From Crisis, Hope

Written By Kevin Shane

A Design Research Story

The Birth of Man

The Sudan region in which South Sudan was born has a rich history owing largely to its near proximity to the Nile River Valley; man’s presence there dates back to the 8th millennium BC. The legendary Kingdom of Kush rose to prominence in the area now known as Sudan in the 1st millennium BC, and its empire stretched all the way to the Sinai Peninsula, rivaling that of the Pharaohs in Egypt. In fact, the Kush invaded Egypt in the 8th century BC, giving credence to its empire as a significant rival.

This warrior aristocracy remained largely intact and in power until the rise of Christianity and Islam in the region, which was owed largely to the migratory merchant populations throughout the Middle East. After numerous battles and invasion attempts by both sides, Egypt and Sudan drew up what were essentially peace treaties that governed relations between the two countries for nearly 700 years.

 
 

In The Furnace: Forging the Foundations

In the early 1800s AD, the Ottoman Empire was ruling Egypt and took a portion of northern Sudan as well. Seeking to incorporate this area into Egypt, the Ottomans made significant improvements to the infrastructure, especially with respect to irrigation and cotton production. These activities were largely focused in the northern part of the country though, leading to a disparity in quality of life between northern and southern Sudanese that would echo into modernity.

Corruption and mismanagement of the region led the Ottomans to reach out to the British for assistance. The latter of which began its occupation of Egypt and nearby areas in the 1880s AD. The Sudanese people led many uprisings. Wanting to control the Nile and to safeguard the Aswan dam, the British began to treat Sudan as a colony, fearing its instability would be exploited by other world powers.

 

Copyright 1897 by The Strobridge Lith Co, Cincinnati & New York.

 

In 1899, the British and Egyptians came to an agreement in which Sudan would be ruled by an Egyptian governor with British consent. In reality, Sudan became essentially a crown colony as the British were none too keen on Egypt succeeding in uniting countries around the Nile Valley under Egyptian control.

Beginning in the early 1920s AD, and lasting until independence in 1956, Britain had a policy of running Sudan as two separate territories: north and south. Issues between Egypt and Britain regarding the unification of Egypt and Sudan, and the continued British administration of Sudan led to ever-increasing tension, which reached a boiling point during the Egyptian revolution of 1952, an event that set in motion Sudan’s own march to independence.

 

Photo: Paul Banks/UN Photo

 

Independence!

As Sudan prepared to gain its independence from joint British and Egyptian rule in 1956, southern leaders accused the new authorities in Khartoum of backing out of promises to create a federal system, and of trying to impose an Islamic and Arabic identity. In 1955, southern army officers mutinied, sparking off a civil war between the south, led by the Anya Nya guerrilla movement, and the Sudanese government. The conflict only ended when the Addis Ababa peace agreement of 1972 accorded the south a measure of autonomy. But, in 1983, the south, led by the Sudan People’s Liberation Movement (SPLM) and its armed wing, the Sudan People’s Liberation Army (SPLA), again rose in rebellion when the Sudanese government cancelled the autonomy arrangements.

 

Photo: Goran Tomasevic/Reuters

 

At least 1.5 million people are thought to have lost their lives and more than four million were displaced in the ensuing 22 years of guerrilla warfare. Large numbers of South Sudanese fled the fighting, either to the north or to neighboring countries, where many still remain.

The conflict finally ended with the 2005 Comprehensive Peace Agreement, under which the south was granted regional autonomy along with guaranteed representation in a national power-sharing government. The agreement also provided for a referendum in the south on independence in 2011, in which 99% of southern Sudanese voted to split from Sudan. On July 9th, 2011 the Republic of South Sudan celebrates its birthday, and 5 days later it joined the United Nations as the world’s 193rd nation.

 

Photo: Goran Tomasevic/Reuters

 

From Prosperity to Calamity

Within three years of gaining its independence the country was at war and bankrupted, and much of this was due to the manner in which it was able to ensure its freedom.

Prior to independence, the Sudanese government in Khartoum was able to buy off southern Sudanese fighters to ensure it retained control over the country. Then president of southern Sudan (and current president of South Sudan) Salva Kiir countered this by bringing all the disparate militias throughout the region into his SPLA fold with promises of wealth. The group continued to grow and grow as more and more generals, militias, and disenfranchised youth sign on.

South Sudan came into existence amid great challenges. Secession from Sudan marked a major milestone and a fresh opportunity for South Sudanese. Oil income meant happy days for the government. But massive state-corroding corruption, political instability within the ruling party (the SPLM), and persistent tensions with Sudan over the sharing of oil revenues left South Sudan deeply vulnerable to renewed conflict.

 

Photo: AFP/Getty

 

At the time of independence, an untenable 98% of South Sudan’s revenue came from its oil exports. Even still, the oil reserves made the country extremely rich. But then came time for President Kiir to keep his promises to his SPLA legions: nearly 60% of the country’s budget went to the military and police, with officer’s salaries accounting for nearly one-third of it. Very little was left over for infrastructure, education, health, and other vital services.

Under a 2005 agreement with Sudan, the oil revenue was to be split but that ceased to be the case when South Sudan gained its independence: it simply kept all of the revenues and refused to pay for access to a pipeline the Khartoum government built. In 2012, tensions between Sudan and South Sudan hit a breaking point, which led the latter to take the unprecedented step of shutting off all oil production from January 2012 until April 2013. With the country running out of money, President Kiir fired most of his cabinet and a new era of cronyism began.

 

Photo: Goran Tomasevic/Reuters

 

Inter-ethnic conflict, particularly between the Nuer and Dinka tribal groups which pre-dated South Sudan gaining its independence, further added to the tension and confusion as the upstart nation sought to establish itself. Rebel groups with tribal bonds began aligning themselves with various government officials and groups. The SPLA, rebel forces loyal to certain politicians, tribal groups, and the Sudanese armed forces of northern Sudan all clashed, with alliances formed and broken with great fluidity, all seeking the same goal: to carve off as much of the world’s youngest country for themselves as possible.

 

Photo: Kieran Doherty/Oxfam

 

Tensions between factions loyal to President Salva Kiir, of the Dinka ethnic group, and those aligned with his former Vice President, Riek Machar, of the Nuer ethnic group, exploded into fighting on the streets of Juba, the capital city. The country, less than three years old, is gripped by a still ongoing civil war.

South Sudan’s dramatic return to war tore communities apart and has left an estimated 300,000 dead, over 400,000 refugees having fled to neighboring countries, and well over 1 million people internally displaced. For a country with an estimated population of 8 million, this is simply staggering. The impact on the country, and the toll it as taken in terms of lives destroyed, is akin to that of the Khmer Rouge and its reign of terror in Cambodia.

The conflict severely limited all aspects of life in South Sudan. Educational and employment opportunities have been scarce, infrastructure such as roads and sewerage are still all but nonexistent, and conflict is so rife and omnipresent that people are too scared to return to their homes. Making matters far, far worse is the resultant and widespread famine that has gripped the country for years.

 

Photo: Amey Bansod/Quicksand

 

Malnutrition

The UN estimates that nearly 3 million South Sudanese are facing “acute” food and nutrition insecurity. That’s more than one-third of the entire country. The persistent conflict throughout much of South Sudan, as well as the competing interests of the wealthy and connected, has only exacerbated an already catastrophic problem.

The factors underlying chronically high levels of acute malnutrition across the country continue to persist, and there is no end in sight. With nearly 40 percent of the national population in need of emergency food assistance, rates of acute malnutrition will continue to rise with children at the greatest risk followed by pregnant and lactating women. Meeting the needs of these children and women has already taken concerted and considerable effort by humanitarian and development actors, with an estimated 140 NGOs preventing wider suffering through their efforts.

Even still, simply moving about the country can be extremely challenging and hazardous. People lack the means to so much as survive, let alone avail medical facilities and treatment centers where such can be found. There is little to do but wait and hope while the rest of the world looks on and attempts to find some solutions for these persistent and deadly problems.

 

Photo: Kevin Shane/Quicksand

 

A Human-Centered, Design-Led Approach

Numerous NGOs and Humanitarian Aid organizations work to help alleviate the suffering of the people of South Sudan, particularly in the malnutrition crisis.

One such organization identified bringing treatment of severe acute malnutrition to the household level in order to increase the number of people receiving treatment and, by extension, decrease the number of lives being lost. As such they began developing a toolkit that would allow individuals, even those lacking literacy and numeracy, to accomplish this goal. The team was falling short of this, though, and looked to partner with an organization to help make this dream a reality.

While working with Quicksand, Kevin and a larger design team initially engaged with them to provide an introduction to design thinking processes and tools while also exploring innovation opportunities within its programs. Early on, this toolkit emerged as a key opportunity for innovation and collaborative exploration.

 

Photo: Kevin Shane/Quicksand

 

The initial step was to bring together the nutrition teams from various countries in Africa, along with representatives from their New York headquarters, and a team of design researchers from Quicksand for a week-long ideation workshop in Mali. There the challenges of bringing treatment for severe acute malnutrition to the household level were discussed and brainstormed around.

Though there is a need for the tools to be developed around this objective to be applicable in all contexts, it was decided that the sheer scale of the crisis in South Sudan provided the best opportunity for designing the toolkit.

 

Photo: Kevin Shane/Quicksand

 

With insights and learnings from the Mali workshop, the Quicksand team pivoted from the initial concept, worked to develop a toolkit of artefacts that, when used together, could not only identify and track severe acute malnutrition, but also aid in determining the daily dosage of ready-to-eat therapeutic food (RUTF) sachets for children, as well as to calculate a week’s supply of the same.

Several iterations of these artefacts were field tested in India with healthcare workers working in the malnutrition sector. A series of workshops were conducted to determine the best-in-class tools, with the healthcare workers interacting with each and providing real-time feedback. Following this, the artefacts determined to be the most effective and preferred were refined based on feedback and observations gleaned from this proxy testing, and ultimately taken to South Sudan for additional testing in a real-world context (i.e., with actual patients in healthcare centers).

 

Photo: Kevin Shane/Quicksand

 

The testing and refinement in South Sudan was done in collaboration between the organisation’s staff from both the New York headquarters and the country staff and community-based healthcare workers operating in the villages there. The same design research team that developed and tested the artefacts in India spent a month in-country, living with the field staff there, and engaging with mothers and children in several remote villages most affected by the famine and conflict on a daily basis.

The design team revised the artefacts whilst in South Sudan to best utilize the time in-country. This allowed for several iterations of the artefacts to be developed and tested, greatly accelerating the product development cycle. This was done through daily workshops with the healthcare workers to observe them using the artefacts with actual patients and by recording their feedback.

This then served as the basis for daily debriefs and ideation sessions with the larger project team to synthesize and act on the insights that emerged. Upon returning to India following the month in South Sudan, the Quicksand design team spent another few weeks refining the artefacts with the regular inputs from partner organisation’s staff in New York.

 

Photo: Amey Bansod/Quicksand

 

An Optimistic Future

Ultimately the project was a success. We were able to prove that, with the right system of tools, even individuals lacking literacy and numeracy have the capacity to identify and track instances of severe acute malnutrition. The implication is certainly cause for some level of hope: if monitoring and treatment can happen at the household level, many more children and mothers can be helped if not saved.

The unfortunate reality is that this is largely the proverbial drop in the bucket. We only treated but one small part of one symptom of a much, much larger disease. It makes one wonder what it will take for peace and stability to ever reach forgotten corners of our world like South Sudan, and how many more innocent people have to die in the meantime.

With the latest renewal of violence, it would be easy to assume the chaos will continue ad infinitum, to take a cynical, pessimistic view of the situation. However, those we met in South Sudan are some of the most gracious, positive, and welcoming people we’ve ever been fortunate to work with. Wandering through those villages, walking with children and shaking hands with adults was transformative, life-changing. Despite witnessing an unprecedented level of suffering in South Sudan, we’ve also never seen such optimism and hope. It’s easy then to believe that together we will overcome, that human spirit will always triumph irrespective of the challenges it faces.

 

Photo: Kevin Shane/Quicksand

 
 
 
 

This design fiction narrative was inspired by Kevin’s experience working on a research engagement seeking to develop innovative ways to empower local community members to provide monitoring and treatment for children suffering from severe acute malnutrition in conflict settings throughout Africa.. To learn more about this project, please visit this case study.

Kevin Shane
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