By REUTERS

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More than half the people in this nation of 50 million are suffering from severe hunger. Hundreds are estimated to be dying from starvation and hunger-related disease each day.

But life-saving international aid – cooking oil, salt, grain, lentils and more – is unable to reach millions of people who desperately need it. Among them is Raous Fleg, a 39-year-old mother of nine. She lives in a sprawling displaced persons camp in Boram county, in the state of South Kordofan, sheltering from fighting sparked by the civil war between the Sudanese army and a paramilitary called the Rapid Support Forces.

Since Fleg arrived nine months ago, United Nations food aid has gotten through only once – back in May. Her family’s share ran out in 10 days, she said. The camp, home to an estimated 50,000 people, is in an area run by local rebels who hold about half the state. The Sudanese army won’t let most food aid cross the lines of control into the area, aid officials say.

So, every day after dawn, Fleg and other emaciated women from the camp make a two-hour trek to a forest to pick leaves off bushes. On a recent outing, several ate the leaves raw, to dull their hunger. Back at the camp, the women cooked the leaves, boiling them in a pot of water sprinkled with tamarind seeds to blunt the bitter taste.

For Fleg and the thousands of others in the camp, the barely edible mush is a daily staple. It isn’t enough. Some have starved to death, camp medics say. Fleg’s mother is one of them.

“I came here and found nothing to eat,” said Fleg. “There are days when I don’t know if I’m alive or dead.”

Raous Fleg sits outside a hut at a displaced persons camp she fled to in Boram County within the Nuba Mountains, South Kordofan, Sudan June 22, 2024. Reuters

The world has an elaborate global system to monitor and tackle hunger in vulnerable lands. It consists of United Nations agencies, non-governmental aid groups and Western donor countries led by the United States. They provide technical expertise to identify hunger zones and billions of dollars in funding each year to feed people.

Sudan is a stark example of what happens when the final, critical stage in that intricate system – the delivery of food to the starving – breaks down. And it exposes a shaky premise on which the system rests: that governments in famine-stricken countries will welcome the help.

Sometimes, in Sudan and elsewhere, governments and warring parties block crucial aid providers – including the UN’s main food-relief arm, the World Food Program (WFP) – from getting food to the starving. And these organizations are sometimes incapable or fearful of pushing back.

In August, the world’s leading hunger monitor reported that the war in Sudan and restrictions on aid delivery have caused famine in at least one location, in the state of North Darfur, and that other areas of the country were potentially experiencing famine. Earlier, the hunger watchdog, known as the Integrated Food Security Phase Classification (IPC), announced that nine million people – almost a fifth of Sudan’s population – are in a food emergency or worse, meaning immediate action is needed to save lives.

A truck carrying aid to areas in South Kordofan controlled by the rebel Sudan People's Liberation Movement-North (SPLM-N) group, stuck in the mud is seen in Boram County, Nuba Mountains, South Kordofan, Sudan June 19, 2024. Reuters

It was just the fourth time the IPC has issued a famine finding since it was set up 20 years ago. But despite this year’s dire warnings, the vast majority of Sudanese who desperately need food aid aren’t getting it. A major stumbling block: the main provider of aid, the United Nations relief agencies, won’t dispense aid in places without the approval of Sudan’s army-backed government, which the world body recognizes as sovereign.

Parts of Sudan have become a “humanitarian desert,” said Christos Christou, the president of Doctors Without Borders, which is active on the ground in Darfur. The UN is in “hibernation mode,” he said.

Rising death toll

People are dying in the meantime: A Reuters analysis of satellite imagery found that graveyards in Darfur are expanding fast as starvation and attendant diseases take hold. More than 100 people are perishing every day from starvation, the UK’s Africa minister, Ray Collins, told parliament this month.

Aid is being distributed far more widely in areas controlled by the army. But relief workers say the military doesn’t want food falling into the hands of enemy forces in areas it doesn’t control and is using starvation tactics against civilians to destabilize these areas. The army-backed government, now based in Port Sudan, has held up aid delivery by denying or delaying travel permits and clearances, making it tough to access areas controlled by an opposing faction.

In internal meeting minutes reviewed by Reuters, UN and NGO logistics coordinators have reported for four months in a row, from May to August, that Sudanese authorities are refusing to issue travel permits for aid convoys to places in South Kordofan and Darfur.

The UN’s reticence to confront Sudan’s government over the blocking of aid has effectively made it a hostage of the government, a dozen aid workers told Reuters.

“The UN has been very shy and not brave in calling out the deliberate obstruction of access happening in this country,” said Mathilde Vu, the Norwegian Refugee Council’s advocacy adviser for Sudan.

Four UN officials, speaking on condition of anonymity, said they fear that if they defy the military, aid workers and agencies could be expelled from Sudan. They point to 2009, when the now-deposed autocrat, Omar al-Bashir, kicked out 13 non-government aid groups after the International Criminal Court issued a warrant for his arrest on war-crimes charges.

A spokesperson for the UN’s emergency-response arm, the Office for the Coordination of Humanitarian Affairs (OCHA), said aid organizations “face serious challenges” in reaching people who need help in Sudan. These include the volatile security situation, roadblocks, looting and “various restrictions on the movement of humanitarian supplies and personnel imposed by the parties to the conflict,” said Eri Kaneko, the OCHA spokesperson.

The World Food Program said it has assisted 4.9 million people so far this year across Sudan. That amounts to just one in five of the 25 million people who are enduring severe hunger. The organization didn’t say how many times these people received aid, or how much each person got.

The army’s main foe, the RSF, is also using food as a weapon, Reuters reporting has shown. The two sides, formerly allies, went to war 17 months ago for control of the country. The RSF has looted aid hubs and blocked relief agencies from accessing areas at risk of famine, including displaced persons camps in Darfur and areas of South Kordofan. The group has also conducted an ethnic cleansing campaign against the Masalit people in Darfur, driving hundreds of thousands from their homes and creating the conditions for famine.

Breaking the impasse

Some at the UN are calling on Washington and its allies to do more to break the impasse. Among them is Justin Brady, the Sudan head of OCHA. He says the main donor countries – primarily the United States, the United Kingdom and European Union nations – need to engage directly with the Sudanese government on the ground in Port Sudan. After the army seized power in a 2021 coup, the U.S. cut off economic aid to Sudan. Western funding for food aid to the hungry is channeled mainly through the UN.

“It’s the donor governments that have the leverage,” Brady said. “We are left on our own” in dealing with the Sudanese authorities.

The Sudanese military and the RSF are to blame for the country’s food crisis, according to Tom Perriello, the U.S. special envoy to Sudan. “This famine was not created by a natural disaster or drought,” he told Reuters. “It was created by men – the same men who can choose to end this war and ensure unhindered access to every corner of Sudan.”

Sudan’s army-backed government and the RSF didn’t respond to questions for this story. The two warring parties have blamed each other for hold-ups in the delivery of aid. Army chief General Abdel Fattah al-Burhan and RSF leader Mohamed Hamdan Dagalo both said this week they were committed to facilitating the flow of aid.

Another impediment may come from inside the World Food Program itself. The WFP has been rocked by alleged corruption within its Sudan operation, which some humanitarian officials and diplomats worry may have affected aid flows. Reuters revealed in late August that the WFP is investigating two of its top officials in Sudan over allegations of fraud and concealing information from donors about the army’s role in blocking aid.

Orphans and children separated from their parents in Kadugli gather to eat boiled leaves at an IDP Camp within the Sudan People's Liberation Movement-North (SPLM-N) controlled area in Boram County, Nuba Mountains, South Kordofan, Sudan June 22, 2024. Reuters

The disarray in Sudan comes as the global famine-fighting system faces one of its greatest tests in years. The IPC estimates that 168 million people in 42 nations are enduring a food crisis or worse, meaning they live in areas where acute malnutrition ranges from 10% to more than 30% of the populace. Like Sudan, many of the worst hunger zones are also conflict zones – including Myanmar, Afghanistan, South Sudan, Haiti, Nigeria and Gaza. War makes it all the harder for the international community to intervene.

In Sudan, a Reuters team visited parts of South Kordofan in June and July that are run by the Sudan People's Liberation Movement-North (SPLM-N), a rebel group that has been fighting the army for years. The journalists traveled to towns and displaced persons’ camps, many of which haven’t received food aid for months. The group has significantly expanded the amount of territory it holds in South Kordofan since the start of the war.

Reuters also spoke to more than three dozen UN aid officials, diplomats and NGO workers, including in South Kordofan, and reviewed medical records of dozens of children diagnosed with severe malnutrition in the state.

A general view shows an IDP camp within the Sudan People's Liberation Movement-North (SPLM-N) controlled area in Reif Ashargi County, Nuba Mountains, South Kordofan, Sudan June 24, 2024. Reuters

Before the war, South Kordofan had some two million people. The need for outside help has intensified as some 700,000 displaced people have poured into camps and towns in SPLM-N areas since the war erupted.

Food stocks in the state were already low before the war. A poor harvest in 2023 was compounded by a locust plague that devoured crops. The war and the resulting refugee influx made things far worse.

In the communities Reuters visited, hunger and disease are everywhere. In one camp in the county of Um Durain, home to some 50,000 people, children have been dying of malnutrition and diarrhea for the past year, said community leader Abdel-Aziz Osman.

Nutrition workers at a treatment center in the camp are seeing 50 cases a month of children and mothers suffering malnutrition. Before the war, medics were treating five to 10 cases of malnutrition a month in the entire county.

In the camp in Boram, toddlers with bloated stomachs and rail-thin arms stood outside huts made of sticks, plastic and clothes – vulnerable to rain, snakes and scorpions.

Raous Fleg, the woman who makes the leafy mush, arrived in the camp from Kadugli, the capital of South Kordofan, in December with her mother and six of her children. She left three of her children behind with her husband, a soldier in the Sudanese army. They made the treacherous journey on foot over a pass in the Nuba Mountains, an area that’s home to a mix of ethnic groups.

Fleg is a member of the Nuba people, who form the main support base of the SPLM-N. Growing up in the Kadugli area, Fleg says, she endured repeated aerial bombardments by government forces.

In the early 2000s, when she was a teenager, fighter jets dropped barrel bombs on her home. Seven members of her family died, including her father and two siblings. She recalls being buried beneath the rubble and getting pulled out alive. Her mother also survived.

“The blood flowed like this,” she said, holding a plastic bottle filled with water and pouring it onto the ground.

Orphans and children separated from their parents in Kadugli gather to eat boiled leaves at an IDP Camp within the Sudan People's Liberation Movement-North (SPLM-N) controlled area in Boram County, Nuba Mountains, South Kordofan, Sudan June 22, 2024. Reuters

Thirteen years later, her in-laws and two more siblings were killed in another air strike by government forces. A third sibling died in hospital after losing two limbs in the attack. Again, she and her mother survived.

After they arrived in Boram county, Fleg’s mother felt weak. There was nothing to eat, so Fleg gave her some water with seeds to drink. But it gave her diarrhea. Doctors at a nearby clinic said her mother was suffering from dehydration and hunger, said Fleg.

On the evening of Jan. 5, Fleg felt her mother’s chest to check if she was still breathing. She wasn’t. After she’d survived years of air strikes, “hunger killed her,” said Fleg.

Access denied

UN organizations face high hurdles operating in South Kordofan. The UN’s Food and Agriculture Organization said it has no active operations in the SPLM-N areas.

UN aid officials say it’s tough to get food and medical aid into SPLM-N parts of the state. So far this year, some 135,000 people in these SPLM-N areas have received aid, according to WFP. The organization described these as “a three-month ration.” Overall, some 1.3 million people in the area are enduring severe hunger, according to the Food Security Monitoring Unit, an NGO operating in the region.

Jumaa Idriss, regional director of the SPLM-N’s humanitarian arm, called on the UN to break the army’s blockade. “The government is using food as a weapon of war,” Idriss said. “The UN agencies shouldn’t allow this to happen. People are starving.”

In the state capital Kadugli, where Fleg lived, there’s an added complication: having to deal with three warring parties. Each fighting force controls a different section of the main highway into the city. But access has been blocked largely by the RSF and its allied Arab militias, according to two senior UN officials.

As supplies in the city dwindled, the little food for sale – staples like oil and corn – became too expensive to buy, according to multiple residents who fled. Traders had to pay levies to bandits on the roads to get produce into Kadugli, further pushing up prices. Cash was scarce: There was no work, and the war destroyed Sudan’s banking system.

An internally displaced elderly woman from Kadugli shows roots she resorted to eating to survive at an IDP Camp within the Sudan People's Liberation Movement-North (SPLM-N) controlled area in Boram County, Nuba Mountains, South Kordofan, Sudan June 22, 2024. Reuters

Some Kadugli residents say the SPLM-N is also to blame for food shortages. Merchants trying to reach the city have had difficulty getting through roadblocks controlled by the SPLM-N. The group says it seized control of part of the road to protect the Nuba people from the army and the RSF.

A log of shipments by the WFP shows that the last time food aid was delivered to Kadugli was in October 2023. In June this year, the UN again tried to send a convoy to the city. But it had to turn back amid fighting.

“It was too dicey, and we would have lost equipment and maybe staff,” said Brady, the Sudan chief of UN emergency-response arm OCHA. “We withdrew the mission back to Port Sudan. It’s a very frustrating situation for us.”

Confronting the government over its food-aid blockages could carry risks.

Last year, army chief General Abdel Fattah al-Burhan declared Volker Perthes, the UN special envoy to Sudan, persona non grata in the country. Burhan accused Perthes of being biased, without citing evidence. Perthes later resigned his post.

Perthes told Reuters the Sudanese authorities were annoyed with him for referring to them as a “warring party” rather than as the legitimate government. When a diplomat is barred from entering a country or “one side says they don’t want to work with you,” it becomes difficult to do the job, Perthes said, explaining his reason for stepping down.

Challenging geopolitical backdrop 

UN officials “are afraid they will fall on the wrong side of the government and the situation will become worse than it already is,” said Chris Wulliman, who previously worked for the WFP in Sudan. “The government can come to their offices and say, ‘You guys are out, you have to leave.’”

Not all UN officials believe the government would retaliate now if confronted over food aid. According to one senior UN official in Port Sudan, the government relies heavily on aid to feed the millions of people in areas under its control and wouldn’t risk severing this lifeline by shutting down UN operations.

In Sudan, the limited aid reaching areas without government consent is being delivered mostly by non-governmental aid groups. While international relief groups may decide to cross national borders in a crisis without permission, the United Nations cannot do so. It needs the approval of governments to operate in a country or authorization from the UN Security Council.

A group of people rest at a displaced persons camp in Boram county controlled by the Sudan People's Liberation Movement-North (SPLM-N) rebel group, in South Kordofan, Sudan June 22, 2024. Reuters

The Security Council has passed two resolutions this year – in March and June – in which it called for “unhindered” humanitarian access across borders and lines of conflict in Sudan. Neither step has broken the aid logjam.

In August, the government made a limited concession, agreeing to let aid be brought into part of Darfur under RSF control for three months – via a border crossing from the Chadian town of Adre. By that time, the rainy season was already underway, hampering aid delivery as roads were swamped and bridges damaged by flooding. While over 100 trucks carrying aid have crossed from Adre, many are currently stuck in West Darfur, unable to reach their destinations, UN officials told Reuters.

The WFP said aid has reached 1.2 million people across all of Darfur so far this year, mostly to areas not under government control. The WFP didn’t specify how often these people received aid or how much they got. Seven million people in Darfur are facing severe hunger.

The Security Council resolutions that passed this year were ineffective, said two senior UN officials. What’s needed is a resolution that clearly authorizes the UN to deliver humanitarian relief without government consent, they said.

The dynamics within the Security Council – especially between archrival members Russia and the U.S. – haven’t helped. Since the outbreak of the Russia-Ukraine war, the council has struggled to find agreement on multiple geopolitical issues, said Perthes, the former UN Sudan envoy.

“Sudan is a victim of the lack of unity at the Security Council,” he said. If the council isn’t united, “then of course the UN on the ground becomes easy prey for those in the host country who don't want them.”

'I wish I died'

As hunger spreads in South Kordofan, mothers are having to make impossible choices.

Roda Tia had to decide which of her 14 children to take with her and which to leave behind when she fled Kadugli. For months, she said, the family had survived on a porridge made of tree leaves and flour. Her children obtained the flour by begging in a local market.

As the children grew weaker and the fighting flared, she resolved to leave. In June, she took three with her and left the rest behind, including two older children, aged 16 and 18. She doesn’t know what’s become of them.

“What do I do?” said Tia, explaining her decision. “It’s hunger.”

They crossed the Nuba Mountains on foot after leaving Kadugli. Exhausted from hunger, her 12-year-old son, Khalil, slipped and fell heavily on a rock. He got up and trudged on.

Roda Tia, 55, grieves after the death of her 12-year-old son Khalil at the paediatric ward of the Mother of Mercy Hospital in Gidel, near Kauda, within the Sudan People's Liberation Movement-North (SPLM-N) controlled area of the Nuba Mountains, South Kordofan, Sudan June 25, 2024. Reuters

After a couple of days they reached an area controlled by the SPLM-N. Tia took the boy to the nearest clinic. It was here the Reuters team first encountered the family. The facility had few staff and little medication. As with food aid, only limited medical supplies have been brought into SPLM-N areas of South Kordofan.

Khalil lay on a green plastic-covered mattress breathing heavily. The bed had no sheets or pillows. The clinic was unable to treat him. He was referred to the better-equipped Mother of Mercy Hospital some 100 kilometers away.

It took two days for Tia to find someone to drive them there. After their arrival, Reuters again crossed paths with Tia. Khalil had undergone surgery for the injury from the fall – a ruptured intestine, according to Thomas Catena, an American physician who has practiced in the area since 2008.

Khalil lay on a bed, his wide eyes staring blankly. Tia sat wiping his forehead. An IV tube had been inserted into his nose. Khalil had an infection and was running a high fever. He was malnourished and too weak to fight the infection, Dr Catena explained.

Around 3:45 pm on June 25, he died.

Tia stood in the hospital corridor clutching her sides, unable to enter the room where Khalil’s body lay. She’d fled Kadugli to save him from starvation. She wondered if it would have been better to stay in Kadugli, even if it meant the whole family perishing there.

She clapped her hands in anguish as she repeated over and over: “I wish I died with my child.”