In Juba, the capital of South Sudan, the pandemic was merely the most recent form of grave danger.
A sense of crisis has prevailed since a paroxysm of violence four years ago in a long-running civil war fueled by ethnic division. Amid the fighting, people fled the surrounding countryside for refuge in camps inside the city. Without access to their fields, many became dependent on food distributed by relief agencies along with anything they could buy at the market.
South Sudan was already one of the world’s poorest countries, with 80 percent of its roughly 11 million people living in a state of absolute poverty, surviving on less than $2 a day, according to the World Bank. The reinvigorated conflict posed an economic shock. As the government printed currency to pay its bills, runaway inflation resulted, dropping teachers’ salaries from the equivalent of $100 a month to $1.
Food prices soared. Most items were trucked in from neighboring Kenya and Uganda and priced in dollars, making them more expensive as the nation’s currency plunged. A 50 kilogram (110 pound) bag of corn flour that fetched $20 four years ago was more than $30 by late last year.
Poverty and hunger proved mutually reinforcing. As mosquito nets increased in price, that enhanced the risks of a lethal strain of malaria, which itself reduced appetites and worsened malnutrition among children.
Last year, heavy rains that fell in too short a time created torrential flooding that decimated crops and killed cattle.
By the beginning of 2020, roughly six million people in South Sudan were technically food insecure, meaning they could not reliably count on satisfying their dietary requirements.
“Nutrition is a lot more than food,” said Mads Oyen, chief of field operations for UNICEF in South Sudan, speaking by videoconference from Juba. “You’ve got malaria and measles and a lack of nutrients and other health issues. It’s about the lack of clean water, which means cholera.”
This was all before the arrival of the worst pandemic in a century.
As the virus sowed chaos in transportation networks across East Africa, the price of staple foods sold in Juba leaped another 25 percent. At the same time, a lockdown imposed by the government derailed local businesses like food stalls, decimating incomes.
These were the forces that brought Mary Pica to a primary health care center in Juba in early May. It was run by the international relief organization World Vision. She carried her then-10-month-old son. He weighed only 5.4 kilograms (11.9 pounds), well below healthy.
Ms. Pica lived with her husband’s family in a household of nine people. Her husband had worked loading baggage onto buses. That job was a casualty of the fighting, as bus service largely shut down.
Her mother-in-law grew greens on a small plot of land outside Juba, using the proceeds to buy other items that balanced their diet — yogurt, fruit, fish and eggs. With the market closed, she could not earn cash. The family was subsisting almost entirely on greens. Ms. Pica, who had become pregnant again, was no longer breastfeeding her baby. He was wasting away.
The clinic provided her with a peanut-based paste donated by UNICEF. Every two weeks, she goes back to to pick up another supply. The baby has been gaining weight.
But Ms. Pica sees dangers everywhere. Her sister-in-law’s child, a 2-year-old boy, has malaria. The pandemic is unrelenting.
“I’m worried,” she said, speaking in Arabic by phone from Juba. “I have no hope that the situation will change tomorrow. I can only pray to God that it changes.”