Access to healthcare remains a significant challenge for people in South Sudan, as two-thirds of the country’s health facilities are non-functional. Despite the strong presence of humanitarian organisations, the reduction in funding has had a marked impact on the provision of medical care. During the year, a surge in conflict in neighbouring Sudan, and recurrent disease outbreaks across many areas of the country, aggravated existing issues, such as displacement, food insecurity and a lack of basic healthcare, including vaccinations.

In 2023, our response in South Sudan continued to be one of the largest we run anywhere in the world. We delivered a broad range of basic and specialised health services to remote communities, refugees and people displaced by violence, through both fixed and mobile clinics, as well as through community-based programmes. In addition to responding to emergencies and disease outbreaks, our teams carried out preventive activities, including vaccination campaigns and awareness-raising sessions on physical and mental health. Working in seven of the 10 states and in two administrative areas, our teams provided health services to well over one million people across South Sudan.

Assisting people affected by conflict
After conflict broke out in Sudan in 2023, over 600,000 people fled into South Sudan,* 80 per cent of them South Sudanese returnees and the remainder refugees seeking safety. Our teams set up mobile clinics around transit centres for people returning home and for refugees in Renk, a town on the Sudanese border. In Upper Nile state, we helped returnees at the Bulukat transit centre by operating a medical facility offering general check-ups, vaccinations, social support, and protection programmes. We also transferred patients needing hospital care to our facilities in Malakal. Additionally, we assisted people in Wedweil by operating a mobile health clinic and providing daily water trucking. These transit centres remain active in receiving new arrivals.

In Renk, the busiest entry point, we established a measles isolation unit and a therapeutic feeding ward at the county hospital for children with severe acute malnutrition. In addition, our teams conducted vaccination campaigns and distributed mosquito nets in response to the alarming increase in malaria cases.

During the year, our teams also responded to violence-related emergencies arising from conflicts within South Sudan, which forced thousands of people to flee their homes. In Melut, we offered general healthcare for displaced families and referrals for patients needing specialist care, and worked to improve sanitation and hygiene facilities. In August, our South Sudan Emergency Response Unit launched an intervention for returnees in Paloich to address high levels of severe acute malnutrition and an outbreak of measles. We also conducted general healthcare consultations and distributed relief supplies such as mosquito nets, bars of soap and jerry cans to families. In Kodok, we focused on addressing the mental health needs of people traumatised by conflict and violence. In Yei, an area affected by ongoing conflict, we significantly expanded our outreach activities through integrated community case management and mobile clinics.

In February 2023, MSF opened a newly rehabilitated hospital in collaboration with the Ministry of Health in Kajo Keji. This project addresses the needs of people who fled to Uganda during the war in South Sudan, which also resulted in the destruction of the hospital buildings, and who are now returning.

Responding to disease outbreaks
Repeated waves of displacement exacerbated the spread of measles and other diseases in 2023. In Bentiu hospital, we increased the bed capacity from 10 to 25 for the treatment of severe measles cases, and supported the Ministry of Health in conducting a mass-vaccination campaign against measles for displaced people during an outbreak. In Lankien, our teams also supported with treatment and vaccinations.

During a cholera outbreak in Malakal, we saw an increasing number of patients with non-bloody diarrhoea at the Protection of Civilians camp. Our teams increased the bed capacity of the health facility and conducted health promotion activities in the community.

In September, the health ministry declared a hepatitis E outbreak in Fangak county. In response, we launched a vaccination campaign – the first to ever be conducted in South Sudan during the initial stages of an active outbreak in such a remote location – targeting women and girls of childbearing age, the group most vulnerable to the disease.

Malnutrition
The primary causes of malnutrition are poor food security, inadequate access to clean water and sanitation, and substandard healthcare. Unfortunately, these are all present in South Sudan, along with other contributing factors, such as disease outbreaks, conflict and displacement. At the end of 2023, the country was grappling with a malnutrition crisis affecting approximately seven million people, a number expected to rise in 2024.

In an effort to tackle this crisis, we set up paediatric nutrition wards in all our health facilities across the country, where our teams offer inpatient care and run intensive feeding programmes for severely ill children.

Sexual and gender-based violence
Our health facilities provide comprehensive care focusing on victims and survivors of sexual and gender-based violence. As lack of access to care for victims and survivors seeking care after sexual violence remains a key challenge in the areas in which we operate, our teams have been working with community-based care models to address some of the access challenges, while advocating with all relevant organisations to scale up their response.

MSF Academy
We have faced recruitment hurdles due to years of conflict and underinvestment in healthcare in South Sudan, resulting in a shortage of qualified health professionals and medical infrastructure.
To combat this, we set up the Academy for Healthcare programme to improve healthcare quality. In 2023, 171 students graduated from Lankien, Malakal, and Old Fangak after an 18-month training course. We also began training sessions for staff in Ulang.
 

* https://reliefweb.int/map/sudan/sudan-situation-regional-displacement-update-25-mar-2024