Activities in 2025
In 2025, there was a sharp escalation in armed conflict, with increasing attacks on health care facilities, medical staff, and patients. We recorded nine attacks on our staff and facilities during the year, in locations including Ulang, Old Fangak, Morobo, Yei River, and Lankien. These incidents pushed health care even farther out of people’s reach. After our hospital in Ulang was looted and destroyed, we were forced to close it and withdraw support to 13 general health care facilities in the county. We also closed our hospital in Old Fangak after it was bombed and relocated activities to Toch. In Central Equatoria state, we suspended activities in Yei River and Morobo counties following the abduction of a staff member. In Lankien, airstrikes near MSF’s hospital forced us to evacuate some staff, leaving a smaller team to continue activities.
Tackling cholera
The cholera outbreak that began in October 2024 is the worst in the country’s history. Throughout 2025, it continued to spread across South Sudan, affecting multiple states and putting additional pressure on the overstretched health system. The rapid transmission was fueled by mass displacement driven by conflict, limited emergency surge capacity, and chronically under-resourced water, sanitation, and hygiene services. No MSF project across the country was left untouched by cholera.
In January, cases surged in Unity state, particularly in Bentiu and the surrounding areas. Between February and March, a new hotspot emerged, with over 1,000 cholera cases reported in Akobo, a remote border county in Jonglei state with few health care facilities. In response, we established cholera treatment centers, and provided medical supplies, training, and support for treatment at Akobo and Bentiu state hospitals and in the town of Rubkona. We also assisted an oral vaccination campaign against cholera in Bentiu displacement camp.
We also operated cholera treatment centers in Malakal and Ulang in Upper Nile state, and supported the Ministry of Health in the capital, Juba, by establishing a cholera treatment unit, strengthening epidemiological surveillance, running vaccination campaigns, and improving water and sanitation facilities.
Responding to malaria and flooding
Malaria remains the leading cause of illness and death in South Sudan, with outbreaks closely linked to seasonal rains and environmental conditions. The high burden reflects broader gaps in health care, including shortages of antimalarial drugs and the inconsistent rollout of prevention tools, such as seasonal malaria chemoprevention and insecticide-treated bed nets. MSF conducted chemoprevention ahead of the peak season to protect children under 5 in the worst-affected counties, including Twic and Aweil. In the pediatric ward at Yambio state hospital in October, during peak malaria season, we donated essential drugs and medical supplies and trained staff in infection prevention and control measures, as well as in waste management.
We also treated people with malaria in Bentiu, Leer, and Old Fangak after severe flooding, which caused widespread damage and heightened the risk of waterborne diseases, such as cholera and typhoid.
In early August, MSF detected a spike in suspected hepatitis E cases in Aweil, driven by poor water, sanitation, and hygiene infrastructure. Pregnant women, whom the disease most severely affects, along with immunocompromised people, were arriving late to hospital, and some passed away. We responded by treating patients, distributing chlorine tablets, and rehabilitating wells and hand pumps.
Supporting people displaced by the war in Sudan
Since the beginning of the Sudan war in April 2023, more than 1 million refugees and returnees have crossed from Sudan into South Sudan, placing an enormous strain on local health services, particularly in Upper Nile and Abyei Special Administrative Area. Many people arrived with nothing after weeks of dangerous travel, having endured violence, including sexual and gender-based assault, and extortion.
As the crisis escalated, we significantly expanded our medical and humanitarian response in Renk. Our teams ran mobile clinics in the informal settlements of Atam, Gosfami, and Girbanat, and provided assistance with water treatment and safe water supply to reduce the risk of waterborne disease in these areas.
Our teams offered treatment for a range of health issues, including acute and chronic diseases, obstetric complications, violence-related injuries, and mental health conditions. At Renk Civil Hospital, we worked in the pediatric, maternal, and surgical wards, as well as in the blood bank. We also supported the functioning of the hospital by providing water and electricity, as well as food for patients.
Handing over medical activities to sustain health care services
In 2025, we focused on ensuring sustainable access to health care by progressively integrating key services into Ministry of Health facilities. This strategic shift aimed to strengthen local health systems and preserve the ministry’s capacity to respond effectively to emergencies.
In June, after more than a decade of providing care at a hospital in Bentiu displacement camp, we successfully transferred all of our core medical services to Bentiu State Hospital, a public health facility that MSF runs in partnership with the Ministry of Health.
In July, we also transferred our long-running activities in the Malakal Protection of Civilians site to Malakal Teaching Hospital, aiming to build a more efficient and accessible health system for people in Malakal and across Upper Nile. In addition, we contributed to the provision of lifesaving surgical care at the hospital by renovating the operating theater and a 30-bed post-operative ward, and by providing specialized staff to assist with emergency cesarean sections and trauma injuries.
Toward the end of 2025, MSF opened a new project in Upper Nile, which adopts an agile approach to support multiple health facilities along the Sobat River. We have started delivering urgently needed medical care to people affected by displacement and conflict.
