Lost between borders: South Sudan’s forgotten crises

For nearly three years, the war in neighboring Sudan has unleashed yet another emergency, forcing hundreds of thousands of people to flee across the border into a country unprepared to absorb such large numbers of refugees and returnees. In a collaboration with Doctors Without Borders/Médecins Sans Frontières (MSF), internationally renowned photographer Nicolò Filippo Rosso traveled to the border between Sudan and South Sudan to document the crisis and the people impacted.

“I've been observing the Sudanese conflict from the sidelines for some time now,” says Rosso. “I did several reportages to eastern Chad, where I mainly encountered women and children fleeing the conflict in Sudan seeking refuge in overcrowded camps. In South Sudan, the crisis is quite different: I saw a total collapse of the health system and an extremely layered crisis both for Sudanese refugees and internally displaced people.” 

An improvised escape route for people fleeing Sudan

After landing in Juba, the capital of South Sudan, and attending several briefings with MSF teams, Nicolo traveled to Abyei Special Administrative Area, a territory long disputed between Sudan and South Sudan. The area has been hosting internally displaced people fleeing violence in other states for years, but the outbreak of the war in Sudan has pushed the situation to a critical level.

“What really struck me in Abyei was the number of injuries,” Rosso says. “I saw people with gunshot wounds and severe burns arriving at the hospital. I couldn’t help but wonder what was happening back home for those who stayed, and the conditions they were living in.”

The war in Sudan has raged for more than 1,000 days, but there is no sign of respite as the fighting pushes deeper into Darfur and the Kordofan states. Abyei has become an escape route for many civilians arriving by foot from Sudan or other parts of South Sudan affected by years of violence and displacement. These large-scale arrivals place immense pressure on health facilities that were never designed to cope with such a massive and sustained influx of displaced populations.

“I met a woman named Regina,” recalls Nicolò. “She was very sick with tuberculosis and feared she might die. She didn’t have the strength to carry her children with her to the hospital, so she left her children by the market under a tree with a few belongings and some food, asking someone she knew to watch over them. She went to get treatment with no phone, no connection, hoping that after several weeks she could return and find them. It was a heartbreaking story.”

MSF’s Ameth Bek Hospital, the only functioning hospital care facility in the region, is increasingly overwhelmed by patients. Teams there are focusing on emergency services, including surgery, but also inpatient care and midwifery. Between January and September, MSF provided surgical care to 1,240 patients, including those with violence-related injuries. 

Meeting the needs of remote communities

In addition to running Ameth Bek Hospital, MSF has nine integrated community case management sites managed by trained local volunteers in collaboration with local health authorities. MSF’s team travels long distances to the village health posts to bring medicine and support the trained community health workers. 

“Some communities are really counting on the community health sites because they are extremely isolated,” explains Rosso. “When they visit those sites, they can find trained staff and receive the care they need. It was the case of Ayom Deng, a young girl who suffered a serious burn injury while cooking at home. Her mother brought her to the community health site after seeing the wound worsen. Ayom received wound care and follow-up instructions as part of the program. It really brings essential health care closer to villages far from formal health facilities.”

Comprehensive care for uprooted families  

After several days of documenting the situation in Abyei, Rosso traveled further south to Mayen-Abun. There, displacement has taken a different form, but is no less urgent: Families have been forced to flee their homes repeatedly by long-standing conflicts, including cattle raiding, land-use disputes, intercommunal violence, and climate-related crises. At the MSF-supported hospital, teams focus on providing comprehensive care, from outpatient consultations to emergency and maternity care.

“I had the chance to accompany Abuk throughout her delivery, from the moment she was admitted until the birth of her baby,” says Rosso. “Births are always very emotional moments, and mothers are generally quite open to being accompanied by a camera. It was a very intimate moment, and I even got a high five after she made her final push.”

In rural communities outside Mayen-Abun, access to basic health care is also extremely limited. Clinics are few, distances between settlements are long, and many families must walk for hours to reach the nearest health post. 

As in Abyei, MSF works closely with communities in Mayen-Abun. By bringing basic but essential care closer to where people live, these essential sites help bridge the gaps left by a collapsing health system and the insecurity that prevents families from reaching hospitals.

Funding cuts hit a fallen health system 

As the world’s youngest country, South Sudan is heavily dependent on humanitarian aid: More than 80 percent of essential health services are supported by NGOs. 

In July 2024, the Health Sector Transformation Project launched a multi-donor-funded initiative (including the World Bank) to support basic health and nutrition services and emergency preparedness in South Sudan. Led by the government and implemented in collaboration with the World Health Organization (WHO), UNICEF, and other partners, the model initially planned to support 1,158 health facilities across 10 states and three administrative areas over three years. However, due to funding constraints, it will now support only 816 facilities until 2027, leaving significant gaps in coverage.

Today, it’s clearer than ever that this model is deeply unsustainable. The entire health system is collapsing as organizations are forced to close their doors due to massive cuts in international aid as well as insecurity and violent attacks. For patients receiving care from MSF, this is a painful reality: Once they leave the facilities, there are few, if any, other places to turn for help and support.

MSF teams across the country are witnessing the devastating impact of a chronically under-resourced system. Many primary health care facilities are non-functional, essential medicines are frequently unavailable, staff salaries are delayed, and hospitals are neglected. As a result, people in need of lifesaving surgery or emergency maternal care have extremely limited options. 

These pressures are unfolding alongside the overlapping crises of violence, mass displacement, flooding, and disease outbreaks, adding further strain to an already fragile system. In 2025 alone, MSF opened 12 emergency projects in response to cholera outbreaks, malaria peaks, flooding, and displacement linked to violence — more than double the number of emergency responses launched in 2024. 

“Access to health care is so limited that people are sometimes treated days after being injured," says Rosso. "Once they have received care, they have nowhere to go. There are almost no other organizations left and no camps to provide shelter for them.”

MSF continues to call on international actors to prioritize South Sudan, with a coordinated response to support people facing the country’s multi-layered crisis.

“What felt different about South Sudan compared to other countries I’ve worked in was that I didn’t really have to do any investigative journalism,” says Rosso. “Elsewhere, you have to dig to find the story. In South Sudan, everything is visible: a stark manifestation of layers upon layers of violence, tragedy, and conflict.”