Malakal, South Sudan – One morning in mid-April, Nyandeng Meeth was fetching water from a borehole in Mat town, in South Sudan’s Jonglei State, before heading home to cook for her nine children and open her small street stall.

Suddenly, the sound of gunfire and shelling tore through the familiarity and routine of the 50-year-old mother’s everyday life. She remembers the town being plunged into chaos as people scrambled to save what they could – their families or a few belongings.

Afraid for her children, Meeth rushed home. “I [had] left the children at home when I went to fetch water,” she said. “I ran home, but when I returned, there was no one.” Along with the rest of the community, the nine siblings aged 7 to 15 had fled.

The attacks, reportedly by Sudan People’s Liberation Army-in-Opposition forces (SPLA-IO), were part of a broader escalation in fighting between government forces – the South Sudan People’s Defence Forces (SSPDF) – and opposition troops, including the White Army group aligned with First Vice President Riek Machar.

Since late February, violence has swept across Jonglei and Upper Nile states, displacing more than 130,000 people. Aerial bombardments and fighter raids have since emptied entire towns, disrupted aid and cut off vital trade routes from neighbouring Ethiopia.

The fighting is also prompting the country’s worst cholera outbreak in two decades, aid groups say, as patients fled medical centres where they were receiving treatment when the conflict broke out, spreading the disease in the process.

But for Meeth, recent events have revived the terror she felt nearly a decade ago, during an earlier phase of the conflict, when her husband was killed.

In 2013, just two years after South Sudan became an independent country, a civil war erupted between forces loyal to President Salva Kiir and those aligned with Machar. The war killed an estimated 400,000 people and displaced 2.5 million – more than a fifth of the population.

Meeth’s husband, who was a soldier, was killed in 2015.

Though a peace agreement was signed between the warring factions in 2018, disagreements over fulfilling the deal, including delayed elections, have kept the rivalry brewing.

Unresolved political disputes have driven cycles of violence over the years. But things escalated this year with clashes between government forces and opposition fighter groups, and the arrests of opposition leaders including Machar. The United Nations has warned that the country could be on the brink of a return to a full-scale civil war.

‘My life in Mat was better’

On that mid-April day in Mat town, more explosions rang out around Meeth, who had still not located her children. She ran towards the Sobat River, where panicked residents scrambled to flee across to neighbouring Upper Nile State.

In the crowd, she spotted her youngest daughter, 7, running alone towards the riverbank. She grabbed her hand, climbed into a canoe, and crossed, not knowing whether her eight other children had survived.

They landed in Panam, a town in Panyikang County in Upper Nile, about 2km (1.2 miles) from their home, where thousands of displaced families who have fled bouts of conflict from previous years are gathered, with little access to food, water, or medical care.

Meeth said she spent two anxious nights there, unable to eat or rest. “If your child is lost, you can’t be happy; even when I get food, I didn’t feel like eating it,” she said, sitting beneath a coconut tree that has now become her shelter.

Volunteers from the Panam community searched along the riverbanks and through the surrounding bushes for missing people. After two days, Meeth’s eight other children were found.

“Some of them hid in the river, while others stayed under the shades of trees,” Meeth said, explaining that her children could still hear gunfire from where they were, so they hid out of fear.

The ordeal had taken a toll on them. Their skin, she said, had gone pale from hunger and exposure, and their bodies were covered in mosquito bites.

Now, she and her children sleep under the coconut trees along the river, surviving on the roots of yellow water lilies and other wild plants, as fighting is still preventing aid access.

Before the latest wave of violence, Meeth supported her family in Mat by selling tea, sugar, and other household essentials from an informal stall. Sometimes, relatives returning from fishing would share their catch, helping feed the family when drought or floods ruined their harvest.

But the fighting has taken what little she had. “My life in Mat was better because I had shelter, I had a mosquito net and shoes, and access to a hospital,” she said. “I had two goats but had to leave them,” she added, saying relatives who fled Mat after she did told her the rebels had stolen her livestock.

‘Life is very difficult’

Even before the latest wave of fighting, daily life in South Sudan was marked by hardship.

The country ranks among the world’s poorest, and a recent World Bank report estimates that 92 percent of the population lives in poverty and nearly 7.7 million are facing crisis, emergency or catastrophic levels of hunger.

Not far from the Meeth family in Panam, 70-year-old Nyankhor Ayuel sat under the shade of another coconut tree with her seven children.

They fled from Khorfulus in Jonglei’s Pigi County in April.

“We were sitting at home with the children. We had already prepared food, and as we started eating, the shelling started,” she said. “We ran without any luggage or food.”

Though they escaped the immediate violence, Ayuel said hunger and illness now pose a different kind of threat. Pregnant and nursing mothers, she said, are suffering from diarrhoea and vomiting due to lack of access to clean water and food.

“Life is very difficult,” she told Al Jazeera. “There’s no food or medical facilities where we are staying.”

For families like Zechariah Monywut Chuol’s, who also fled Khorfulus, hardship has only deepened.

The 57-year-old father of 12 had just started building a permanent home for his family when the shelling began. “I was at home digging the foundation when it started. We ran to the riverbank and got into canoes,” he said.

Now, like so many others in Panam, Chuol and his family live under the trees, surviving on coconut water and whatever fruits they can find along the Sobat River.

“If hunger could kill like sickness, many people would have already died,” he said.

A fragile future

Across South Sudan, more than 9.3 million people – three-quarters of the population – require humanitarian assistance, according to the UN. Nearly half of them are children.

The conflicts in Upper Nile and Jonglei have brought all aid efforts to a ground halt. Aerial bombardment and danger forced aid agencies to withdraw staff, shut down cholera treatment centres, and stop aid deliveries.

This weekend, the “deliberate bombing of [a Doctors Without Borders] hospital in Old Fangak” in Jonglei killed several people, the medical charity known by its French initials, MSF, said.

Last month, the World Food Programme (WFP) paused operations in several areas due to access constraints.

Mary-Ellen McGroarty, South Sudan country director for WFP, said physical access can be challenging at the best of times. “But with active conflict, WFP cannot go up, we cannot go down the river. And these are areas where there are no roads, no cars, no trucks,” she told a UN press briefing at the time.

According to Peter Matai, director of the government-run Relief and Rehabilitation Commission, which works with international organisations to support the internally displaced, more than 30,000 people who fled violence in Pigi County are now sheltering in displacement sites such as Panam, where aid has yet to arrive.

“We’ve reported the situation to both the state government and international organisations,” said Matai. But several weeks into the fighting, “aid agencies are still waiting for clearance from the UN Office for the Coordination of Humanitarian Affairs to access displacement sites and deliver aid.”

With the violence ongoing and humanitarian access limited, thousands of displaced families remain in limbo, caught between conflict, disease and hunger – uncertain when, or if, it will be safe to return home.

For Meeth, who also serves as a deacon in the Episcopal Church of South Sudan, all she can do now is pray for her children’s safety, and hope that others will step in to help.

“We are suffering,” she said. “We need our people living abroad to hear that we are in a bad situation. They should help us provide for our needs.”

This piece was published in collaboration with Egab.