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What It's Like to Build a Hospital in a Warzone

An engineer in war-torn South Sudan explains what its like to build medical infrastructure in a place so violent that the UN can't send in its own ground workers.

by Andy Jones
May 8 2018, 2:33pm

An ambulance in South Sudan. Photo by Alessandro Rota / Getty

South Sudan is the world’s newest country—formed in 2011 after breaking away from Sudan—but also one of its most chaotic. Torn apart by civil war, it is currently so dangerous that UN ground workers cannot be sent in. Engineer and British Army lieutenant colonel Katie Hislop, 41, has been leading nearly 400 troops as the commander of Operation Trenton, a UN-backed mission to build a hospital in the middle of a war zone.

Even in an era of humanitarian disasters being played out on global news, South Sudan still feels like a secret, hidden horror. Political violence exploded in December 2013 between those loyal to the Nuer and Dinka tribes, resulting in thousands being killed and more than four million fleeing their homes. At the height of the conflict, 400 men and women were killed in the town of Bentiu—where Hislop’s troops are now based—with bodies littering the streets up to a week later. They will also build a protected camp to house displaced civilians in Malakal, some 300 miles away from the capital Juba.

On top of that, South Sudan has no police force, infrastructure, or banks, which means civilians live on the edge of their nerves every day. “People from the camps go in to buy and sell goods or go to markets, then come nightfall they all flee back to the protected camps.” Hislop says. “The violence isn’t just from warring factions, but also roving criminal activity as well, people robbing and mugging through desperation. There are no banks which means people have to spend money as soon as they have it or risk having it stolen. Malakal is a town as big as Fleet or Guildford [in England] and it’s sat on the banks of the Nile—it should be a place with nice bars and restaurants and vibrancy, yet that has been stripped out and destroyed from years of conflict.”


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Hislop is also the first female commander of a UN mission in the country, at a time when Amnesty International has drawn attention to an epidemic of sexual violence and mutilations at the hands of government forces, often using sticks and knives.

Understandably, this means the sight of male militia of any kind strikes fear into local women, giving Hislop an increased position of trust.“I always see myself as an officer first, rather than a female officer," she says. "But being female can be a huge help on humanitarian missions like this, seeing a woman in charge can be very helpful at ground level. Local women may be more likely to talk to or trust a women in uniform than a man.”

Even then, building anything is tough. There are no usable roads and no building materials available in South Sudan—not a scaffolding pole or a bag of cement—and so every piece of the jigsaw is flown in from other nations. Throw in a four-month long rainy season that fills every trench the moment its dug, and assembling anything becomes like building a house of cards in a storm.

Engineer and British Army lieutenant colonel Katie Hislop with UN troops. Photo courtesy of subject

“It affects everything about how you would normally build,” Hislop says. “All the living accommodation for locals here is just a mish-mash of homemade shelters on mud and soil, propped together with corrugated iron or wood or metal, anything people could get their hands on [and] then with a tarpaulin roof—that is about it. There are no materials here on the ground. You have to use less cement for the foundations and plan everything so far ahead.”

Hislop’s career as an engineer has taken her through working to rebuild Kosovo after its 1999 conflict to managing a 120 strong team in Iraq building protection structures for troops. She previously organized the many heart-rending repatriation ceremonies at Brize Norton, where fallen troops are returned home to UK soil when killed abroad. “You owe it to those families to make sure it all goes correctly, all the rehearsals, every element,” she says. “You can’t fix the situation, but it’s about making it as dignified and as bearable for those families as possible.”

Hislop is spinning two jobs. Her day job is Commanding Officer of 500-plus staff at 32 Engineer Regiment in Catterick, UK, alongside this six-month deployment as the Commander of Operation Trenton, the British contribution to the United Nations Mission in South Sudan (UNMISS).

Reflecting on the six months she spent away from her husband and two daughters—aged eight and ten—Hislop says, “I missed them terribly,” she says, a note of emotion breaking through the precise military dialect. “But it helps me recognize other soldiers are missing their children as well, that brings you all closer together regardless of what else is going on.”

Even though the UN is providing a multinational task force of assembled armies, before they let in aid workers and ground staff, outbreaks of violence are still common in South Sudan. “You are in a very fragile environment and history says incidents can happen without warning,” Hislop says. “A whole generation of young people have known nothing but violence and fear all their lives. Mental health is therefore a big issue and within that unfortunately is desperation and sadly some very serious criminal activity. There is fighting and robbery on a routine basis, both in the protected camps and in the towns.”

Hislop says her troops have spent any spare time from their work teaching young South Sudanese skills like woodwork, martial arts, and photography, something which has broken through the harsh day to day squalor of the camp. She says, “Many people here have degrees and skills and are determined to make the most of what opportunity they had been given. But equally, people are desperate, there are still Rwandan and Mongolian [UN peacekeeping] forces there to stop the fighting and robberies that can happen on a daily basis.”

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