Tens of thousands of people in South Sudan have died, and roughly one in three have been forced from their homes since renewed conflict broke out in December 2013. Our teams are constantly on the move to continue to provide displaced people with medical care. Our South Sudanese staff have also been displaced and have continued to care for patients while hiding from violence. We also provide much-needed medical and mental health care in Protection of Civilians camps, where hundreds of thousands of people remain trapped in a hostile and insalubrious environment.
Exposed to extreme violence and living in fear for their lives, hundreds of thousands of people in South Sudan are unable to access basic necessities such as food, water and healthcare.
We work in hospitals and clinics throughout the country, where we are running some of our biggest programmes worldwide.
Medical care is practically non-existent for people living in remote areas of South Sudan, even those spared from much of the violence associated with the war. We run hospitals and clinics and support existing state facilities, in particular with maternal, paediatric and neonatal care and outbreak response. We train community healthcare workers, run outreach and preventive activities such as vaccination campaigns, and treat diseases such as tuberculosis and kala azar (visceral leishmaniasis).
Malaria is one of the leading causes of sickness and death in South Sudan, especially among children. Hundreds of thousands of people are at risk of contracting malaria during the three-month malaria peak, which begins in the country’s rainy season and can overwhelm medical workers.
At their peak in 2017, malnutrition rates among our patients in Pibor were three times higher than the previous year. We carried out an emergency nutritional intervention here and in response to reports of alarming levels of malnutrition in Mayendit and Leer counties.
Like malaria, cholera is endemic in South Sudan. As well as vaccinating almost 200,000 people in the capital, Juba, in cooperation with the Ministry of Health, our teams responded to outbreaks in Lankien and Aburoc in 2017.
We provide basic and specialised healthcare for Sudanese refugees living in camps in Yida and Doro and for the surrounding communities, including mass vaccinations and treatment for malaria and malnutrition.
Finding reasons for hope in South Sudan
WHAT’S HAPPENING IN SOUTH SUDAN? HOW IS MSF MEETING URGENT MEDICAL NEEDS? HOW ARE WE MAKING A LONG-TERM IMPACT?
Splintered by conflict, South Sudan struggles to meet the essential needs of its people. For many, access to even basic healthcare, food and water is a struggle.
Will Harper, a former head of mission for MSF in South Sudan, talks about some reasons for optimism despite the tremendous humanitarian challenges.
Our activities in 2022 in South Sudan
Data and information from the International Activity Report 2022.
People in South Sudan continued to suffer the consequences of recurrent violence, poor access to healthcare, economic instability and a fourth consecutive year of disastrous flooding. More than two-thirds of the population remained in need of humanitarian assistance in 2022, and this figure is likely to increase as substantial cuts were made to international aid during the year.
In 2022, Doctors Without Borders (MSF) provided a range of healthcare services, including basic and specialist care, and sent mobile teams to assist displaced people and remote communities in two administrative areas and eight of the country’s 10 states. As well as responding to emergencies and disease outbreaks, we carried out preventive activities, such as vaccination campaigns and seasonal malaria chemoprevention. We also opened an inpatient department in a remote region of the Greater Pibor Administrative Area and started rehabilitating a hospital in Kajo Keji.
Around two-thirds of South Sudan was covered by floodwaters in 2022’s rainy season, affecting over a million people.2 For the past four years, the flooding has been unprecedented in its intensity, putting the country on the frontlines of the climate crisis. Tens of thousands of people live in displacement camps, where there is a lack of shelter, safe drinking water, healthcare and sanitation facilities.
With many communities marooned on ‘islands’, MSF ran mobile clinics to improve access to healthcare, and provided emergency referrals by boat. In some places, we also set up temporary structures to ensure continuity of care. In Bentiu, Unity state, we responded to an influx of patients with waterborne diseases by increasing our bed capacity from 135 to 175. In Maban, Upper Nile state, we distributed relief items, such as plastic sheeting, blankets, hygiene kits and cooking equipment, and installed water and sanitation facilities. At times, our teams had to travel on foot for several hours to deliver drugs to people displaced by flooding in Abyei Special Administrative Area.
Violence escalated in many areas in 2022. Our teams responded to conflict-related emergencies in seven locations, distributing relief items and running mobile clinics in the affected communities.
The conflict between armed groups in Upper Nile and Greater Fangak caused hundreds of casualties and displaced tens of thousands of people. Our hospitals in Old Fangak, Malakal town and the Malakal Protection of Civilians (POC) site – the last remaining POC in the country – received many wounded patients. Some arrived with serious infections, as it sometimes took them days to reach the hospital, due to insecurity and flooding.
In July, we launched a three-month emergency intervention and distributed relief items in Magwi county, Eastern Equatoria state, to assist communities with medical and water and sanitation needs, after conflict broke out in the region. We also started supporting medical services in five general healthcare facilities. In an emergency intervention in Tambura, Western Equatoria state, following the displacement of around 80,000 people due to violence, our teams provided general healthcare and vaccinations, along with maternal health and mental health support.
Our teams were not immune to the violence. A South Sudanese nurse from our Agok hospital was killed inside his home in February when intercommunal fighting broke out. Another MSF staff member was shot dead in Leer county. In Yei, an armed group robbed an MSF team on the road and set two of our vehicles on fire.
When violent clashes broke out in Agok in February and March, most residents fled to Abyei town or Twic county. We moved with them, to continue responding to their needs, supporting services in Ameth-Bek hospital in Abyei and providing medical assistance to displaced people in Twic county. In addition, we offered general healthcare, including mental health support, in Tambura county, Western Equatoria state, and supported five general health facilities in Leer county, Unity state, where we also distributed relief items to people affected by the violence.
In a world first, our teams carried out a mass vaccination campaign in the largest displacement camp in South Sudan in response to an active outbreak of hepatitis E; it is a virus that is particularly deadly among pregnant women, killing up to 25 per cent of infected pregnant women. In March, April and October, MSF and the Ministry of Health jointly carried out three rounds of vaccinations in the camp in Bentiu county. MSF hopes that this precedent will encourage uptake of the vaccine in other countries experiencing similar outbreaks.
Our teams also ran vaccination campaigns to respond to measles outbreaks in five states and Greater Pibor Administrative Area. In Maban, we distributed mosquito nets to households to protect them from malaria, after other organisations ceased malaria activities due to funding cuts.
Handovers in Mundri and Yei
In May, after more than five years of delivering lifesaving care to the people of Greater Mundri, Western Equatoria state, we handed over our activities to the Ministry of Health. We launched an emergency intervention in Mundri in 2016, in response to critical humanitarian and medical needs; however, as the project attained stability, we decided to focus on assisting communities in more neglected areas. Throughout the five years, we treated hundreds of thousands of patients, responded to local emergencies and trained medical staff – many of whom are now qualified healthcare workers.
We also handed over the inpatient department in Yei hospital to the Ministry of Health in 2022. We began supporting the department in September 2018, by donating drugs and equipment, training staff and assisting with maintenance of the facility. We have now expanded our outreach activities in Yei county, providing healthcare through three Ministry of Health facilities, and running mobile clinics and community-based health services.
After decades of conflict, severe shortages of health infrastructure and qualified medical professionals continue to pose major challenges to the development of a good healthcare system in this, the world’s youngest nation. MSF Academy for Healthcare aims to strengthen competencies of healthcare workers and improve the quality of care. In June, the first group of 35 nursing students in Old Fangak, Jonglei state, graduated after completing 18 months of nursing care training.