In the skies over Sudan

Wounded persons are brought from the bush to the plane by any means possible.

Though the light of dawn is still faint, Loki airport is abuzz with activity. Engines of cargo planes - mighty Antonov, Hercules and Illuyshian aircraft - roar into life and, one-by-one, take off northwards towards the vast territory that is South Sudan.

Our aircraft sits humbly to the side, a dignified-looking Hawker Sidley 748, one of the last to roll off the production line back in 1976. Today the plane is equipped to seat some thirty people with enough space leftover for a sizeable cargo of fuel drums, boxes of various pharmaceuticals and pipes for water projects.

Our mission today, on a mid-March morning, is a Medevac (medical evacuation) operation to bring discharged patients from the nearby ICRC Lopiding surgical hospital and orthopaedic centre home to their towns and villages in some of the remotest corners of South Sudan. Once there, we will pick up more patients in need of urgent medical attention.

In recent times, during the height of the conflict, many of the patients flown into Lopiding were war-wounded; today, with peace on the horizon, most cases concern people wounded in tribal clashes or those suffering from complicated pregnancies, snakebites and various life-threatening illnesses.

Medevac operations began at the start of this tragic conflict waged in South Sudan for over twenty years, claiming the lives of some two million people. Millions more are displaced all over Sudan (some two million in and around Khartoum alone) and across the borders in neighbouring countries.

My travelling companion, Eunace, a youthful-looking and very experienced Kenyan nurse is in charge of the operation today. She makes sure that everyone is accounted for and safely on board, that any minor illnesses can be quickly dealt with and, importantly, that nobody gets off at the wrong airstrip!

The passengers range from the newborn to elderly women and there is a hum of anticipation as the Hawker Sidley kicks into life. All is checked and rechecked and after Eunace gives the thumbs up, we roar and shake into the red-streaked sky heading northwest towards our first stop, Maridi, in the province of Western Equatoria.

As we cross over the border into South Sudan the beautiful Didinga Hills quickly flatten out into a vast emptiness creased with thick veins of acacia bushes running across the valley floor. After one hundred minutes we touch down in Maridi, a small settlement lying north across the border from the Democratic Republic of the Congo.

With the peace process in Sudan, fewer patients are undergoing war surgery in Lockichokio hospital, northern Kenya.

A number of people carefully climb down from the plane and a cheer goes up from the throng of waiting well-wishers and relatives. A man in his thirties, writhing in agony with a badly broken leg, is stretchered aboard. Eunace sees to it that he is properly strapped in and administers some pain killers to ease his journey ahead. Soon we are in the air again, Maridi disappearing below as we continue northwest to Tambura, a village near to the southeast corner of the Central African Republic.

Reaching Tambura we again make a quick stop replacing the healthy with the infirm. A young man named John Paul cycles up on a bicycle to greet us.

John Paul tells me that Tambura is in the grip of sleeping sickness, a painful disease carried by the tsetse fly which, if left untreated, will result in certain death. MSF (Médecins sans frontières) Spain are present and doing their best to combat the disease, he says, but the treatment for sleeping sickness is very complicated and he feels the odds are stacked against them.

We are then bound for Chelkou, a very remote spot in the northwest of South Sudan (not far from southern Darfur) and a location where the ICRC has been supporting a primary health care post for many years.

Bouncing down onto the dusty airstrip we rattle to a stop and are immediately surrounded by the local community. We are greeted by Mariano Nor, a bright-eyed young man who is in charge of running the health post.

After their recovery, patients will be flown back to their villages.

We set off on foot to visit the clinic which, Mariano tells me, serves thirty-nine villages and around ten thousand people. After about twenty minutes, we arrive at a well-kept and busy facility. The staff and patients gather to greet us and are very eager to provide a tour of the health centre.

Daniel Nok, the resident doctor, resplendent in a bright blue uniform, invites me into his consultation room (a traditional straw-roofed tukul hut with a concrete floor) where he is treating a young girl with a nasty-looking snakebite. Daniel says they have managed to treat the girl in good time and that neither her leg nor life is in danger.

Across the compound, there is a pharmacy, more consultation rooms, a registrar and reception, a meeting room and a hand-pump installed by the ICRC for the local community. The clinic seems to be the centre of Chelkou's village life with all sorts of people sitting around and talking. Young barefoot boys, smeared in ash to ward of mosquitoes, are particularly enthralled with our visit and jostle each other from a safe distance to get the best view.

Two hours later we are strapped back into our Hawker Sidley and, as the plane shudders into the sky our new passengers smile weakly, looking forward no doubt to starting back on the road to full health.

Down below, an arid and parched landscape opens up as we swing southward. The land is pockmarked with thorny acacia and long, snake-like trenches of dried-out riverbeds provide a constant reminder of the daily struggle for water in this part of the world.

We pass through the villages of Thiet and Mapel, dropping off former patients and picking up new cases for urgent treatment back in Loki. In each place, boxes of medicines are left in the care of the local health clinic representative.

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Lokichokio, on the border between northern Kenya and South Sudan, has long been known in humanitarian circles as a major centre of activity and launch pad for large-scale relief operations into southern Sudan. Today, one of the many positive consequences since the signing of the Comprehensive Peace Agreement between the Khartoum government and their long-time adversary, the Sudan People's Liberation Army/Movement in January 2005, has been a refocusing of aid agencies' activities from war to peace and a gradual move out of Lokichokio across the border into the territory of South Sudan. As the people of South Sudan look to reaping the dividends of peace, Lokichokio, or Loki as it is affectionately known, still remains an important logistical hub.

In Mapel, a semi-conscious snakebite victim is lifted aboard and a choking, rancid odour from the rotting flesh fills the cabin of our plane. Later in the evening, in a life-saving operation, the girl will have her decomposing leg amputated at the Lopiding hospital. She will also be fitted with a customized orthopaedic limb produced at the hospital's workshop.

We next land in the town of Yirol where the aircraft is refuelled.

Flying over the river Nile I realize we are on the way south towards our final destination. Below, the shimmering aluminium roofs sparkle skyward from the town of Juba, a major urban centre in South Sudan. Beyond Juba, the moss-green flood plains of the Nile stretch into the distance until again the landscape changes to acacia and bramble and rocks.

After safely touching down in Loki ninety minutes later our pilot says we have covered two thousand kilometres during our twelve hour day. ICRC ambulances, marshalled by Eunace, wait on the asphalt of Loki runway to transport the patients to Lopiding hospital on the outskirts of town.

They will be well cared for by a dedicated team of surgeons and nurses who have been tending to the ill and injured from the conflict in South Sudan since ICRC first established the hospital back in July 1987. Since that time more than eighty thousand people have passed through the doors of Lopiding, delivered and returned home by the ICRC Medevac.

It remains a critical service in such an enormous region, where access to healthcare, especially surgical care, is a distant aspiration for many.