Walking into the CARE supported clinic in Pariang, I see a little girl with edema - her belly is swollen because she hasn't got enough to eat. It's been a long time since I've seen a child with edema, and I certainly didn't expect to see one in this part of the country. Of all the places that CARE supports health care, Pariang, in Unity state, has traditionally been the least food insecure.
But we're seeing more children with edema these days, especially in the three states most affected by the conflict: Unity, Upper Nile and Jonglei. Here in Pariang, malnutrition rates among children have reached critical levels, as they have elsewhere in Unity.
It's a reminder of how deadly this conflict has become, even if you manage to escape from the fighting, there are no guarantees. The latest figures estimate around 3.8 million people were food insecure in April. In simple terms, it means 3.8 million South Sudanese - almost a quarter of the population here - didn't have enough to eat and require humanitarian assistance. These figures are expected to rise to 4.6 million by July. These numbers are bad, but without the work of organisations like CARE, they'd be a lot worse.
Around 500,000 of these people live in Unity state. The Pariang nutrition team explains to me that they are struggling to help explain to people where to get nutritious food; many of the fruits and vegetables that were previously available in the market here are no longer sold. The old trade and transportation routes have collapsed, replaced by new ones that sporadically make their way into rural communities, ceasefires permitting.
South Sudan's economy is starting to buckle under the weight of 17 months of conflict and plunging oil prices. Costs are soaring, especially for food, but because of the conflict, there's less food to buy, and not a lot of cash to buy it with. Shortages are everywhere. Last week the capital Juba had almost no bread, drinking water was difficult to find and fuel lines were stretching for a kilometer at the petrol stations I passed on my way home. For ordinary South Sudanese, who spend around 80 percent of their income on food, this is life-threatening.
Daniel Pau, the head of CARE's environment team up in Pariang, has a partial solution for the lack of diverse diet. People can grow fruits and vegetables if they are taught how. South Sudanese from this part of the country are not traditionally farmers. They tend livestock. So Daniel's project, a seedling nursery, has started to distribute plants to families with malnourished children so that they can grow their own nutritious food. They are growing mangoes, lemon, oranges, pawpaw, guava, and passion fruit so that families, especially children, have a more diverse and healthy diet.
The role of humanitarian organisations in this crisis is more critical now than ever before, yet CARE has been forced to close programmes because we no longer have the funding to run them. The need is still there, but the cost of running programmes is high. Every kilo of assistance we send to the field costs USD6.70 to transport because distances are so vast and infrastructure so poor.
So we're focusing our efforts, reducing the number of sectors and locations in which we work. We're now making cuts to our health and sanitation programmes in order to provide food and nutrition assistance in the coming months. That's more than 160,000 South Sudanese we're no longer able to help.
I asked an economist what can be done to stop the collapse of the economy. "Simple," he said, "stop the war."
But peace seems a long way off. Until it happens, it will be the NGOs, the UN, committed local authorities and the resilience of the South Sudanese people that will help to make the country work. We are building for the future...but we need both the leadership of the country and those outside the country to support our efforts and work to finding peace. In the meantime, we will continue to provide services as best we can.