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.

Floods

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

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.

Outbreak responses

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.

MSF Academy

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.