People in remote areas of Upper Nile State in South Sudan are suffering from a lack of access to health care as attacks on medical boats and armed lootings of medical facilities affect our ability to operate in Ulang county. As a result of the escalating insecurity, Doctors Without Borders/Médecins Sans Frontières (MSF) has been forced to close our hospital in Ulang and halt activities supporting 13 community-based primary health care facilities in the county.
The closure of MSF’s hospital has left an area of more than 125 miles from the Ethiopian border to Malakal town without any functional secondary-level health care facility. MSF calls on all parties to adhere to international humanitarian law, cease such indiscriminate attacks, and ensure the protection of medical facilities, health workers, and patients.
Worst violence since 2018
Since February 2025, South Sudan has been experiencing its worst spike in violence since 2018. Fighting between government forces and armed youth militias has escalated across multiple states, including Upper Nile, Jonglei, Unity, and Central Equatoria. This has led to mass displacement, widespread civilian casualties, and a total collapse of already fragile public services.
Despite these closures, MSF remains dedicated to supporting the health care needs of displaced and vulnerable people in Ulang and Nasir counties. A mobile emergency team is assessing the needs and is prepared to provide short-term health care services wherever security conditions and access allow. MSF is continuing to provide health care services in its other projects in Upper Nile State, including in Malakal and Renk counties.
An escalating trend of violence against health care
In January 2025, unidentified gunmen shot at MSF staff by their boats as they returned from delivering medical supplies to Nasir County Hospital. This attack forced MSF to suspend all its outreach activities in Nasir and Ulang counties, which included medical referrals by boat along the Sobat River allowed women to deliver their babies safely.
In April 2025, armed individuals forced their way into the hospital in Ulang where they threatened staff and patients and looted the hospital so extensively that MSF no longer had the necessary resources to continue operations safely and effectively.
“They took everything: medical equipment, laptops, patients’ beds, and mattresses from the wards, and approximately nine months’ worth of medical supplies, including two planeloads of surgical kits and drugs delivered just the week before,” said Zakaria Mwatia, MSF head of mission for South Sudan. “Whatever they could not carry, they destroyed.”
Within a month, another MSF hospital was bombed in Old Fangak, a town in neighboring Jonglei state, leaving the facility completely non-functional. This is part of a worrying rise in attacks on health care facilities in South Sudan.
Local communities depended on MSF for prenatal care
“During my third pregnancy, I decided to come to the hospital well in advance before my delivery," said Nyapual Jok, a young mother from the outskirts of Ulang County. "I lost my two first children because I did not make it to the hospital on time."
Nyapual had been transported to the hospital by one of MSF boat ambulances, since she lives in a remote village far away from Ulang hospital. Ulang, a vast flood-prone area, is spotted with remote villages that often suffer severe mobility restrictions during the rainy seasons. MSF ran boat transportation services to ensure access to health care to mothers like Nyapual.
“It’s very hard to access health care here," said Nyapual. "If we had a hospital closer during my previous deliveries, maybe my children would be alive today."
Nyapual shared her story in November 2024, only two months before the attack on the same boats that helped her deliver her baby safely.
Facility closures create gaps that are difficult to fill
The attacks’ effect of stopping medical referrals by boat has had fatal consequences for the people living in remote areas in the region. People in Ulang and Nasir counties had to wait for days, sometimes even weeks, to find a boat to take them to Ulang hospital. In desperate situations, they would walk for days through a muddy landscape that is nearly impossible to cross on foot during rainy season.
Veronica Nyakuoth, an MSF midwife at the Ulang hospital, shared the story of a patient she attended to at the maternity ward: “She was in labor when she suffered birth complications—she had to go to a hospital as soon as possible. Normally, MSF mobile teams would have been able to pick her up by boat, but since that service was cut off, instead she had to wait two days for a private boat to take her. When she finally made it to Ulang hospital, it was too late: the team could not find a heartbeat from the twins she was carrying.”
More than 150,000 people cut off from care
With the closure of the hospital and the withdrawal of support to the decentralized facilities including transportation of patients, more than 150,000 patients, including mothers like Nyapual, will now face even more difficulty accessing health care in Ulang county. Over 800 patients with chronic illnesses such as HIV and tuberculosis have lost access to treatment due to the closure of MSF services in the area.
“We need a hospital nearby that can help mothers and children. Without it, many will suffer and lose their lives,” Nyapual said.
Nyapual’s story, along with those of many others, serves as a stark reminder that health care is a fundamental right and should never be a target. The consequences of attacks on health care are more than the damage to a building; it’s the loss of hope, safety, and the chance for a healthier future.
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MSF in Ulang
Since 2018, MSF had been providing vital health services in Ulang including trauma, maternal, and pediatric care. Our teams also supported 13 facilities to offer primary health care services. Over the past seven years, MSF teams carried out more than 139,730 outpatient consultations, admitted 19,350 patients, treated 32,966 cases of malaria, and assisted 2,685 maternal deliveries, among other essential services. During this time, MSF also provided support to Nasir County Hospital and responded to multiple emergencies and disease outbreaks.
