After fleeing violence, challenges continue for displaced families in South Sudan

Conflict and climate shocks have compounded hardships faced by displaced people in Twic County, South Sudan. Families living in camps across the region face a lack of food, water, and health care; recurrent outbreaks of disease; and limited capacity from nongovernmental organizations to adequately address the situation.

Among the displaced are 10,000 people who fled the city of Agok last year due to violence. Doctors Without Borders/Médecins Sans Frontières (MSF), which had been running a hospital in Agok for eight years, followed the displaced communities south to Gomgoi camp, where teams have been providing medical humanitarian aid since March 2022. In addition to running mobile clinics, which are critical to providing care to communities afflicted by violence and displacement, MSF has distributed food, plastic sheeting, and other relief items, and constructed latrines and water points in makeshift displacement camps in the area.

Health needs continue to increase for people living in camps

Margaret Abuk, an MSF community health worker, is one of the people who fled south into Twic County. She has been living in a shelter with her three daughters, in Majak Aher camp, next to Turalei town.

“We had to run,” she explained, “because of the conflict, because we were afraid, because people were killing us and our children. I decided to come to Turalei because I knew there is public administration and protection as well as nongovernmental organizations that would help us in the camp.”

Amou Lang Deng brought her 16-month-old daughter, Adhar, to the MSF-supported clinic of Mayen-Abun for fever, diarrhea, and severe acute malnutrition. The baby is also anemic and needs regular blood transfusion while still she is fed through a nasogastric tube.

This is not the first time Adhar has been displaced in her short life. After she was born at MSF’s Agok hospital, her mother moved the baby and her siblings to the Abindau displacement camp due to violence that erupted in February. “When you look at my children, you can tell that food is missing, because they are very skinny,” said Amou.

Maternity unit - Mayen-Abun, northern part of South Sudan — Amou Lang Deng's 16-month-old daughter, Adhar was born in MSF's Agok hospital and receives treatment for malnutrition, diarrhea, and fever at an MSF-supported clinic in Mayen-Abun.

From emergency to comprehensive care

Last year, MSF’s work shifted from emergency response to comprehensive and decentralized medical care. We are supporting an 86-bed hospital in Mayen-Abun and health posts in Gomgoi, Nyin Deng Ayuel, and the camps Aweng, Majak Aher, Majok Noon, and Abindau.

At the MSF-supported clinic in Mayen-Abun, we work hand-in-hand with South Sudan’s Ministry of Health to provide comprehensive care, from outpatient consultations to emergency and maternal care. MSF also helped open a chronic care unit, which is one of very few options for patients with HIV, tuberculosis, and other diseases.

MSF teams also provide psychological support to trauma survivors and others in the camp. To reduce the burden on the clinic in Mayen-Abun, we also provide consultations in accessible locations inside the camps or at nearby health posts.

“We receive many children with moderate or severe acute malnutrition,” explained James Tikuei Nyibango Okoth, MSF medical activity manager in Twic County. “They come mainly from the displacement camps, but also from the host community, because food is lacking all over the region. We face an influx of patients suffering from malaria during the rainy season and a high number of malnourished children during the dry period. Our teams are stretched to capacity, and the needs are immense.”

South Sudan: Catastrophic floods cause an escalating humanitarian crisis

More support is needed

Akon Garan was referred to a hospital in Aweil for urgent surgery for her eight-day-old son, Athan, who has a malformation. There is no surgical capacity in all of Twic County, so they will need to drive for six hours to the hospital. The shortage of medical facilities puts many lives at risk.

“If a patient is bleeding, or a pregnant woman has an obstructed labor it is very difficult,” said James. “We have also lost patients on the way due to the long distance.”

The effects of climate change present another challenge, as recurrent floods over the past three years have made many areas inaccessible and led to spikes in rates of diseases like malaria, which is spread by mosquitos that breed in standing waters. Floods have also destroyed crops and ruined harvests, compounding an existing food shortage. The coming rainy season is anticipated to worsen living conditions as well as increase health needs.

“We continue to run our medical programs, but there are acute needs for food, water supply, sanitation, shelter, and protection,” said Beatriz Martinez de la Fuente, MSF project coordinator in Twic. “Because of the ongoing conflict and the likelihood of flooding during the rainy season, this situation could become even more difficult for people here.”

Soaring needs and limited humanitarian assistance are putting lives in danger across South Sudan. While organizations like MSF are working hard to provide urgent care, more help is needed to address continuing challenges faced by displaced people.

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