South Sudan was hit by multiple emergencies in 2020, including escalating violence, COVID-19, severe flooding and high levels of food insecurity. A total of 7.5 million people – around two-thirds of the population – were in need of humanitarian assistance.

Médecins Sans Frontières (MSF) responded to the urgent medical and humanitarian needs, while ensuring essential healthcare services continued in the 16 projects we run in the country.

Increased violence and fighting
There were repeated outbreaks of intense fighting, some lasting for months at a time, across South Sudan in 2020. Between January and October, more than 2,000 people were killed* – including a South Sudanese member of our staff – and tens of thousands of people were displaced.

In Jonglei state and the Greater Pibor Administrative Area, our teams in Pieri, Lankien and Pibor provided emergency medical care to people arriving in mass influxes of casualties, many with serious gunshot and stab wounds. The most critical patients from Pieri and Lankien were evacuated by plane to our hospital in the Protection of Civilians (PoC) site in Bentiu for surgery. Our teams also improved water and sanitation for the thousands of people who took refuge in an area next to the United Nations Mission in South Sudan (UNMISS), in Pibor town.

Brutal fighting forced our teams to suspend medical activities in Pieri for two days in May. In June, we suspended activities in Pibor after most of our staff sought safety in the remote bush area. When violence broke out again in August, we launched an emergency response. The project was closed in December, to enable the reorganisation of our medical activities in a more agile and efficient manner to respond to the community’s emergency health needs.

Widespread flooding
For the second consecutive year, severe flooding affected more than one million people across a wide swathe of South Sudan, submerging their homes and health facilities, and leaving them without adequate food, water or shelter.

Our teams in Pibor, Old Fangak and Leer responded to the massive needs, delivering emergency healthcare through mobile clinics, hospitals and clinics. In Upper Nile state, we set up an emergency clinic serving the towns of Canal and Khor Ulus ─ which can only be reached by boat from Malakal town ─ and carried out an emergency intervention in Ulang Sobat region.

In Greater Pibor, malnutrition was a major concern. We scaled up our nutritional support for young children, through mobile clinics and our inpatient therapeutic feeding centre in Pibor town. We also distributed 60,000 litres of drinking water per day where floodwater had contaminated wells.

Across these projects, our teams treated thousands of people, mostly for malaria, respiratory tract infections and acute watery diarrhoea. We also supported a mass measles vaccination campaign in Malakal town and PoC. In addition, we offered psychosocial assistance and distributed relief items, including plastic sheeting, mosquito nets and soap, to thousands of displaced families.

COVID-19 response
As the COVID-19 pandemic spread globally in early 2020, concerns that an outbreak would exacerbate an already dire humanitarian situation led MSF to integrate COVID-19 measures and new activities into all existing projects across the country, and start dedicated projects in Juba and Malakal teaching hospitals.

In Juba, we focused on strengthening infection prevention and control measures in health facilities, including the teaching hospital, and the national public health laboratory, the country’s primary testing facility. Our teams also trained healthcare workers, donated supplies, conducted health promotion activities and set up handwashing points in several public locations.

Refugees and internally displaced people
In July, UNMISS announced it would begin to hand over the five PoC sites in the country to the national government. In Bentiu and Malakal PoCs, where we manage hospitals, the process had not yet started. However, in Bentiu, patients and community members voiced concerns to our staff about their safety once the UN is no longer protecting the site.

In both PoCs, our teams continued to treat conditions caused mainly by the living conditions, including malaria, diarrhoeal disease, hepatitis E, cholera, typhoid fever, trachoma and skin infections, and call for improved water and sanitation.

In Yei county, following new waves of displacement, MSF outreach and mobile teams distributed relief items and offered general medical consultations, immunisations and psychosocial help. We also supported the paediatric ward of Yei state hospital and ran general healthcare services at our clinic in Jansuk.

At our clinic in Doro camp, and in the hospital in Bunj in Upper Nile state, we provided medical care to refugee and host communities, including vaccinations, treatment for malaria and malnutrition, care for victims of sexual and gender-based violence, and assistance with births.

Mother and child care
We offered paediatric and maternal healthcare throughout the year at Aweil state hospital, which serves around 1.3 million people. In October, we supported the health ministry’s response to a seasonal peak in malaria, with rapid diagnostic tests, medication and supervision at the hospital and in general healthcare centres.

Abyei Special Administrative Area
In Abyei, a disputed area between Sudan and South Sudan, our 180-bed hospital in Agok town continued to provide surgery, neonatal and paediatric care, and treat people for snakebites and diseases such as HIV, tuberculosis, malaria and diabetes.

Project closure
In July, we closed the projects we had been running for 14 years in Yambio county, Western Equatoria state. These projects focused on seasonal malaria chemoprevention for vulnerable children in rural areas, support for the regional hospital and an intervention assisting demobilised child soldiers.

*OCHA - South Sudan Humanitarian Needs Overview