Violence and cholera ravage both sides of South Sudan-Ethiopia border

Recurring cholera outbreaks are spreading as people are displaced

South Sudan has been grappling with cholera outbreaks across various parts of the country since last year. The latest wave  is now spreading from Upper Nile state into neighboring Jonglei state, in the Greater Pibor Administrative Area, and across the border into Ethiopia’s Gambella region, where MSF teams are treating patients as cases surge.

In Upper Nile state, MSF is treating those wounded in the violence and supporting cholera treatment facilities in Ulang, Malakal, and Renk counties. In Jonglei state, MSF is responding in Lankien as well as in Akobo, where a 100-bed cholera treatment unit set up by MSF in Akobo County Hospital has treated more than 300 patients in just over two weeks. MSF is also responding in Pibor town in the Greater Pibor Administrative Area. Since the beginning of March, MSF teams have treated over 1,000 cholera patients across South Sudan and have received over 30 patients wounded in the violence.

Ruach Riek Chuol was admitted to MSF’s hospital in Ulang with injuries he sustained in the violence. “My goods and property for my business were all burned inside the house,” he says. “Everything was destroyed in the fire, including the house where I was.”

In Ethiopia's Gambella region, MSF in collaboration with the Ministry of Health has treated over 560 cholera patients since the start of the response in early March, in its cholera treatment centre and units (CTC/CTUs) in Mattar, Moan, and Burbeiye with a capacity of 100 beds. MSF is also running oral rehydration points and conducting water, sanitation, and hygiene (WASH) and community-based activities, including door-to-door cholera awareness and water purification efforts, reaching over 5,000 people across multiple locations. In addition to cholera treatment, MSF teams have provided medical care to 160 patients wounded in the clashes in South Sudan.

Thousands arriving with little more than what they can carry

The situation is rapidly deteriorating as thousands fleeing violence in South Sudan cross the border to seek safety. In Wanthoa Woreda, a new encampment in Burbeiye, Ethiopia has emerged almost overnight, with over 6,500 new arrivals reported by local administrators—many of them women, children, and the elderly, arriving after days of travel.  

"I came here because back home in Nasir, people are being killed," says a South Sudanese mother who recently arrived in Burbeiye. "There was nothing to eat, and when we arrived at the areas where we took respite, my kids became sick. There were no health facilities that we could run to."

“The displaced people are arriving in Gambella with little more than what they can carry," says Joshua Eckley, MSF head of mission in Ethiopia. “Our teams are responding to the cholera outbreak and providing care to those arriving exhausted and in poor condition. There are significant needs, and without additional support, the situation could worsen.”

Cholera crisis comes amid funding cuts

This crisis comes at a time when South Sudan and Ethiopia are facing major reductions in donor funding, including the recent USAID cuts. While MSF does not accept funding from the US government, the cuts in humanitarian and health assistance would severely reduce the capacity of other organizations to respond to such crises.

“In places like Akobo in Jonglei state, the cholera response has been highly impacted by funding cuts, including closure of critical health services,” says Zakaria. “A number of mobile clinics have already shut down following US funding cuts, and some organizations that supported health facilities, including cholera treatment units, have suspended all activities. This is part of a broader trend across the country.”

The health care system in South Sudan suffers from chronic underfunding, shortages of skilled health staff, medicines, and supplies, and has limited capacity to respond to emergencies. The country, already struggling to meet its own medical and humanitarian needs, is further burdened by the arrival of over 1 million people fleeing war in neighboring Sudan. Urgent support is needed to provide safe water, implement widespread cholera vaccination campaigns, and reinforce treatment capacity for both cholera patients and trauma cases.

“Disruptions in cholera treatment services, combined with actors’ reduced capacity to support oral vaccination campaigns, heighten the risk of further spread,” Zakaria adds. “We urge donors to allocate emergency funds for emergency response in South Sudan and neighboring Ethiopia amid this escalating crisis.”