South Sudan: After Two Years of Fighting

Matthias Steinbach

December 15, 2015, marks two years of conflict since fighting broke out in South Sudan's capital, Juba, and spread rapidly throughout the country. This collection of photographs reflects the work of Doctors Without Borders/Médecins Sans Frontières (MSF) in 18 locations in South Sudan and in camps across the borders in Ethiopia and Uganda where many South Sudanese have taken shelter. 

MSF employs more than 2,900 South Sudanese and 300 international staff who respond to a wide range of medical emergencies, including complicated deliveries, war trauma, malnutrition, and the neglected disease kala azar.

In recent months, southern Unity State has been the focus of much of the violence related to the conflict, and, as we've seen in previous years, MSF’s staff and facilities have not been spared.

On this second anniversary of the conflict, MSF calls for an increased humanitarian response to the dire conditions faced by the population of South Sudan. The malnutrition situation in southern Unity State is of particular concern and the need for access to health care for the people of South Sudan is as great as it has ever been in the past two years. Following the recent killing of five of its staff members in southern Unity State, MSF reiterates its call for respect for its medical facilities and its staff, as well as the protection of the civilian population who, caught up in the ongoing fighting, are suffering immeasurably.

Nearly every day either new refugees come from the south sudan by UN trucks into the dzaipi transit camp or get transported into other camps due to the overcrowded transit camp which has at about 25000 refugees. *** Local Caption *** Around 52,000 South Sudanese refugees have settled in Adjumani district, in northern Uganda. And refugees are still arriving. Upon their arrival, they stay in a transit centre before being transferred to a permanent settlement. MSF is providing health care in the transit centre and three permanent camps. In Dzaipi, MSF is running an OPD, an IPD and a therapeutic nutritional centre.
Matthias Steinbach
A patient of the MSF clinic in Mellut in the dressing room
Matthias Steinbach
Akuot Yel carries her sick four-year-old son, Agok, from their village of Maluil to the nearby private clinic in town. Yesterday, Akuot took her son to the government-run primary health care unit (PHCU) nearby but they found nobody there. It was closed. PHCUs have no trained personnel to administer quinine intravenously, and often have no oral ACT medication in stock, so they do not open at all, thinking that there is nothing for them to do for patients that come in, the vast majority of which suffer from malaria. The private clinic in town would have cost Akout 15 SSP for the test, and 80 SSP to purchase the medicine needed. Akuot has two twins at home who are also ill, but Agok's state was most serious. Akuot can't afford medication for three sick children all at once so she tried to take care of Agok first. She could have received free medicine at the the government-run health care center in Panthui, but the walk will take about two hours, and there was no guarantee that they will have medicine in stock. The PHCU has a car to provide free transportation for patients that need to be referreed to Panthou health care center for treatment, but that wasn't an option for Agok since they found the PHCU closed. Later, Abdifatah also found Agok had symptoms of severe anemia. MSF outreach manager and nurse Abdifatah, en route to Panthui, offered Akuot and Agok a ride to the health care center there. At home, they use a mosquito net that they received from an NGO who distributed them in the area two years ago. It is old now and tearing.
Diana Zeyneb Alhindawi
Jessica, MSF training nurse with a young child in the intensive care unit.
Pierre-Yves Bernard/MSF
Intended to illustrate the Tomping day-in-the-life photostory - In a shocking display of indifference, senior United Nations Mission in South Sudan (UNMISS) officials have refused to improve living conditions for 21,000 displaced people living in a flood-prone part of a UN compound, exposed to waterborne diseases and potential epidemics. Despite repeated requests from humanitarian organisations, UNMISS is taking no actions in the camp to improve their chances of survival. MSF today (09 April 2014) questions the UN’s commitment to meeting the needs of the war-torn country’s most vulnerable groups and calls for immediate action to save lives in Tomping camp.
Claudia Blume/MSF
A family arrives at the middle of the night and prepares a bednet and mattress on the floor in the crowded hospital at Bentiu POC. Photo by Brendan Bannon. September 2015. Bentiu, South Sudan
Brendan Bannon
Health promotion posters flank the entrance to the incinerated remains of the emergency room at the MSF hospital in Leer, South Sudan, February 23, 2014. The hospital was thoroughly looted, burned, ransacked, and effectively destroyed, along with most of Leer, sometime between the final days of January and early February, 2014, leaving hundreds of thousands of people cut off from critical, lifesaving medical care. The hospital, opened by MSF 25 years ago, was the only secondary health care facility in Unity State.
Michael Goldfarb/MSF
An MSF midwife conducts a medical check-up on a pregnant woman. MSF constructed a small hut (tukul) in the bush, where women can enter to have their check-ups in private. The place is located about an hour from the MSF base in Pamat, NBEG.
Matthias Steinbach
Continuing clashes in Upper Nile state in South Sudan are leading to more deaths and displacements of people. Over 1,665 families, mainly from the Shilluk tribe, have left Melut since the beginning of April and sought refuge in Noon, across the river Nile. They live under trees and have extremely limited access to latrines, leading to open defecation and have to travel long distances to fetch water from the Nile. MSF is using speed boat and donkeys to carry drugs and food items to Noon.
Inigo Ranz/MSF