South Sudan was engulfed by severe instability throughout 2022 and into early 2023, with eight out of its ten states rocked by violence.
This upheaval triggered extensive displacement, predominantly in the Abyei administrative area, a region claimed by both South Sudan and Sudan and which remains a contested issue, as well as other areas such as Twic County. This mass displacement has been aggravated by a historical backdrop of conflict, an escalating climate crisis, economic hardship, and a lack of access to lifesaving health care.
Here, Doctors Without Borders/Médecins Sans Frontières (MSF) team members on the ground offer a glimpse of their work—and what drives them to keep serving their communities in South Sudan.
“In my heart, I am every bit an ‘Abyei girl’”
In the heart of South Sudan, nestled within the confines of Abyei, is where my story begins.
My name is Awa Abdou, but to the locals and the volunteers here, I'm lovingly known as Nyan Abyei, the 'Abyei Lady.' Though I arrived as an outsider, this community has embraced me, making me feel as if I've known and been a part of Abyei for a lifetime. Now, in their eyes and in my heart, I am every bit an Abyei girl.
I wear my title as MSF nurse activity manager with pride. I've been entrusted with a significant responsibility: to train volunteers, supply vital medication to the community, and provide oversight to ensure our objectives are being met.
Awa and two community volunteers during a weekly visit to one of the 17 ICCM sites in Abyei. South Sudan 2023 © Isaac Buay/MSF
Our operation spans 17 Integrated Community Case Management (ICCM) sites. At each, two dedicated volunteers and a water carrier work tirelessly. Their mission? To diagnose and treat malaria, address cases of diarrhea, and screen for malnutrition. Equipped with rapid diagnostic tests, the teams provide immediate care. A positive test? They know the protocol. A case of uncomplicated diarrhea? They're ready to intervene.
Yet, our mission here isn't without challenges. The most formidable? The roads. During the rainy season, they're impassable. Vehicles are of no use; it takes sheer determination and a pair of resilient feet to reach our ICCM sites. But these obstacles pale in comparison to the health needs.
MSF's presence in Abyei is a beacon of hope for the community. There's no other health unit, no other place for patients to seek medical care. It is solely our ICCM sites, established with the help of the community, that help prevent and treat diseases. And it's not just about supplying medicines; MSF funds these volunteers who serve their communities.
When it rains, our sites teem with activity. Over one hundred patients gather every Wednesday and Friday. They come in search of medical support, and we stand ready, reporting data, stocking up medicines, and most importantly, providing health care.
The community trusts us, so our reach and impact are enormous. A recent interaction with community leaders highlighted this. They spoke about the positive impact of MSF. Such positive sentiments drive us to continue working. No matter how shaky the roads, no matter how vast the distance to reach patients, it is the joy and relief on the faces of those we serve that fuels our humanitarian work. For in their smiles, in their gratitude, we find our purpose.
Healing hearts in Abyei
On July 31, 2023, I set foot in the Abyei area, commonly known as ‘the box’: a region in South Sudan that has been plagued by conflict and has left its people in desperate need of medical aid. As an MSF staff member, I accompanied Sean Sutton, a photographer contracted by our communications team, to document the crucial mission of MSF providing health care to those who have long been cut off from such services.
There are 17 ICCM sites, each not less than an hour’s drive from the main hospital in Abyei. Each site has two volunteers trained by MSF teams in Abyei. MSF’s outreach team goes to these sites to deliver medicine, record data, and refer severely sick patients to the main hospital.
Since Abyei is a war-torn region, many remote areas are almost completely cut off from health care, making it nearly impossible for people to access health facilities. Floods pose a great threat during the rainy seasons, while conflict poses another in the dry season. Equipped with medical supplies and a purposeful vision, our MSF teams travel long distances, crossing unforgiving terrain to reach villages and communities that are desperate for help.
After a two-hour walk to one of the health sites, the sight that greeted us was heart-wrenching. Families were living in makeshift shelters, their strength challenged by the harsh realities of life in the village. The outreach team delivered much-needed medicines to combat malaria, diarrhea, and malnutrition. Many lives are saved daily by these community health volunteers, who breathe hope into the hearts of the people of these villages.
While MSF’s mobile clinics cater to the immediate health care needs of these remote communities, MSF also provides secondary health care services at the main hospital in Abyei. The hospital is a beacon of hope, a place where lives are transformed and healing takes place. MSF doctors, nurses, and support staff work tirelessly, dedicating their expertise to a community that has long been neglected.
Amidst the already-dire situation in Abyei, a new challenge has arisen: the arrival of returnees and refugees fleeing Sudan's ongoing fighting. Families displaced from their homes in Sudan have sought refuge in Abyei, hoping for safety and a chance to rebuild their shattered lives.
MSF teams have witnessed firsthand the desperation and urgency among these newly arrived people. Many have suffered injuries in Sudan and are in dire need of medical attention on arrival. All have endured long and unsafe journeys, often lacking access to even the most basic health care services.
With each act of providing medical care, MSF continues to support those who have been forgotten and left behind.
Abyei may be just one chapter in our journey, but my experience working with MSF here will forever be etched in my heart, serving as a constant reminder of the power of humanity.
As I look toward the future, I am determined to carry the lessons I've learned and share them with the world, hoping that no community is left without the care its people deserve.
“We are here to save lives and that’s what we are doing.”
I started with MSF as a nurse in Sudan in 2007. I did all my studies in Al Jazeera state, about a three-hour drive south of Khartoum. I went to Sudan with my family when I was only four years old. It was 1986 and the civil war was terrible at that time, we were refugees. I was born in Abyei, near the oil fields in the north.
Currently I manage six nurses and eight nurse aids in the inpatient department of the MSF hospital in Abyei. We have 32 beds in the busy rainy season—like now, because of malaria—and 20 beds in the dry season.
MSF really helps people by engaging with the communities. Having the hospital means a lot to the community. People feel safe there. But simply having a hospital is not enough—it is having a hospital that runs well and serves everyone.
That means that everyone wants to come to MSF’s hospital, and they travel far distances to get here. Everyone knows this is a good hospital. The problem is that many patients come to our facilities who do not meet the admission criteria. This is a secondary level health care facility and that means we only treat people with serious illnesses. We don’t have the capacity to do more.
At Agok hospital, we had more capacity, with 160 beds, 450 locally hired staff, and 30 international staff working there. This served the people in Abyei but also people in neighboring states including Unity, Warrap, and Bahr El Ghazal states.
Hospitals mean so much to the community. A good example was when violence broke out in Agok last year, and the hospital was not damaged nor looted. Nobody touched it because it is too important to everyone. But we as a team were forced to close the Agok hospital and we handed over management to the Ministry of Health. At first, we tried to keep the hospital open while it was safe to commute to it. But the violence kept getting worse and fighting came very close, so MSF did a security assessment and made the decision to stop operations in the hospital.
Major constraints persist, such as insecurity on the roads, which means people can’t access health care. Government-run hospitals often have issues with staffing and supplies, such as medicines. It is a big challenge, especially in the rainy season, when many people die in the community because of malaria and because they cannot access health care.
I have spent my whole career with MSF, and I am very grateful for the experience. One thing that I will always remember was at the beginning of my career. We had to transfer a patient to Khartoum. On the northern border of Abyei, we transferred the patient to another vehicle that had come from Khartoum. I had to stay overnight at a guest house. When I walked into the compound wearing my MSF T-shirt, all of the aid workers warmly greeted me. “Wow,” they said, “You must be good at your job, you must be a hard worker to be working with MSF.” I was so surprised and very happy. They made me very welcome, and I felt very proud. I’ll never forget that moment.
About our work in Abyei
MSF supports secondary health care services at Ameth Bek Hospital in Abyei, the only secondary health care hospital and surgical service in the area. Our teams provide a range of services including inpatient care, around-the-clock emergency care, surgery, comprehensive maternal and neonatal care, treatment for chronic illnesses, mental health support, health promotion, and ICCM, and we collaborate with local health care authorities.
