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.
Why are we here?
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 2021 in South Sudan
Data and information from the International Activity Report 2021.
During 2021, South Sudan was hit by several concurrent emergencies, including severe flooding, violence, food insecurity and disease outbreaks. By the end of the year, 8.9 million people* – more than two-thirds of the population – were estimated to be in need of humanitarian assistance.
Médecins Sans Frontières (MSF) continued to respond to urgent medical and humanitarian needs, while maintaining essential healthcare services across six states and two administrative areas.
Third consecutive year of severe flooding
Some 835,000 people across vast areas of the country were affected by the floods, with Jonglei and Unity States the hardest hit. People’s homes and livelihoods (their crops and cattle), as well as health facilities, schools and markets, were submerged by floodwaters.
Bentiu, the capital of Unity state, was one of the worst affected areas. Thousands of people fleeing floodwaters arrived in the already overcrowded Bentiu displacement camp (formerly a Protection of Civilians [PoC] site**), while others set up makeshift camps in Bentiu and Rubkona towns. Meanwhile, in the villages of Haat, Pakur and Pakuem in western Ayod county, Jonglei State, thousands were displaced and marooned on precarious ‘islands’ when floodwater levels rose.
Our teams in Bentiu, Leer and Mayom in Unity state, and Ayod and Fangak in Jonglei state, responded to the immense needs, delivering emergency healthcare through mobile clinics, hospitals and health centres. Across these projects, we treated tens of thousands of people, mostly for malaria, malnutrition, respiratory tract infections and acute watery diarrhoea. In addition, we distributed relief items, including plastic sheeting, mosquito nets and soap, to displaced families.
Violence and fighting
Subnational conflicts and factional fighting continued in many parts of the country in 2021. In Tambura in Western Equatoria state, tens of thousands of people were displaced by fighting in the second half of the year, and there were reports of hundreds of casualties. In response, we sent emergency teams to the area to provide a range of medical and humanitarian assistance. This included water, sanitation and hygiene support in Duma, Nagero, Tambura and nearby camps; training and donations of drugs and medical materials to basic healthcare facilities in Duma and Ezo county; and help with the rehabilitation of the outpatient, inpatient and maternity departments in two clinics in Tambura. In addition, our mobile clinics offered basic healthcare and screening for malnutrition in displacement camps in Source Yubu. We established mental health services, conducted health promotion activities and supported routine vaccinations for children and the referral of critically ill patients.
In Riang, Jonglei state, an MSF emergency team was sent to assist remote communities struggling to access clean water and basic healthcare, following years of protracted violence and flooding. We set up mobile clinics, which tested and treated hundreds of children for malaria, and distributed relief items.
In June, we opened a new project in the east of the Greater Pibor Administrative Area, a vast region near the border with Ethiopia in which there have been sporadic outbreaks of fighting between various ethnic groups in recent years. MSF teams constructed a new basic healthcare centre in Maruwa to serve local communities and the semi-nomadic people living scattered across the area, who have very limited access to medical services. We also rehabilitated Boma hospital’s paediatric ward.
Refugees and displaced people
In March, management of Bentiu displacement camp was handed over to the national government, while Malakal – the last remaining PoC site – remained under the management of the UN Mission in South Sudan (UNMISS).
In the hospitals we run in these sites, our teams continued to treat illnesses and preventable diseases caused by the dire living conditions, for example, an outbreak of hepatitis E in Bentiu in July. Despite our repeated warnings of the health risks associated with poor hygiene and sanitation, services only started to improve marginally at the end of 2021.
Following a 50 per cent reduction in food rations and increasing food insecurity due to the floods, severe acute malnutrition levels rose well above emergency thresholds. At our hospital in Bentiu camp, we opened a third inpatient therapeutic feeding centre to address an 80 per cent increase in admissions.
In response to new waves of displacements in September in Yei county, we sent mobile teams to distribute relief items and provide basic healthcare, vaccinations and psychosocial support. In June and July, we also ran mobile clinics in Yei town to respond to a malaria peak. Meanwhile, we continued to support Yei hospital’s paediatric ward, three health centres in Logo, Yaribe and Ombasi, and offer basic healthcare through our clinic in Jansuk.
In September, we handed over our clinic in Doro refugee camp in Upper Nile state to the NGO Relief International, and shifted our focus to assisting people in hard-to-reach areas in Maban county, by running mobile clinics and supporting health centres. We also maintained our support to Bunj hospital’s outpatient department, which serves both refugees and host communities.
Innovative malaria treatment
MSF has been implementing seasonal malaria chemoprevention (SMC) programmes in South Sudan since 2019, aiming to reduce the high numbers of deaths from the disease. In 2021, we launched an SMC programme in Aweil, where we already support paediatric and maternal healthcare at the state hospital. By the end of the year, our teams had reached tens of thousands of children.
Abyei Special Administrative Area
In Abyei, a disputed area between Sudan and South Sudan, we run a 180-bed hospital in Agok town, providing surgery, neonatal and paediatric care, maternity services and treatment for snakebites and diseases such as HIV, tuberculosis, malaria and diabetes.
**PoC site – a Protection of Civilians site is a United-Nations protected camp for displaced people, first set up during the civil war when people fled to UN bases.