An American’s View from a Foxhole in Sudan

highcountryhealth.com - by C. Louis “pj” Perrinjaquet, MD - June 12, 2014

As may become clear if you continue reading… I’m a doctor not a writer.  But, just as I was compelled to volunteer the past 6 weeks in the Nuba Mts. of Sudan, I am compelled to write and tell the story of what is happening there. 

Since May 2011 when the government on Sudan in Khartoum launched a campaign “to exterminate the Nuba people like bugs”, the civilian population has been subjected to daily aerial bombardment and has been denied access to humanitarian aid.  Unable to plant crops people are starving to death or surviving on bugs and grass, risking death to venture outside their caves in search of food and water.

The one hospital in the entire Nuba Mts, Mother of Mercy in Gidel, staffed by one fulltime physician, Dr. Tom Catena,  have been spared bombardment… until last month.

The following is taken directly from my journal written when the events were fresh.

May 2, 2014 - Yesterday morning I had just been told, “Land Cruiser needs fixed again.  No trip to the outreach clinic today”… I was walking to the outpatient department to help out there when I heard a jet.   I was unafraid and looked up curious how close it would come.  Within seconds it was on top of us, people screaming, running, I remembered Dr. Tom’s instructions – “Don’t run! Just get down!”  I dove to the ground and covered my head as a loud explosion came from the South, the area of TB / Leprosy village.  – wind, sand, dust -  I looked up.  People running in every direction, no longer screaming – or I just couldn’t hear yet - I saw the pharmacist run with purpose so I started in her direction.  She tripped over a wire fence she didn’t see and tumbled into an overfull foxhole.  I turned and saw the director of emergency response also moving with purpose, that seemed like the person to follow -  I sprinted behind her a couple 100 yards through the gate to the doctors compound and into an empty foxhole ~ 6 x 6 ft square, 3 ft deep.  We waited … not long & again LOUD jet, fast, close, lay flat, cover head, seconds, moments later even louder explosion, very near, but just behind compound.  Wait, Wait, Wait ~ 10 minutes. Out & back.  That’s it.  Jet is done. Time to go to hospital to help with casualties.  I could see Dr. Tom enter children’s ward from the North… NOT OVER! No time, Jet upon us, flat in nearest fox hole body to body in a line, women & children, one mass of quivering humanity.  Moments later another explosion, again close enough to shake the ground, but missed the hospital.  No one moves, children are quieted, our collective hearts pounding, my head on the scarf of the woman behind me, my left elbow under the head of the woman in front of me, a custom fit puzzle of necessity.  We knew the jet would be circling back.  A few rapid breaths and an eternity later, here it comes, VERY close, closer & louder than before.  I would die in an instant if we were struck… or survive.  There was nothing more to do.  I accepted that reality and felt a great calm.   The noise was deafening… then just as quickly faded.  We had survived.

The rest of yesterday was spent inspecting the damage and cleaning up.  The second missile struck 30 yards behind our small cinder block doctors quarters.  The ground was a thick mat of shredded leaves blow off the now bare branches of nearby trees, the back fence destroyed, a 6 foot across 1 foot deep crater, metal shards of shrapnel had the force to sheer 8 inch limbs off trees.  Incredibly, the only loss of life was one goat when the same jet attacked the next village.  Not a single significant physical human injury.  Psychologically however everyone to some degree or another is shaken.  The rest of the day was quiet.  Most patients left the hospital.  Unless paralyzed or in traction, they were out in the rocks and caves.  The roof in our quarters is damaged.  Dr. Tom’s room had a back door that was blown off it’s hinges and inside looked, well, “like a bomb had gone off“.

Over a warm Russian beer, over dinner, walking to and from the hospital, everyone was telling and retelling their own experience, cheering, encouraging each other that it would not happen again…  until today, 10am during rounds on Men’s ward we heard the low distant rumble of an Antonov high altitude bomber.  Tom said, “Too far away to worry right now.”  Then, quickly, when we could perceive and comprehend, no in fact it’s getting closer. “Move everyone out!” then, “No time! Just lie down!!!” 

Flat on my belly, eyes clenched shut, hands clasped behind my head, ears covered by my upper arms -  BOOM BOOM! Ground shook, dust flew, VERY loud.  Half minute later, get up and run outside, debris still falling from across dry riverbed a half mile away.  I joined mostly old men and one nurse Anna who was crying and wanting to go home to her baby – we got her into a foxhole knowing the plane would be circling back before she could make it home – I helped lower a patient into the foxhole who was on crutches already having lost a leg when an Antonov bombed his village.  We kept our heads low to the ground.  BOOM BOOM!   The return pass again missed by ½ mile.  We waited ~ it circled back 2 more passes – 4 more bombs – 8 total.  Only one casualty.  A man who sought shelter inside a hollow Baobab tree was struck in the foot by shrapnel that had penetrated the 6 inch outer trunk of the tree. 

The second day, back to back, did leave psychological casualties.  “Is this a pattern?” “Will they return every morning?” “ Will they come at night?”  There’s enough work to focus on that these thoughts don’t stick, but they do come back.  I am surprisingly calm.  I am not proud or ashamed of that because I didn’t do anything to be calm.  I just am for now.   Right now actually I’m just very sleepy – even that is all luck.  I will enjoy a sound night’s sleep and see what tomorrow brings.

The world has a mandate to intervene.

I don’t think of myself as a brave man.  I do feel bold in writing this story and hope those reading it will have the courage to tell others: call their government representatives, sign a petition or at least talk about going on in Sudan with a friend over coffee. 

I first heard of the Nuba Mts. in 2007 from a Nuba physician working with me at a refugee camp in Darfur in the west of Sudan.  The government of Sudan continues to arm Arab militia, Janjaweed, which means “Men with weapons riding on animals”.  Somewhere in the order of a million black African farmers have been displaced to massive refugee camps and still live in fear of attack and famine. The International Criminal Court (ICC) website states that the President of Sudan, Omar al-Bashir, has been indicted by the ICC on 10 counts:

• five counts of crimes against humanity: murder, extermination, forcible transfer, torture and rape.
• two counts of war crimes: intentionally directing attacks against a civilian population as such or against individual civilians not taking part in hostilities and pillaging.
• three counts of genocide: by killing, by causing serious bodily or mental harm and by deliberately inflicting on each target group conditions of life calculated to bring about the group’s physical destruction.

Framing this situation in a positive way, humankind has an amazing opportunity in this one small place to learn how to end war.  The Nuba Mountains are roughly the size of Iowa.   We, the 6 billion people on Earth who are living on more than a dollar a day, can do this!

We must figure out a way to protect innocent people who just want the same things we all want… the freedom to pursue happiness.   If the Khartoum government would stop aerial bombardments the Nuba would return to their subsistence living and begin to develop their many resources and quickly be a self-sufficient partner in the world.

The Nuba are by nature a joyful people.  I have been fortunate enough to observe a rich culture of Nuba singing and dancing at every occasion.  I also witnessed the heroic stoicism of patients smiling up from hospital beds despite missing limbs, lying for weeks in traction, having lost family members and all their positions.  Their spirit is strong and will eventually overcome the suffering that is being brought to them by an unjust government. 

Restoring peace to this area will not be easy.  The Nuba Mts. of Sudan is just north of the new boundary between South Sudan and Sudan where oil fuels both economies.   It lies between the world’s largest desert and the world’s largest swamp where rock outcroppings and slightly higher ground allow a sparse population to subsist on goats and sorghum.  Most of the population live in stone and grass huts.   Even before the current conflict, women’s death rate during childbirth and infant mortality rates were among the highest in the world.  Malaria, leprosy and exotic diseases developed countries have eradicated decades ago are as common as the common cold.  

There are still some small parts of the world that need big changes.  It is so fulfilling to participate in that change. That joy is what will bring me back to the Nuba Mts. 

Again, I’m a doctor not a world leader.  Not many of us are community organizers, political activists or consider ourselves as having the power to change the outcome of situations as complex and generally awful as the Nuba Mts. 

If we do nothing, we can be sure we are not helping.  Actually we will be hurting by our complacency.  If we do at least try, then there’s a chance that good will grow.

Below is a link to a 4 min. video produced by local Nuba journalists.  Click the small red box to the left of the title when the website opens.  
http://nubareports.org/sudan-targets-only-hospital-in-nuba-mountains/

C. Louis “pj” Perrinjaquet, MD, MPH is President of High Country Health Care and practices family medicine in Breckenridge, Colorado.  He is also Medical Director of Doctors to the World, (not to be confused with Doctors ofthe World) search Facebook: Louis Perrinjaquet for more information) or contact directly at ***@***.***

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http://www.highcountryhealth.com/2014/06/one-summit-county-doctors-view-foxhole-sudan/