tested positive for malaria. We have more malaria cases now since the flooding increased, the water does not go away anymore and there are more mosquitoes. We do not have enough food here; our community is weak and people really suffer when they get sick. Since Medair came to help our community, the situation has got much better. Before you came, we had no access to medical treatment. I used to have nothing, as my cattle died due to the flooding and I was very afraid of the future to come. Now, working as a community health distributor for Medair, I can support my family again and that makes me proud. Curing the diseases of our community members is something new I learned and I really like it.”

A humanitarian aid worker gives medical treatment to a girl child and her mother in South Sudan

Six-year-old Nyalual suffers as her mother brings her to Community Health Worker John for treatment in Yup village. Since Medair provided training and drugs, he is able to help the people in his village. ©Medair/Stefan Kewitz

Every day, many patients like Nyaruot, and her six-year-old daughter Nyalual visit John for diagnose and treatment. The child is crying from headache as they arrive. The night before, she had a high fever and was complaining of body pains. Her mother Nyaruot already heard about Medair’s emergency aid and knew where to bring her daughter. “We live so remote here and the next health facility is hard to reach since the ones nearer by were closed some time ago, the mother complains. Our community is glad you came to help. We witnessed that community members died on their way to the next health care facility in Nyal because they were so sick and exhausted. We hope that will not happen again as you are here now.”

Humanitarian aid workers testing a child for malaria in South Sudan

John testing his little patient Nyalual for malaria. With a rapid blood test, the infection can be diagnosed very quick. ©Medair/Stefan Kewitz

John has as good routine in his work already. Soothingly he tests the child. After a few minutes the test shows that Nyalual is positive for malaria. With his medicine supplies from Medair at hand, John is able to provide immediate treatment for the child to relieve her suffering and protect her from an even more serious course of the infection. John is patient and precise while teaching the mother how to give medication to her sick daughter in the coming days.

Humanitarian aid worker gives malaria medicine to a patient in South Sudan

After Nyalual is tested positive for malaria, Community Health worker John explains to her mother how frequently she needs to treat her daughter with drugs in the coming days. ©Medair/Stefan Kewitz

To ensure quality health services for the communities, the ERT visits the remote villages weekly to conduct t interviews with patients after treatment to learn about their experience and to advise the Community Based Distributors how to constantly improve. The Medair also staff trains health workers from other local partners, to refresh their education and make sure knowledge and learnings will remain beyond Medair’s temporarily intervention in this area.

Humanitarian aid workers and a local community leader in talking to each other in South Sudan

After the successful cure of his malaria case, Gabriel is thankful and convinced of Medair’s medical treatment. ©Medair/Stefan Kewitz

“Only thanks to you I am still alive”, Gabriel, the community leader in Meer resumes. “I never believed in drugs and this kind of medicine, nor did my community. But without the medication, I would not sit her and talk to you right now. Everybody was surprised and happy I survived. And everybody is convinced now, due to my case, that your way of treatment with medicine really has an impact. From now on we value the importance of medicine and professional treatment very much.”

When Medair’s ERT left the Sudd after this three month intervention, it handed over the services for these remote communities in Nyal to another partnering NGO . In a country where a staggering 76% of the population are expected to need humanitarian assistance in 2023, Medair’s emergency response team is well placed to continue reaching those in the most remote locations to bring life-saving aid.

Humanitarian aid workers in a canoe in the swamp of South Sudan

Emelda, Gatmai and their team work tireless to save as much lives as possible during this emergency. The next village is just ahead so they continue their series of supervision visits in Nyal Payam. ©Medair/Stefan Kewitz

“Every emergency response has a lasting impact”, Emelda shares confidently out of her long experience. We cannot solve all the problems at once, but every single life that we save makes a big change and creates new hope and future, for the people we serve, and for us as Medair as well.”


The health intervention in Nyal Payam was funded by aid from the European Union (ECHO).

This content was produced with resources gathered by Medair field and headquarters staff. The views expressed herein are those solely of Medair and should not be taken, in any way, to reflect the official opinion of any other organisation.