In photos: The health effects of climate change in Old Fangak

In communities in and around Old Fangak, South Sudan, MSF is witnessing the effects of climate change and treating people who are falling ill because of it.

Aerial shot of Old Fangak, which has been significantly impacted by climate change.

South Sudan 2023 © Samir Bol

Old Fangak, a remote marshland area in South Sudan that has historically been a safe haven for people fleeing conflict, has faced unprecedented flooding in recent years. This has left people increasingly vulnerable to vector-borne diseases like malaria, waterborne diseases like hepatitis E, and malnutrition.

South Sudan—ranked the fifth most vulnerable country to climate change—is just one of the places where Doctors Without Borders/Médecins Sans Frontières (MSF) patients and communities are already feeling the impacts of climate change. To survive, they are forced to adapt.

Old Fangak hospital entrance.
Old Fangak hospital entrance.
South Sudan 2023 © Samir Bol

Started in 2014, MSF's activities in Old Fangak include providing inpatient, outpatient, and maternity care to the 20,000 people in the immediate vicinity as well as in villages hours away. MSF has approximately 170 staff working in the hospital of Old Fangak, which is the only facility of its kind in the area.

Patients who need specialized care and surgeries are referred to other health facilities in South Sudan, including those in Juba, Malakal, and Bentiu. However, patients can only travel to other facilities by boat or, when nearby airstrips are dry enough, by plane—sometimes causing deadly delays.

Midwife activity manager provides care in maternity ward of Old Fangak hospital.
Midwife activity manager Harriet Wikoru talks to Nyawal Chuit Riek, who recently gave birth to her first child, a baby girl.
South Sudan 2023 © Samir Bol

While this year's rainy season hasn't been as intense as it has been in previous years, the resulting floodwater hasn't receded back into the Bahr el Zeraf River—which feeds into the Nile River. This is partly because the soil isn't able to absorb the water since it remains saturated from previous years, and the river levels are high from stronger rainy seasons elsewhere on the continent.

People can currently only reach Old Fangak by canoe, which makes accessing even the most basic health services like maternity care impossible for some. Delays in pregnancy-related care can increase the rate and severity of complications like obstructed labor. South Sudan already has one of the highest infant mortality rates in the world.

A child receives treatment for malaria and malnutrition in Old Fangak, South Sudan.
Nyakena Mathot's two-year-old daughter, Chudier, receives treatment for malaria and malnutrition in Old Fangak. Nyakena fled conflict in Sudan with her six children and now lives in Old Fangak there with her mother-in-law. South Sudan 2023 © Samir Bol

Not only does flooding make it difficult for people to access medical services when they need them, it also increases the chance of someone getting sick in the first place.

The main disease MSF teams treat at the hospital in Old Fangak is malaria, as mosquitos can rapidly breed in the stagnant water that has engulfed the area.

The peak malaria season always coincides with the rainy season in South Sudan. However, the rainy season has been inconsistent in recent years, making it difficult for MSF to predict case trends or the amount of supplies and medications that will be needed to treat people for malaria.

Reflection of two people on the surface of water in South Sudan
Children in a village near Old Fangak. There is an outbreak of hepatitis E in the area—a waterborne disease that can be especially deadly for pregnant people.
South Sudan 2023 © Samir Bol

Latrines have not been spared by the flooding, which has contributed to the contamination of drinking water sources.

As a result, many people drink dirty water since they can't find or afford clean drinking water. Sometimes people boil water before drinking it, but cooking fuel has become scarce because the floods have killed trees.

MSF has recently seen a deadly outbreak of hepatitis E, a waterborne disease that can be especially deadly for pregnant people. In response, MSF has a 10-bed hepatitis E isolation unit at the hospital of Old Fangak, and is currently planning to carry out a hepatitis E vaccination campaign to help curb the spread.

MSF treats children for malnutrition in Old Fangak.
Elizabeth Nyapini Panyuan cares for her 5-year-old granddaughter, Nyakuoth Bolth, who has malnutrition and acute watery diarrhea. Elizabeth used to work as a traditional birth attendant for MSF in Old Fangak before moving to Sudan. When conflict broke out there, she decided to return so Nyakuoth could receive quality health care.
South Sudan 2023 © Samir Bol

Instead of fleeing the region, the people of Old Fangak have adapted to these changing climatic conditions. As lands have flooded year after year, crops haven’t been able to grow and cattle have died because they had nowhere to graze, forcing people to find new food sources. Many men have turned to fishing to feed themselves and their families, and women have started harvesting water lilies.

Dwindling food sources and recent cuts to World Food Program distributions amid increased global needs have left people vulnerable to malnutrition. Malnutrition can be especially deadly for young children as it leaves them with weakened immune systems, increasing their susceptibility to getting sick with other diseases.

MSF conducts vaccination campaigns around Old Fangak.
MSF medical ward supervisor Gabriel Kalany Khalifa and vaccinator Buom Wal prepare a vaccination during a routine childhood vaccination campaign in the village of Wangmok near Old Fangak.
South Sudan 2023 © Samir Bol

Vaccination campaigns are critical in and around Old Fangak as health care options are limited for those who fall ill. Parents often wait eagerly for MSF to come to their villages so their children can receive their routine childhood vaccinations.

Over the last few years—to allow for uninterrupted access to medical services—MSF teams have shifted toward providing access to care outside of health facilities. Additionally, MSF currently carries out outreach activities like malaria and malnutrition testing in 17 communities around Old Fangak.

Villages here rely on each other to survive the flooding. Surrounding communities help each other build dikes to keep the water at bay, and families offer up their homes to those who've been displaced so they have somewhere dry to sleep. In Old Fangak, MSF is considered just another community member helping those who need it most.

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