Women who fled Mayendit rest in a shelter in Ganyiel. Famine was declared in Mayendit in February, meaning that at least 30 percent of the population was acutely malnourished. (Albert Gonzalez Farran/For The Washington Post)

When his stepbrother starved to death in January, Matthew Yaw buried him in the sand next to the family’s shack of sticks and plastic, one more grave at the epicenter of the world’s most severe hunger crisis.

It is a man-made disaster — born not of drought or floods but a vicious conflict that destroyed the livelihoods of farmers like Yaw and then prevented aid workers from entering their villages.

A U.N. declaration of famine in February was supposed to bring a surge of assistance to this northern county. But within days, the South Sudanese government ordered aid workers to leave ahead of a planned offensive, and the area was soon consumed with fighting.

Yaw and his neighbors have been reduced to eating waterlilies and an occasional fish from a nearby river. The few relief workers who managed to visit Mayendit county in recent days saw people languishing half-
naked. Their clothes had been burned in the last attack.

There are now four hunger crises across the Middle East and Africa in what is emerging as the greatest humanitarian disaster since World War II, according to the United Nations. In each place — Nigeria, Somalia, Yemen and South Sudan — aid workers are being blocked from reaching the needy, in some cases by insurgents, in others by soldiers
or bureaucratic restrictions. Twenty million people across the four countries could starve if they don’t quickly get help, according to the United Nations.

“When you get one month of food for three months, you go hungry,” said Yaw, 37, a tall man who leaned on a stick, his ankle shattered last year by a bullet as he fled the fighting.

Deliberate starvation?

Five years ago, the world celebrated South Sudan’s emergence as the world’s newest country, following a peace process with Sudan that was championed by Washington. But in 2013, a clash broke out between the nation’s president and vice president, soon becoming a broader ethnic conflict. As many as 50,000 people have been killed. More than 40 percent of South Sudan’s 12 million people are now classified as “food insecure.”

The warring parties — particularly government troops — have restricted humanitarian assistance in ways large and small. Some of their actions appear to be brute thuggery, like the theft by soldiers last summer of more than 4,000 tons of food from a warehouse in Juba, the capital, enough to feed 220,000 people for a month.

But aid workers fear the government is intentionally denying aid to regions where it says residents support the rebels. The U.S. deputy ambassador to the United Nations, Michelle Sisson, said last week that the government’s actions “may amount to deliberate starvation tactics.”

There are now more than 70 checkpoints on the 400-mile stretch of road between the capital and Bentiu, a major city north of Mayendit, with soldiers and other armed men demanding money or food before allowing aid trucks to continue.

At least 80 times a month, according to a U.N. tally, the South Sudanese authorities and rebels reject permits for planes to take off bearing emergency food or medical aid, or deny access to entire cities. Humanitarian groups were recently stunned to learn that the government was considering requiring a $10,000 license for every foreign aid worker in the country.

South Sudanese officials say that the government doesn’t have a policy of obstructing aid, but that the country’s dire economic situation has led to rogue soldiers making their own demands.

“Individual officers might stop a humanitarian convoy and harass humanitarian workers, but that doesn’t represent the view of the government,” said Hussein Mar, the minister of humanitarian affairs. “In a war situation, there are people who will take the law into their own hands.”

South Sudanese leaders on both sides of the conflict rarely acknowledge the impact of their restrictions on aid workers.

“It is extraordinary in a place where a famine has been declared for the first time in five years that we’re not hearing more from the leadership about the problems facing the people,” David Shearer, the top U.N. official in South Sudan, said in an interview.

Aid workers are often caught in the crossfire. In 2015, there were 31 attacks against relief workers in South Sudan, more than any other country in the world, according to the Aid Worker Security Database maintained by the research group Humanitarian Outcomes. The findings for 2016 have not yet been released. ­Seventy-nine aid workers have been killed since the war began, including six who were slain last Saturday in an ambush on the road from Juba to Pibor, in the east.

The greatest barrier

In Mayendit, one of two regions officially experiencing famine, the greatest barrier to reaching starving residents has been the near-constant fighting between government forces and rebels. In some cases, even after the United Nations airdropped food, soldiers ransacked villages and stole the provisions from civilians.

Nyakuma Tap, left, and her older sister Nyakuoth Kuol say an attack in October by armed men destroyed their home in the village of Dablual in Mayendit, South Sudan. (Albert Gonzalez Farran/For The Washington Post)

Last week, on a scorching afternoon, a small team of U.N. officials landed in Mayendit in a white helicopter, trying to figure out what they could do to improve their access to the hungry. It was a particularly tense moment. Eight aid workers from the North Carolina-based charity Samaritan’s Purse had recently been detained in the area for a day by rebels. There were rumors that government forces were planning another attack.

“They can’t behave like this and expect humanitarians to continue going in,” said Joyce Luma, the World Food Program (WFP) country director, who was on the trip.

The U.N. team disappeared into a small, run-down building with rebel leaders. They had become accustomed to this kind of negotiation — nearly every food drop, convoy and official visit requiring a litany of permits and diplomatic entreaties. A WFP team now keeps a satellite phone with dozens of numbers for rebel and government commanders at hand.

In some cases, relief workers have been able to persuade commanders to delay offensives while they deliver bags of food. But in many others, they have not.

In Juba, aid officials said privately that the government was restricting assistance to starve those it perceived as its enemies, including women and children in rebel-held regions like Mayendit. But the aid officials, fearing that their efforts will be further impeded, have been reluctant to speak publicly about such tactics.

“When the government carries out a counterinsurgency campaign, they end up treating civilians as the enemy,” said one senior relief official.

Descent into famine

Mayendit’s descent into famine took years, as spurts of violence ravaged the county, eroding the ability of local farmers and herders to provide for themselves.

Aid officials warned again and again that the county was falling apart. Without a political solution to the war, they said, they would be racing to keep people alive after each clash. That political solution never came.

Aid workers watched helplessly as the situation deteriorated. Employees of an Italian development organization, Intersos, described how students and teachers in its schools were forcibly recruited by armed groups on both sides of the conflict. Over time, as fighters destroyed crops and stole livestock, hunger began to stalk the region.

When the schoolchildren spotted aid airplanes flying overhead, preparing to drop bags of sorghum or maize, they ran out of the classroom singing “Babaje,” or “Father has come.” But there were long gaps between those drops — not just because of the fighting but because the United Nations has enough money to regularly feed only a fraction of the South Sudanese in need of aid.

“The children stopped coming to school because their parents told them to hunt for fruit,” said Herbert Mayemba, a health officer for Intersos.

Famine was declared in Mayendit and neighboring Leer county in February, meaning that at least 30 percent of the population was acutely malnourished, and that two adults or four children per 10,000 people were dying each day. The lack of food wasn’t the only problem — cholera had broken out because of the scarcity of clean water and poor sanitation. And people continued to die from the violence itself, particularly bullet wounds.

The only hospital in the region, located in Leer, was looted four times in two years, with medicine, equipment and fuel stolen. Doctors Without Borders, the global medical charity, closed the hospital last year and instead dispatched small, lesser-resourced health teams to Mayendit.

“We see Mayendit as a place badly in need of help, but it’s just too dangerous for us to work there,” said an official from one organization that had pulled its staff from the county. He spoke on the condition of anonymity because he was afraid to be seen as criticizing the government.

These days, even the most basic illnesses can’t be treated.

Nyarier Niey, right, and his son-in-law James Gawar, center, who fled Mayendit, are being hosted by Simon Gadiet, left, in Ganyiel. (Albert Gonzalez Farran/For The Washington Post)

In the village of Dablual, a 50-year-old woman named ­Nyatuai Dem said she had been suffering from diarrhea for over a week after subsisting on nothing but waterlilies. She hadn’t received any treatment for the illness, which can be fatal. Her family wrapped a piece of fabric around her stomach and pulled it tight as an attempted fix.

Thousands of other people have poured out of the county, walking for days to reach displacement camps like one in Ganyiel.

“We came here because we were tired of our food being stolen,” said James Gawar, 35. “Our children were sick. We needed a place where there was help.”

South Sudan has the world’s fastest-growing refu­gee crisis, with 1.6 million having fled the country and nearly 2 million more displaced internally.

About 80,000 people have decided to stay in Mayendit. For now, Matthew Yaw is one of them. He can’t walk without pain, and he’s not sure he would survive the journey from his home in Dablual to a displacement camp.

From his shack, he can see the farmland where he once grew maize. He pointed with his walking stick to the fields in the distance.

“We used to be able to cultivate for ourselves. We didn’t need any help,” he said. “Now we can just wait for the next donations.”

Ganyiel has become a destination for hundreds of people fleeing violence and famine in the counties of Mayendit and Leer, which are under the control of opposition troops. (Albert Gonzalez Farran/For The Washington Post)