In addition to recurrent conflicts, the country continues to suffer from concurrent emergencies, including severe flooding, food insecurity and disease outbreaks. According to the United Nations*, two-thirds of people are in need of humanitarian assistance such as food, water and healthcare.
Our teams provide a range of services including general healthcare, mental healthcare and specialist hospital care. Our mobile teams also provide health assistance to displaced people and remote communities in eight of the country’s 10 states and in two administrative areas. In addition to responding to emergencies and disease outbreaks, we also carry out preventative activities, such as vaccination campaigns, seasonal malaria chemoprevention, safe drinking water and non-food items distribution.
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 adapting their response to ensure we can continue providing displaced people with medical and humanitarian assistance. We also provide much-needed medical and mental healthcare in the former and current Protection of Civilians camps, where hundreds of thousands of people remain trapped in a hostile and insalubrious environment.
Medical care is practically non-existent for people living in remote areas in South Sudan. MSF runs hospitals and clinics and supports existing government-run facilities, in particular with maternal, paediatric, neonatal and surgical care, and mental health support. Our teams also train community healthcare workers and run outreach and preventative activities, such as vaccination campaigns.
South Sudan experiences recurrent infectious disease outbreaks, including measles and cholera. Malaria is also endemic and is one of the leading causes of sickness and death especially among children. In collaboration with the Ministry of Health, we organise mass vaccination campaigns against these diseases. We also provide seasonal chemoprophylaxis for malaria – and for all diseases we provide care and treatment for patients.
South Sudan has a high burden of neglected diseases such as kala azar, sleeping sickness and snakebites. Our teams provide specialised care to people suffering from these diseases in our facilities. We also advocate for better access to treatment, since very few options are available in the country.
South Sudanese have experienced successive years of flooding caused by heavy rains. Hundreds of thousands have been forced to leave their homes and live in dire conditions with limited access to healthcare, drinking water and food. This recurrent situation has amplified the risk of outbreaks of infectious and water-borne diseases. We run mobile clinics in remote areas to improve access to healthcare and often provide emergency referrals by boat. We also distribute emergency items such as tents and water containers.
Providing clean drinking water, and correctly processing wastewater, protects people from waterborne diseases such as cholera. Our teams provide clean water and run a waste management system in all the health facilities where we work. We also assist with the provision of safe water and adequate sanitation conflict-hit regions and in areas where displaced communities live.
After decades of conflict and underinvestment, the severe shortages of health infrastructure and qualified medical professionals continue to pose major challenges to the development of a good healthcare system in the country. The MSF Academy for Healthcare is training locally hired South Sudanese healthcare workers in several states to strengthen competencies and improve the quality of care.
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, Médecins Sans Frontières (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*. 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.