Kanjak, South Sudan - Awae Koek's grandmother Abanga Kok would usually be in charge of the children today, but inside the house she is lying on the floor groaning in pain, her eyes barely open.

Weeks earlier doctors diagnosed Abanga with a stomach parasite normally seen off quickly by a healthy immune system. But Abanga is also suffering from acute malnutrition, leading the doctors to question if she's strong enough to survive the illness. Antibiotics would help, but her family can't afford to buy them.

Since her grandmother became ill, Awae, 14, stands against the earthen wall of the family home watching over her young siblings. Their father is at the market buying what little food they can afford.

He is now a single parent as their mother left some months ago, fleeing the family's village of Kanjak to Sudan without saying goodbye. Many people in the village have left "because of food insecurity", says Chout Kur Athian, the village chief.

"We have nothing to eat now," Awae says of her and her family. It is late afternoon, but the last time she ate solid food was yesterday. Earlier she foraged some leaves from nearby trees and used them to make a thin soup.

Abang Akok lies on the floor of her family home as one of her daughters brushes flies from her [Henry Wilkins/Al Jazeera] 

Kanjak is situated in Northern Bahr el Ghazal, a region of South Sudan close to the border with its neighbour Sudan. It has recently entered "phase 4", an "emergency" on the Integrated Phase Classification (IPC) scale, used by governments and humanitarian organisations to measure the severity of food shortages.

For some, phase 4 means gaps of days between meals. More than 20 percent of the population also suffer from acute malnutrition, while the death rate among the most vulnerable - the old and the young - increases significantly. The next phase on the scale is full-blown famine.

Northern Bahr el Ghazal is a region of South Sudan that is usually self-sufficient in food, but because of an economic collapse in parts of the country and two years of poor rains, it is unable to provide for itself this year.

The day after Al Jazeera first met Awae's grandmother her condition had not improved. One of Abanga's daughters arrived at the house and was sitting beside her on the dusty floor, brushing flies from her mother's face.

"She is unable to pass urine or stool," says her daughter, who believes her liver is failing.

When Abang arrives at the hospital she is carried in by a man from the village and her daughter [Henry Wilkins/Al Jazeera]

The family had been relatively prosperous after they moved from Khartoum in Sudan to Kanjak. They owned cows given as a marriage dowry, but have since been forced to sell them.  

Northern Bahr el Ghazal is especially vulnerable to economic problems as many families, such as Abanga's, are former refugees who have returned to the area after 2005's peace agreement with Sudan.

Many were urban dwellers in Sudan and since returning do not have access to agricultural lands nor the skills to manage them. This means they are reliant on buying food from the market where prices have risen sharply, while family's livelihoods have rapidly declined.

The UN's World Food Programme (WFP) food distribution was happening in the village that day, but Abanga's family had not received any of the sorghum being handed out.

The UN relies on village chiefs to assist in identifying those most in need of food, but an argument had broken out between two chiefs as to whose responsibility Abanga and her family fell under.

They were eventually given enough sorghum to last a few days, but this represents just one of the problems the UN face when distributing aid in complicated circumstances.

Many of the villagers of Kanjak are already starving [Henry Wilkins/Al Jazeera]

George Fominyen, from the WFP, says action needs to be taken quickly if the situation in Northern Bahr el Ghazal is to improve. 

"There are only a few weeks before rains make the roads leading to these places impassable. After that, we are stuck with what [food] we have, which isn't enough."

The WFP in South Sudan currently has a shortfall of $106m in its food distribution budget.

The government is in an inadequate position to help. Since civil war ended a year ago, South Sudan's peace process has stalled as rebel leader Riek Machar remained in exile in the country's northern states.

In early May he returned to Juba and was reinstated as vice president, sparking hope that a new government unifying the previously warring Dinka and Neur tribes would bring a new momentum towards solving some of the country's numerous problems. This has yet to materialise.

South Sudan's economy is largely dependent on oil exports and has been so badly affected by plummeting oil prices internationally that in January reports suggested the country was actually losing money on every barrel it produces.

In December, the South Sudanese pound was devalued by 84 percent, which has led to sharp increases in the prices of staple foods as the country depends largely on imports.

Poor rains last year, as well as this year's El Nino felt across Africa, have also taken a toll.

As a result there has been an exodus of people from the villages in Northern Bahr el Ghazal to Sudan where prospects for families to feed themselves are said to be better. According to the WFP, 38,000 have left the region surrounding Kanjak - known as Aweil East - since February, about 7.6 percent of the population.

A family from Kanjak stand by the grave of a family member who died from not having enough to eat [Henry Wilkins/Al Jazeera]

In the past the UN has provided residents with sheets of corrugated steel, used as an alternative to the traditional thatched roofing.

"When people decide to leave [the village] they roll up the sheets and sell them for a few pounds," explains Chout. Many of the houses lie empty with gaping holes where the roof once was.

Some even have mounds of sand piled outside, the graves of their former inhabitants. Malnutrition is the primary cause of death, Chout says.

One such house, stripped of its roof and windows, belonged to Mhial Awach, whose wife left with his four children shortly before he died in December. He used to cut timber for a living and tried to cultivate ground nuts and sorghum, but the crop failed and he started losing weight.

Awach died after complaining of constipation and stomach pains. The other villagers said they were unable to offer support as they had no food themselves.

Despite the fact Abanga and her family had been given food from the distribution, the WFP decided the best course of action was to take her to a nearby hospital. A local man and Abanga's daughter lifted her into the back of a WFP 4x4. She pleaded with them to stop.

The vehicle traversed the potholed route to the hospital while her cries of pain followed the uneven contours of the road. By the time she arrived at the hospital she was exhausted and lay almost lifeless with her daughter perched on the end of the bed.

As for Abanga, she has now been discharged from hospital, but her condition has not improved. Like South Sudan's economy and Northern Bahr el Ghazal's most vulnerable, her fate hangs in the balance.

Abang Akok was taken to hospital in the back of a WFP vehicle [Henry Wilkins/Al Jazeera]

Source: Al Jazeera