On Aug. 13, Kuwa Hassan’s mother carried him to the German Emergency Doctors Hospital in a rebel-held area of Sudan. Four years old, Kuwa was feverish – suffering from diarrhea – and he weighed less than 16 pounds. He was barely alive.
The clinicians treated him for severe malnutrition and nursed him back to life. They put his three siblings on a feeding program. But when the time came to release them, the mother said there was no food back home, only leaves or other wild greens.
"I think they are going to be staying with us for a while," said Raphael Veicht, who runs the organization’s hospital and three clinics in the war zone.
Last month, global leaders congratulated Sudan and South Sudan for signing agreements to demilitarize their disputed border and to restart oil production and exports.
But the deal didn’t address the most pressing crisis in either country: the ravaged war zones on Sudan’s side of the border, where old conflicts broke wide open last year after South Sudan became independent, spewing out 200,000 refugees and trapping hundreds of thousands more in a cycle of hunger and fear largely unseen by the rest of the world.
Now, with a covert American aid operation blocked by muddy roads and no progress on ways to bring help to the conflict zones, the humanitarian situation is worsening, medical workers reached by Skype and email say. The Sudanese government continues to block official humanitarian aid into the border areas controlled by a South Sudan-friendly rebel group, the Sudan People’s Liberation Movement-North.
Veicht oversees one of the two hospitals in the Nuba Mountains, where the rebel hold is the strongest. Dr. Tom Catena, a Roman Catholic missionary from upstate New York, runs the other.
In conversations before and after the Sept. 27 agreement, Veicht and Catena described rising malnutrition rates, reports of starvation, and a ravaged and displaced civilian population that lies out of the reach of their medical care.
The signs of hunger began growing in April, when Catena’s hospital admitted 11 malnourished children. That number has kept rising, and in September 35 children were admitted for malnutrition, 26 others were put on a feeding program and there were 32 malnourished adults.
Veicht reported that his hospital and clinics fed 133 malnourished children in September.
And that’s only a symptom of the problem, both men think. Most of the population of the rebel-held Nuba Mountains is beyond the reach of either hospital. Even for the roughly 100,000 civilians who are within a day’s walk of medical care, many are too weak to make the journey.
Veicht said that when he traveled to Kuwa’s village of al Azarak last month – about 25 miles away by walking paths – residents told him that children had been dying from "weakness."
"What I can say for sure is that people are really, really skinny up there, and they do look really wasted," said Veicht, who compared them to the famine victims he saw last August working in Mogadishu, Somalia.
The Nuba Mountains may not even be the worse of the two Sudan People’s Liberation Movement-North battlegrounds. Some 140,000 people have poured out of Sudan’s Blue Nile state, where the Sudanese government has been conducting a scorched-earth counterinsurgency campaign that includes torching villages and poisoning wells.
Some fear that the Sudan-South Sudan accords signed last month could make the humanitarian crisis even worse. With the demilitarized border agreement in place and oil revenues expected to bolster its depleted state coffers, Sudan appears primed for a heavy military offensive in the rebel areas. Hunger is expected to be among the weapons, as it is has been in the decades of the region’s brutal civil war.
A letter last month from Nuba representatives addressed to former South African President Thabo Mbeki, who’s been mediating peace talks between Sudan and South Sudan, said the 2005 peace deal hadn’t resolved the issues they faced. It warned that the Nuba people were facing "another vicious circle of never-ending wars and sufferings."
U.S. efforts to persuade Sudan to allow in international aid have failed so far, thanks in part to the icy relations between the countries, made worse by the attack last month on the U.S. Embassy in Khartoum, which prompted the Obama administration to withdraw its diplomats.
The U.S. is supporting a joint United Nations, African Union and Arab League plan – known as the tripartite proposal – to open humanitarian access, but Sudan is refusing to implement the deal.
With that plan stymied, the U.S. rolled out a clandestine plan to send thousands of tons of food from South Sudan by road, until rains made the sole dirt track north impassable in July.
U.S. officials haven’t publicly acknowledged the cross-border aid operation, but in an interview last month with Fox News’ Greta Van Susteren, the Nuba Mountains rebel leader, Abdelaziz al Hilu, credited the American food aid with saving lives.
“Thanks to the American people, to the American government, that they have channeled food somewhat, and they saved thousands and thousands of lives. But it was not enough. It was not enough. And the rainy season also stopped the whole operation, and the suffering has increased," he told Van Susteren during a visit to Washington with other leaders of the Sudan People’s Liberation Movement-North.
This fall’s harvesting season in the Nuba Mountains is expected to ease the food shortage, but only temporarily. Rains were poor, and the fact that thousands of people fled into the mountains as protection from government bombing raids means that many fields were never planted.
"The food situation overall looks fairly bleak for the next year," Catena said in an email. "We’re anticipating food shortages throughout the year and high prices for the small amount which will be available in the market, a repeat of last year."
U.S. special envoy Princeton Lyman said he’d keep pushing for aid to reach the rebel-held areas – some way, somehow.
"What we want is the tripartite agreement. Because that is the best way to get the most aid to the most people," Lyman said Sept. 27 in a phone interview from Ethiopia, after Sudan and South Sudan signed their deal. "The question for the international community is what do we do if that doesn’t happen?"
Asked whether the U.S. will continue sending food after the road from South Sudan reopens, Lyman demurred.
"This is part of what we have to discuss in New York,” he said, referring to the United Nations. “That is not the best and most effective way of doing this."