South Sudan: 10 years after independence, MSF reflects on the humanitarian challenges

Extreme violence

The five-year conflict resulted in nearly 400,000 deaths. Civilians, including children and the elderly, were targeted on the basis of their ethnicity or politics. Many were subjected to sexual and gender-based violence as part of the conflict.

Deaths from preventable diseases 

Violence disrupts access to health care, including routine vaccination, while increasing the risk of disease transmission and food insecurity.

There have been repeated failures to ensure dignified living conditions for displaced people. Instead, people fleeing conflict and violence have, again and again, been forced to live in deplorable conditions—with basic requirements for living space, water, and sanitation unmet, far below the minimum emergency thresholds for survival. At the worst times, MSF recorded three to five children dying per day from preventable diseases—such as malaria—in individual camps or sites for displaced people.

People displaced far from essential services have been forced to live in the open, in the bush and swamps, and have repeatedly suffered the consequences of diseases and extreme hunger. Conflict brought a resurgence of kala azar, a deadly parasitic disease, in some places. There have been outbreaks of measles, hepatitis C, and cholera, among others.

A mental health crisis

Millions of people in South Sudan have been repeatedly exposed to traumatic events. MSF has witnessed increases in suicide attempts and has worked with patients coping with post-traumatic stress disorder.

The impact of protracted conflict and repeated humanitarian crises in South Sudan is worsened by a weak, chronically underfunded health system, which has been destroyed in many areas and largely neglected in others. In 2020, of approximately 2,300 health facilities in the country, more than 1,300 were nonfunctional. Less than half (44 percent) of the total population and just 32 percent of internally displaced people live within three miles of a functional health facility.

Ongoing humanitarian crises

Despite a peace agreement in 2018 that ended five years of civil war, and the formation of a unified government in early 2020, the situation remains volatile in many areas. In 2019, South Sudan saw a resurgence of subnational conflicts and factional fighting, which has since escalated in 2020 and 2021.

Today, 8.3 million people—more than two-thirds of the population—are estimated to be in dire need of humanitarian assistance and protection. Today, in what is the largest refugee crisis in Africa, 2.2 million South Sudanese people are sheltering in neighboring countries. More than 1.6 million people remain displaced within the country. Even in a best-case scenario, South Sudan will remain vulnerable to humanitarian crises for the foreseeable future, and people in South Sudan will need assistance for some time.

South Sudan’s leaders must make every effort to ensure civilians' safety and security and an environment conducive to the delivery of humanitarian assistance, independent of any political agenda.