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Stephen, 12, runs confidently around the sunny yard, sneaking between wheelchair patients while he plays with the other kids, his prosthetic leg barely making a dent.
When he was five years old, the car he was traveling with his family hit a landmine in Bentiu, in northern South Sudan. His grandmother was killed. Her left leg was broken and had to be amputated.
Stephen was airlifted to a physical rehabilitation center run by the International Committee of the Red Cross (ICRC) in Juba, which serves as both a prosthetic and a hospital factory and allows patients from all over countries to be equipped with new members.
"It helped me go to school," Stephen said timidly, pointing to his artificial leg.
After receiving his first prosthesis in 2013, the war prevented Stephen from receiving new devices every six months, as recommended.
Finished prosthetic limbs. By SIMON MAINA (AFP)
When he finally managed to get to the center this month, his prosthesis was far too short.
The five-year civil war in southern Sudan has probably left tens of thousands of people without members, a record that may never be accurately established.
According to the ICRC, about 60% of patients traveling to central Juba – one of only three in the country – suffer gunshot wounds and disabilities.
However, a large part of the country faces limited access to health care as a result of fighting or simply lack of infrastructure, as roads are generally totally impbadable during the rainy season.
Many limbs are amputated for no other reason than lack of treatment.
"A simple injury or fracture that could be easily treated in most countries (…) can lead to infections and amputations due to health care problems," said ICRC prosthesis specialist Régis Tiffeneau.
"The vast majority of patients are affected by the war in one way or another."
Others have become disabled because of polio, rickets – linked to malnutrition – or other diseases that have been eliminated in many other parts of the world.
The lack of access
In the factory, plaster is applied to models of legs that quiver on machines when workers fashion them, then cover them with dark brown plastic.
A technician checks if the finished feet are attached to the prosthetic legs. By SIMON MAINA (AFP)
Emmanuel Loubari, head of the workshop, said that the prosthesis could be made the same day a patient was measured and a cast made. Last year, the center manufactured 580 prostheses, the cost of all treatments being borne by the ICRC.
But many problems arise for patients who need adjustments.
"We have a lot of patients who are supposed to be equipped, but they can not access the center," Loubari said.
In South Sudan, the roads are so bad that the ICRC needs a fleet of planes and helicopters to transport patients to hospitals and physical rehabilitation centers.
During the rainy season, it can be difficult to land in many remote areas.
South Sudan. By (AFP)
Bringing people from across the country, injured in mostly ethnic fighting, is causing its own problems.
"They come here, they are traumatized, most of them are injured by gunfire and mines," said social worker James Soma. "We are talking to them about forgiveness."
He added that an argument had erupted the day before in which one patient accused another of targeting her because of her tribe, and said she would "bring one of my relatives and kill you all" .
Toddlers shot at mothers' backs
For those who have already used a prosthesis, like Stephen, it only takes two or three days before they can go home. But for new patients, it can take a few weeks.
Laytol, five, gives her new member a trial walk. Many amputee victims are children injured by mines or gunshots – often the limb is lost because the injury can not be treated in time. By SIMON MAINA (AFP)
Among the other patients at the center, there is currently a young man with severe scoliosis – a curved spine – who was taken to school in a wheelbarrow until he reached the end of his life. he is brought to get a personalized wheelchair.
Another was bitten by a snake and was not treated for nearly two weeks. He had to have his leg amputated.
"We have a lot of kids arriving," said Oketta physiotherapist Robert Kanyara. "We have five children in the center, slaughtered in different styles … We have children slaughtered while they were tied to their mother's back."
Laytol, five, was probably bitten by a snake. His mother is from the Murle people and doctors have trouble understanding the language. But they think her leg "could probably have been saved" if she had had help in time.
Laytol tests his new leg for the first time by balancing calmly between two metal bars.
Kanyara, the physiotherapist, said that the training of children required the use of games because they did not understand the idea of changing weight and had difficulty following the instructions.
But progress can be made. When the physiotherapist started working with Stephen, the boy who lost a leg in a mine in 2013, the challenges were many.
"It was very, very difficult," said Kanyara. "You tell him to put on weight, but he starts crying, so you have to go slowly."
Little Laytol took her new leg faster.
"She is very good," said Kanyara. "She is equipped today and she does not cry, she walks."
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