Why are we there?
- Armed conflict
- Endemic/epidemic disease
- Health care exclusion
South Sudan: Latest MSF Updates
- South Sudan: Fighting in Wau Displaces Thousands
- South Sudan: Report Details UN's Failures in Protecting Civilians in Malakal
- MSF Internal Review of the February 2016 Attack on the Malakal Protection of Civilians Site and the Post-Event Situation
- The Patients Who Climb Trees: Treating Pediatric Injuries
- South Sudan: Protecting Children from Preventable Diseases
- South Sudan: Treating Children Suffering from Malnutrition in Aweil
- Snakebite: A Neglected Public Health Emergency
Doctors Without Borders/Médecins Sans Frontières (MSF) has worked in the region that today constitutes the Republic of South Sudan since 1983. Today, we employ more than 3,000 South Sudanese staff and 330 international staff to respond to a wide range of medical emergencies and provide free and high quality health care to people in need in 17 project locations across seven of South Sudan's 10 states and the Abyei Special Administrative Area.
MSF is particularly concerned about the precarious health situation inside UN Protection of Civilians (PoC) camps in Bentiu and Malakal, where tens of thousands of new residents have arrived in recent months. In both the PoCs, humanitarian resources are under strain and MSF teams are treating spikes in disease, including malaria, diarrhea, respiratory tract infections, and malnutrition.
2015 activities by the numbers
(January 1–February 29, 2016)
- 110,822 outpatient consultations, of which 44,727 were for children under five years old
- 31,901 patients treated for malaria
- 6,729 patients provided hospital care, of which 2,768 were children under five years old
- 2,148 surgical operations and 622 war-wounded treated
- 1,628 babies delivered
MSF Operations in Response to the Medical Needs in South Sudan
MSF condemns the outrageous violence in the Malakal Protection of Civilians (PoC) site on February 17 and 18, which claimed the lives of 19 people, including two MSF staff. The violence left humanitarian facilities destroyed and thousands of civilian shelters burned to the ground. The population of 47,000 who were sheltering in the camp at the time of the attack had already suffered through two years of conflict and displacement and were living in inhumane and overcrowded conditions. With large sections of the camp now destroyed, protection of civilians and a sustained humanitarian effort is required to provide basic life-saving services to the affected population. MSF strongly condemns the attack, which is yet another instance of brutality in a conflict marked by utter lack of respect for the lives and dignity of civilians. At the same time, MSF calls on all armed actors to respect the provision of medical assistance to vulnerable populations in the wake of the unacceptable looting and ransacking of its medical center in Pibor. Thousands of residents fled to the bush to escape the violence with no access to assistance. In this moment of immense medical need, MSF has launched an urgent response, but its capacity to respond to medical needs in Pibor, Lekuangole, and Gumuruk has been severely diminished as a result of this unacceptable looting.
MSF Condemns Outrageous Attack in UN Protection Site in Malakal
Two MSF staff were among 19 people killed during brazen and unacceptable violence in the PoC site in Malakal on February 17 and 18. At least one of the two MSF staff died while attempting to assist the wounded. In total, MSF treated 108 people injured in the fighting, 46 of whom suffered from gunshot wounds. MSF has received further reports that other people who tried to put out fires or help the wounded were targeted and shot. Large sections of the camp were destroyed, including medical and humanitarian services, as well as thousands of civilian shelters. MSF had warned previously that living conditions in the camp had already been overcrowded and jeopardized the health of the population due to poor hygiene, sanitation, and access to water. This was of particular concern as the 47,000 people seeking protection in the camp were already extremely vulnerable, having endured two years of displacement, conflict, violence against civilians, and destruction of their properties and livelihoods. Now, the population confronts yet another, far more severe humanitarian crisis.
In the wake of the destruction in the PoC, thousands of people are living in dire conditions, in sections of the camp not designed for human habitation and without adequate access to hygiene, sanitation, or shelter. The MSF hospital provides the bulk of the secondary health care available to the population. Teams are already seeing increased numbers of patients admitted for respiratory tract infections and diarrhea, illnesses which are associated with poor living conditions. A further 5,000 displaced people are now living in Malakal town, where MSF has begun to provide mobile clinics to provide basic primary health care to the population. Protection of the population, which continues to fear for its security, must be assured and the humanitarian response in the immediate aftermath of this tragedy must be sustained to improve the conditions of the population and prevent outbreaks of disease.
MSF Launches Urgent Medical Response in Pibor
After being forced to evacuate from the MSF compound amid heavy fighting in Pibor from February 23 to 25, MSF has resumed minimal medical operations in its looted facility in response to urgent medical needs. Amid intense fighting, the MSF team was forced to evacuate to the UN base due to the imminent possibility of being caught in the crossfire between armed groups. In the immediate aftermath, the medical team supported treatment of 36 wounded patients, including one six-year-old child suffering from a gunshot wound who died because it was impossible to provide the intensive care treatment needed. The team established a medical clinic and temporary hospitalization ward in the UN base, where 2,000 people are seeking shelter in substandard conditions, and almost two thirds of MSF’s patients are children under five years old suffering from malaria, respiratory tract infections, or diarrhea.
In Pibor town, the MSF medical center was thoroughly looted in the wake of the fighting. Medical equipment, fuel, patients’ beds, life-saving medicines, and therapeutic food used for treating malnourished children have all been stolen. MSF recently relocated back from the UN base to the MSF compound, where medical teams have resumed limited medical services. Thousands of people fled to the bush amid the recent fighting, where they have no access to medical assistance. MSF completed an assessment mission to Verthet, where teams treated three patients and encountered significant unmet health needs. However, the unacceptable looting of MSF’s medical center has greatly reduced its capacity to respond to present needs or to sustain its programs in Pibor, Lekuangole, and Gumuruk at the level and scale that was previously provided. MSF strongly condemns this unacceptable attack on the provision of medical assistance. The situation on the ground remains tense and MSF demands that all armed actors respect the provision of health care.
Responding to Urgent Needs in Leer and Mayendit Counties
MSF is providing urgent medical assistance to vulnerable, conflict-affected populations in Leer and Mayendit counties with clinics in Leer Hospital and Thonyor as well as mobile medical and nutritional clinics. The population is this region has been heavily affected by conflict, including long-term displacement, destruction of shelters, and livelihoods. With the return of other humanitarian actors in 2016, MSF is beginning to finally see the number of children admitted in its therapeutic feeding programs decreasing. However, the population remains highly food insecure and dependent on humanitarian assistance for survival. A sustained humanitarian presence is urgently needed to prevent deterioration in the health of this extremely vulnerable population.
Other urgent medical needs MSF is addressing in the region are high levels of acute watery diarrhea, skin and eye infections, and respiratory tract infections; all of which are associated with the deplorable conditions in which people have been living while fleeing from conflict. The rainy season will begin in the coming months, along with accompanying annual outbreaks in life-threatening disease, which will increase the medical needs. MSF has been looted three times in Leer since conflict began. As a result of repeated lootings, MSF’s capacity to provide medical assistance is greatly reduced from the scope and quality of services it was able to provide before the conflict began.
To escape the violence in Juba, tens of thousands of people sought refuge in UN compounds, where Protection of Civilians (PoC) sites were designated. MSF set up medical facilities in the Tomping and Juba House PoC sites, but spoke out about the deplorable living conditions there, and in other PoC sites in the country, throughout the year. With the gradual stabilization of medical needs, and as other organizations increased their activities, MSF’s medical projects in the Juba PoC sites were handed over to the International Medical Corps, South Sudan Red Cross, and Health Link South Sudan in August.
The rapidly worsening security situation in January forced the evacuation of international staff from Bentiu. In April MSF was forced to stop providing TB and HIV care in the hospital because of increased violence. The town’s residents fled to the nearby UN compound, where the population swelled from 6,000 people to more than 22,000 in a matter of days.
By the end of the year, the number had increased to 40,000. At the PoC site, MSF maintained a 24-hour emergency room and provided more than 10,000 outpatient consultations, treated nearly 1,000 children for severe malnutrition, and performed 300 emergency surgical interventions, 83 percent of which were conflict-related—mostly gunshot wounds. Tens of thousands of children were vaccinated against measles inside and outside the PoC. MSF ran mobile clinics and set up both a general and an antenatal clinic for people outside the site. Another team maintained a program of comprehensive medical services for some 70,000 Sudanese refugees at Yida camp, and undertook a pneumococcal vaccination campaign—the first ever in a refugee setting. Some 10,000 children under the age of two were vaccinated. MSF also has various decentralized clinics and malaria points throughout the PoC.
In Leer, the international MSF team was evacuated in January due to increased insecurity. Shortly afterwards, 240 South Sudanese MSF hospital staff were forced to escape into the bush with their families and some of the most severely injured patients. By mid-April, the local population had begun to return to the town and in May medical activities resumed. By this time malnutrition in the area had reached crisis levels, and during May and June MSF treated more patients for malnutrition than in all of 2013. Along with the therapeutic feeding program, MSF also provides primary health care for the violence-affected, displaced population through mobile clinics.
South Sudan | A Hospital Destroyed, A Community Devastated
Some 70,000 people fled the town of Bor as a result of violence and the state hospital was ransacked. In April, an MSF team helped the health ministry repair the hospital and resume basic medical activities. MSF now provides support in the emergency room, pharmacy, pediatric inpatient department, and with vaccinations. A team also treated people wounded during an attack at Bor airport. MSF had long supported Lankien Hospital, and in 2014 began emergency surgery to treat the increasing number of war wounded. Of the 910 major surgical interventions performed at the hospital, 76 percent were violence-related. There was also a massive outbreak of kala azar (visceral leishmaniasis) and more than 6,000 patients were treated.
Insecurity in Pibor in 2013 caused MSF to withdraw from a fixed health center and operate instead through mobile clinics. By July 2014, the situation had stabilized and MSF resumed activities in Pibor town, including basic health consultations, inpatient services, and maternity care. Teams also offered health care in nearby Gumuruk, Lekwongole, and Old Fangak, areas regularly affected by the war. In February 2016, MSF was forced to leave the compound in Pibor due to heavy fighting and shelter in the UN base on the other side of town. The MSF compound was then looted, and medical supplies, therapeutic food, and even patients beds were stolen. Anything that was not taken, including drugs and medical documents, was strewn around the compound. MSF continues to treat patients, particularly young children suffering from malaria and other infections, at the UN compound.
Upper Nile State
In a pre-existing project at Nasir Hospital, a monthly average of 4,100 consultations were carried out until heavy fighting broke out nearby. The town’s population fled and the hospital was evacuated in May. MSF staff visiting in June found the hospital completely looted and the town deserted. They had no way of knowing the whereabouts or the health status of those who had fled.
Due to mounting insecurity, MSF had to stop working in the Malakal Public Hospital in April and rapidly opened a clinic in the PoC where 20,000 people were sheltering. In Melut, teams provided medical care to those people displaced by violence, which included treating them for kala azar and TB. As the health situation in the refugee camps stabilized over the year, MSF reduced its number of outpatient clinics.
MSF provided basic and specialist health care, including vaccinations, in Minkamman camp, Awerial.
Around 95,000 displaced people live in the camp, and more have settled in the surrounding areas. Teams carried out more than 52,000 outpatient consultations and 2,700 mental health consultations and also launched vaccination campaigns against measles, polio, cholera, and meningitis.
Following a measles outbreak in Cueibet county in late March, MSF provided support to the health ministry and organized a vaccination campaign against measles and polio which reached 32,700 children under five.
Northern Bahr El Ghazal State
In Pamat, close to the border with Sudan, MSF continued to offer basic and specialist medical care to people displaced by conflict. Staff distributed relief items and provided health consultations to new arrivals in December. Since 2008, MSF has supported Aweil Civil Hospital, with around-the-clock pediatric and maternity services, including high-risk and emergency obstetric care—more than 7,100 women were admitted to the maternity ward and over 1,500 complicated deliveries were assisted during the year. In addition, MSF treated more than 30,000 people for malaria in 2014—three times as many as the previous year.
MSF has also supported Yambio State Hospital in Western Equatoria state since 2008, with specialist pediatric and antenatal care, surgery, and treatment for HIV. There are more than 3,000 patients in the treatment program. In Warrap state, MSF runs a small hospital in Gogrial town providing basic and specialist care, including an operating theater for emergency surgery.
This is an excerpt from MSF's 2015 International Activity Report:
MSF responded to immense medical needs amid a major upsurge in conflict and violence against civilians, as well as an exceptionally severe malaria season.
More than two years of sustained conflict and violence against civilians have taken a huge toll on the people of South Sudan. Over one million people have been displaced and hundreds of thousands have been unable to access medical or humanitarian assistance for months at a time, particularly in Jonglei, Unity and Upper Nile states. MSF scaled up its programs in response, but access was disrupted repeatedly by fighting and attacks on medical facilities. Compounding this humanitarian crisis, there were frequent drug shortages, even in areas not affected by conflict, and the country also experienced one of its worst malaria seasons in years. MSF treated a total of 295,000 patients for malaria during the year – nearly ten times as many as in 2014.
Extreme Levels of Conflict, Violence and Humanitarian Need
There was an escalation in conflict and violence in Unity state between April and November, forcing hundreds of thousands of people to flee their homes. Many hid in the bush and swamps and MSF received reports of executions, mass rapes, abductions and the razing of entire villages. Five South Sudanese MSF staff were killed amid the extreme levels of violence, and 13 remain unaccounted for. MSF was forced to temporarily evacuate from Nyal, in May, and twice from Leer, in May and October. As people sought shelter, the population of the UN protection of civilians site (PoC) in Bentiu in northern Unity state increased from 45,000 to over 100,000 by the end of 2015. MSF runs the only hospital in Bentiu PoC and the team rapidly expanded capacity to meet the enormous medical needs of this vulnerable population. MSF also operated mobile clinics and therapeutic feeding programs in southern Unity state and Bentiu town whenever access was possible. Many patients suffering from severe violence-related injuries were referred to the MSF hospital in Lankien for surgical care. Thousands also fled into northern Jonglei state, where MSF opened a project in Old Fangak providing assistance in a medical center, mobile clinics for the region and referrals by boat ambulance. MSF opened another clinic in Mayom, a remote location in northern Unity state, providing basic healthcare and secondary referrals to its hospital in Agok. Teams also responded to outbreaks of diseases including measles, malaria and meningitis in Yida refugee camp, currently home to 70,000 Sudanese refugees.
Assisting Populations Caught on the Frontline
In Upper Nile state, the surge in conflict impacted populations accessing care in MSF’s projects along the White Nile river in Malakal, Wau Shilluk and Melut. In May, the river became a frontline and humanitarian access was severely restricted. People in Wau Shilluk had extremely limited access to assistance for months, and thousands of civilians crossed the river in search for protection and assistance. The population of the PoC site in Malakal swelled from 21,000 to 48,000 and many were forced to live in overcrowded, unsanitary and inhumane conditions. MSF runs the only hospital in the Malakal PoC and teams responded to major outbreaks of disease including malaria, respiratory tract infections and diarrhoea. In Wau Shilluk, MSF expanded the capacity of its primary healthcare center to include secondary care, in order to meet the increased needs of the population. Elsewhere in Upper Nile state, MSF continued to provide medical assistance in Doro refugee camp for 50,000 Sudanese refugees from the conflict-affected Blue Nile state as well as the host population in Maban county. MSF handed over the medical programs it had been running for Sudanese refugees in Batil and Gendrassa camps since 2011 to other health organisations.
Responding to Emergencies and Outbreaks of Disease
For the second year running, there was an exceptionally severe malaria season across South Sudan, particularly in the northwest. The impact of the outbreak was exacerbated by severe shortages and stockouts of essential medicines in non-MSF health facilities throughout the country. MSF teams saw dramatic spikes in the disease in its projects in Agok, Aweil, Bentiu, Doro, Gogrial, Mayom and Yida and responded by rapidly increasing treatment and bed capacity, conducting large malaria outreach programs and scaling up support to other medical facilities in the surrounding areas. South Sudan was also hit by its second outbreak of cholera in two years. In response, MSF provided treatment, technical capacity and logistical support to the cholera treatment unit in Bor hospital in Jonglei state. Another team in the capital, Juba, opened a cholera treatment center and vaccinated over 160,000 people against the disease. In Western Equatoria state, MSF conducted mobile clinics and donated medical supplies for conflict-affected communities. In September, following the explosion of a fuel truck that killed more than 200 people and injured over 100 in Maridi, MSF provided surgical care, medical supplies and long-term nursing support for injured patients. MSF also continued to run its HIV ‘test and treat’ program in Yambio, despite outbreaks of violence.
At the end of 2015, MSF had 3,322 staff in South Sudan. MSF has been working in the area that is now South Sudan since 1983.