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. 

*United Nations

**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.