A lifeline for remote areas cut off from health care in South Sudan

Unique needs of nomadic groups 

In Boma, Greater Pibor Administrative Area, some communities are semi-nomadic. Cattle herders and farmers move and settle in different areas depending on two major components: water and security. During the rainy season—typically lasting from June to October—routes become extremely difficult to navigate, especially on foot. For some people without access to transportation, walking is the only way to get where they need.

Many communities settle close to the town of Boma, where they can access water, food, and medical care. During the dry season, communities follow the water and settle in the bush, which are extremely remote areas that can take days to reach from town and are far from health facilities. 

“In South Sudan, some communities are forced to live isolated from the rest of the world to find pasture for their herds,” said Iqbal Huba, MSF head of mission in South Sudan.

Animals are increasingly migrating along odd routes in search of water, particularly in agricultural areas, which has caused tensions with farming groups. Competition for water, land, cattle, and harvests has resulted in distrust, grievances, and violence, particularly in Jonglei state and Greater Pibor Administrative Area. As a result, farmers and cattle herder communities live in constant danger of being attacked, looted, or killed. Cattle are at the very heart of South Sudanese culture and livelihoods, so cattle raids are a severe threat, with some leaving people injured or killed.

Children and teenagers are often victims of these conflicts. “I was shot during a fight [in the community] when I was 15 years old and I lost my arm,” said John Oboch, a community health worker for Doctors Without Borders. After realizing he couldn't effectively defend livestock with a missing arm, John decided to pursue an education. As a health worker, he now regularly visits cattle herders to conduct health awareness sessions in communities that he knows well. 

Going where health care is scarce 

During the dry season, Doctors Without Borders teams organize outreach trips to provide medical care to people who have settled in remote areas. Outreach can take up to four days of visiting different locations. 

To ensure people have access to health care, our teams train local community members to administer basic medical care. Our integrated community case management initiative is based on a strategy to build capacity through training and regular supervision, and to supply local health workers with medicines for their community. This helps them diagnose, treat, and refer serious cases to our facilities for common, treatable, and curable illnesses such as malaria, pneumonia, and diarrhea, which continue to be the leading causes of death among children under five in South Sudan.

Respect for traditional customs

Among these community members is Beatrice Johnson, who has been with MSF as a community health educator since 2022. During her two years in this work, Beatrice realized the importance of awareness and sensitization activities in remote areas.

In South Sudan, communities trust and rely on traditional healers. Our outreach team, the majority of whom come from the communities they serve, has deep knowledge and understanding of traditional health customs and beliefs. They engage with traditional healers to discuss treatments and medical care, raising awareness within communities.

For example, blood donation is critical in South Sudan, but there aren't enough donors. To address this problem, Beatrice and our outreach team share knowledge about the importance and benefits of blood donation for both patients and donors. Raising community awareness helps us save lives.

Environmental health staff also join our mobile teams during long outreach trips. Half of South Sudanese households rely on surface water as their main water source, so we provide clean and safe drinking water to protect people from waterborne diseases such as cholera.

Addressing gender inequities

In cattle herder communities, gender roles are clearly defined. Women are responsible for building their houses, fetching wood and water, cooking, and taking care of children; men—and sometimes young boys—are tasked with protecting the community and its cattle.

South Sudan is a vulnerable country with some of the world's lowest socioeconomic indicators, especially for women and children. One out of every 10 children die before the age of five, and the maternal mortality rate is among the highest in the world, with around 1,223 deaths per every 100,000 live births. In South Sudan, 80 percent of women give birth in their community, most with the assistance of traditional birth attendants. 

Living far from functioning health facilities particularly puts the lives of pregnant women and newborns at risk because they require specialized care. 

When Kaka Kolobitot was pregnant, she suffered from severe malaria, a condition that can be fatal both for the mother and the baby. The infection can be directly transmitted from the mother to the fetus, and a high fever can terminate the pregnancy or induce premature labor. 

At only seven months, Kaka gave birth to her son in the middle of the cattle camp. Fortunately, Kaka was aware of the risks associated with premature birth due to information provided by community health workers. After giving birth, she understood she needed to go to a medical facility. “If we had stayed in the cattle camp, my son would not have made it,” Kaka said. 

After walking for two days, Kaka arrived in Maruwa, where she was referred to Boma so our teams could provide a higher level of care for her newborn.

When she arrived at the MSF-supported Boma primary health care center, her son did not have a name yet, so the Doctors Without Borders team called him “Baby Kaka.” One month later, medical staff are still closely monitoring the weight gain and general health of the young survivor.