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South Sudan: Thousands arrive from Sudan in alarming health

An alarming rise in measles and malnutrition cases among Sudanese refugees requires urgent humanitarian response.

Men carrying their belongings on their heads arrive in South Sudan after fleeing violence in Sudan.

South Sudan 2023 © Gale Julius Dada/MSF

JUBA/NEW YORK, August 31, 2023—Doctors Without Borders/Médecins Sans Frontières (MSF) medical teams are seeing an alarming rise in measles and malnutrition among people fleeing from Sudan to South Sudan. MSF calls urgently for humanitarian organizations to provide food, shelter, sanitation, and medical screening. 

The devastating conflict in Sudan has forced more than 245,000 people to flee to South Sudan since April, according to UN agencies. Many arrive in a state of exhaustion and poor health at the border community of Renk, in Upper Nile state, and then have to take a three-day journey on river boats to Bulukat transit center in Malakal.

Since July, MSF has run a mobile clinic in Bulukat, treating patients with measles, malnutrition, and other health conditions, as well as referring patients to MSF's pediatric hospital in Malakal town. Yet medical teams are struggling to meet the needs. The mortality rate at the hospital is very high, at 5.95 percent, often because patients arrive too late. Admissions of malnourished children in the hospital's inpatient therapeutic feeding center increased by 75 percent in July. 

Returnees offloading their luggage from a boat in Bulukat port
People fleeing Sudan arrive at Bulukat port in Malakal, Upper Nile State in South Sudan.

The Bulukat transit center hosts thousands of returnees in temporary shelters. Muddy terrain and other poor living conditions pose threats to people's health. South Sudan 2023 © Gale Julius Dada/MSF

An alarming rise in measles and malnutrition cases in children 

“In our facilities in Malakal, we are recording an alarming rise in the number of measles and malnutrition cases, especially amongst children,” said Luz Linares, MSF head of mission in South Sudan. “The mortality rate in our facilities is extremely high, as the patients arrive so late and sick that the medical teams at times are unable to save lives. There must be an immediate scale-up of the medical and humanitarian response by humanitarian groups for people arriving from Sudan, from the time of entry into South Sudan until their relocation to the areas of their choice.” 

The arrivals are predominantly returnees—South Sudanese nationals who had lived for years in Sudan. These returnees often arrive with no money left to continue traveling or to provide for themselves. About half express their intention to stay within Upper Nile state, which is badly affected by intercommunal conflict and a lack of health care services. 

MSF teams are also providing basic health care through two mobile clinics in Renk, and supporting local treatment facilities for children with measles and malnutrition. MSF calls for the urgent improvement of health screening in Renk—which should be available 24/7—to ensure that people in severe need receive medical attention.  

“What I have witnessed is really terrible, especially the living conditions,” said Apayi Dawa, MSF nurse supervisor in Bulukat. “People don't have shelters. When it rains, the shelters are washed away by the water. We have people dying on the boats. They also have very limited food to eat.” 

MSF Nurse Gatwech Tuoch vaccinates a child against measles at an MSF mobile clinic in South Sudan.
MSF Nurse Gatwech Tuoch vaccinates a child against measles at the MSF mobile clinic in Bulukat, Upper Nile state.
South Sudan 2023 © Gale Julius Dada/MSF

As the rainy season arrives, a more complex health crisis looms 

The Bulukat transit center hosts about 5,000 people at a time, and they may have to wait for weeks for onward transfers. Each returnee is given only $14 to buy food each week, which is very little given the high prices in the area.  

“We need shelter, and we also need good living conditions," said Akuch Deng, who traveled from Sudan with her two children. "We do not have food here. We do not have soap. We also need mosquito nets. The small amount of cash they give here is not enough in the market.” 

In addition to alarming levels of measles and malnutrition, a more complex health crisis is looming with the arrival of the rainy season and poor living conditions.  

“With the rainy season, we could face a big outbreak of malaria if nothing is done in terms of proper shelter and mosquito net distribution,” said Nuru Katikomu, MSF emergency field coordinator in Bulukat. “On top of that, there is risk of a cholera outbreak in such circumstances. It could be catastrophic. That's why we have to push all humanitarian groups to do more to prevent the crisis from worsening."

Learn more about how MSF is responding to the crisis in Sudan >

Sudan crisis response