Consequences of attacks on health care in South Sudan

“I thought my colleagues were dead”

At 2 p.m. on January 15, MSF’s outreach team was fired upon while returning to our base in Ulang by boat on the Sobat River. The team had just delivered medical supplies to Nasir County Hospital and was traveling in two boats bearing MSF’s flag—clearly marked with our logo—when suddenly, the sound of gunfire sparked a panic on board. Chuol, who is in charge of the outreach team, instinctively jumped into the murky water.

Riek, who works as a link between MSF and the local community, was in a nearby village when he heard the gunshots. He ran as fast as he could down to the river, where he saw an empty MSF boat drifting on the water. 

“I was shocked, I thought my colleagues were dead,” said Riek.

Chuol managed to swim ashore and tried to locate everyone in his team. Five team members made it to safety, but one was missing.

Meanwhile, Riek heard someone calling his name. It was the missing team member, who had jumped into the water and was injured. Riek acted quickly, grabbing a canoe and paddling out to his colleague. He managed to help him into the canoe. It turned out that the injury was minor, and the colleague was taken to MSF’s hospital in Ulang for treatment.

MSF has been providing health care in Ulang since 2018, running a hospital and outreach activities at 13 sites along the river. Our outreach teams provide basic medical care, supply patients with medication, and refer patients to the local hospital. After the incident on January 15, MSF was forced to take the difficult decision to suspend all outreach activities in the area for security reasons. MSF also launched an investigation to find out exactly what happened.

Ulang is a volatile environment in which to live or work, affected by intercommunal violence, armed fighting, and displacement. Despite being used to the nearly constant insecurity, the shooting on the river left a mark on Chuol and Riek.

“I had trouble sleeping the first few nights after the attack,” said Chuol.

Riek added, “I felt a nervousness in my body for two days after witnessing the boats being shot at. The shock I felt when I thought my colleagues were dead stayed with me.”

People struggle to access care

At the hospital in Ulang, the MSF team provides services including maternal, pediatric, and emergency care. Many of the beds are now empty.

“Since we had to suspend our outreach activities, we have had fewer patients than usual in the hospital,” explained Dr. Philip. “Without MSF's boats to transport patients to the hospital, patients living far away sometimes have to wait days, or even weeks, for a boat which they can take to Ulang. Those who eventually make it here are often in very poor condition.”

The only other way to get to the hospital is on foot, as most roads are blocked or damaged. During the rainy season, floods make it impossible to cross some areas and boats are often the only way to move around. 

One woman reached the hospital too late to save her stillborn twins. Just as she was about to share her story, a staff member came to tell her that the boat she needed to take her home had arrived. It would take up to a week for the next boat to come. With the help of her relatives, she quickly packed up her things and hurried out of the hospital.

“She was from Nasir, close to where the attack happened,” said Veronica, an MSF midwife. “When complications arose during her labor, she had to get to a hospital as soon as possible. Since July 2024, the hospital in Nasir has not had the staff or technical resources to handle complicated deliveries, so she had to come here to Ulang. Normally, our mobile teams would have been able to pick her up by boat, but instead she had to wait two days for a boat to bring her here. When we were finally able to help her, it was too late, we couldn't hear any heartbeats from the twins in her stomach. She was angry and sad—sad about losing her twins and angry that the attack happened.”

Violence robs vulnerable communities of their only hospital

Since mid-February 2025, escalating conflict between government forces and armed groups in Upper Nile state has driven further instability. On the morning of April 14, dozens of armed men stormed MSF’s hospital and office in Ulang, threatening staff and looting vital medical supplies and equipment. As a result, all medical services at the hospital have been suspended. 

The area around Ulang is now left without a single functioning health facility. The attacks on MSF’s boats and the hospital are part of a broader pattern of insecurity affecting the provision of health care in the area. The violence forced the suspension of both outreach and hospital services, and the cost will be paid by vulnerable communities left without care.

On May 3, a deliberate bombing of the MSF hospital in Old Fangak, Jonglei state caused significant damage, including the complete destruction of the pharmacy, which was burned to the ground. All our medical supplies for the hospital and our outreach activities were stored in the pharmacy. As thousands of people fled the town, we evacuated the wounded and opened a temporary health facility nearby. However, the hospital in Old Fangak was the only one in the entire county. Now, the 110,000 people it served no longer have access to hospital-level care.