PIC: Ayak, 44, survived a suicide attempt but is one of a growing number of people trying to end their own lives in a huge camp for displaced people in South Sudan. (Credit: AFP)
HEALTH | CONFLICT
SOUTH SUDAN - By the time her 19-year-old son was shot in front of her, Ayak had already lost her four brothers and witnessed countless deaths in South Sudan's brutal war.
Living alone in a miserable structure of plastic sheets and tin in a huge camp for displaced people, watching as relentless rains turned earth to mud, it all became too much to bear for the 44 year-old.
"I have seen it all. When I thought about the lives of my relatives and their deaths, I decided to take my own life, too," Ayak says, falling silent as tears fill her eyes.
She survived her suicide attempt but is only one of a growing number of people trying to end their own lives in the camp.
Some 24,000 people are holed up at the site, located a short drive from Malakal - a once flourishing trading hub reduced to a ghost town by years of conflict.
In 2017, 31 people in the camp attempted to kill themselves - 15 women and 16 men - and six people died, according to the International Organisation for Migration (IOM). The previous year, four people died.
In December last year, South Sudan entered the fifth year of a civil war that has killed tens of thousands and displaced some four million people.
With no peace deal in sight, and yet another ceasefire recently crumbling within hours of its signing, many of Malakal's dispossessed have lost hope.
Their previous homes are just a few kilometres (miles) away in the nearby destroyed town.
In the camp - known as a "Protection of Civilians" or PoC site -- there is no privacy and most families sleep on thin mats on the floor, already dreading the rainy season, due to arrive in the weeks ahead.
Movement is confined to the camp, clustered around a UN base, as many still fear insecurity on the outside.
"People entered the PoC when they were children. Children are becoming adults here and are looking at the future and feel hopeless," says the Danish Refugee Council's country director Raphael Capony.
Hopelessness and PTSD
In a study, the US-based National Center for Biotechnology Information found that at least 40 percent of participants asked across South Sudan showed symptoms of post-traumatic stress.
"A lot of problems compound before a person tries to commit suicide.
"Living conditions, a lack of food variety and the difficulty of confinement can contribute to it.
"It's a big burden to not have hope for change," says Raimund Alber, a mental health worker for Doctors Without Borders (known by its French acronym, MSF).
Yet Ayak and dozens of other suicide survivors have given life a second chance. Today she's plugged into a widows' group and receives regular psychological support.
"Many people have the strength to deal with hardship, they have coped with a lot. We're noticing that strength and support it," said IOM psychologist Dmytro Nersisian, who works with Ayak at the camp's support centre.
Aid agencies are filling a gap left by South Sudan's dysfunctional and war-focused government, providing what little mental and psychological support is available in Malakal.
"We've especially seen an increase in suicide attempts since July 2017, which is when we started working on a prevention campaign," Nersisian says, adding that while causes and triggers for suicide vary, people of all ages have made attempts.
James, 32, is another survivor at the centre. When his house was attacked in 2014, he took refuge in the camp with his family where he has since lived in cramped, basic conditions.
"I thought about killing myself for two years. The situation got worse and I barely had any food. I decided it was enough," he tells AFP.
"My friend found me before I could do anything. We sat on the floor together and I started crying."
'You are not alone'
Having received counselling and support over the last year, James recently decided he wanted to help prevent suicide in his community and started out as a volunteer with IOM.
"I knew people here who killed themselves and I understand where they are coming from.
"I use my experience to talk to them. Dying is not a solution to your problems," James says, adding that he was surprised to find out that suicide was happening all over the world.
In the crowded camp, where people have set up small shops and are cooking sorghum in front of their tents, Ayak has found her place once again, but she says it's not easy.
She sits between a group of other widowed women, wearing a colourful beaded necklace and a black hat.
"I want to tell people to be patient. Life is difficult here, but don't think you are alone with your problems," she says.