South Sudan

Cycles of violence have forced millions of people to flee

Sitting in the shade of a tree, patients wait to see a doctor.
SOUTH SUDAN 2017 © Frederic NOY/COSMOS
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Since December 2013, South Sudan has been splintered by conflict and factional fighting. Civilians are frequently targeted by armed groups and lack access to food, water, and basic health care.

Doctors Without Borders/Médecins Sans Frontières (MSF) teams are constantly adapting to respond to the needs—from supporting local hospitals to setting up mobile clinics and training community health workers.

Internal conflict has severely damaged the country’s infrastructure, leaving entire villages razed and many hospitals, schools, and businesses destroyed. More than 4 million people have been uprooted from their homes—including 1.9 million people displaced inside South Sudan, according to United Nations estimates. For many, access to even food and water is a struggle. In February 2017, famine was declared in parts of the country.

We are providing medical care—including treatment for malnutrition—in conflict zones, camps for displaced people, and in remote areas with no access to health care. South Sudan is among MSF’s largest programs, with 3,683 staff members in 2016, the vast majority of whom are South Sudanese. We have established networks of community health workers to help provide care in volatile areas.

Malaria is one of the leading causes of sickness and death in South Sudan, especially among children. In 2016, MSF treated more than 300,000 cases of malaria in the country. In 2017, teams worked to curb the spread of the disease ahead of the rainy season by increasing capacity at health care centers and providing rural communities with the tools to test and treat malaria themselves. As part of the program, MSF trains two volunteers in each village and provides the rapid test to diagnose malaria as well as the drugs for treatment of simple malaria.

“In many villages, it is extremely difficult to reach the hospital during the rainy season. People would have to carry the patient on a blanket or a sheet and walk for several hours,” says Tara Smith, supervisor of the community malaria project in Agok. “Sometimes a few hours can make the difference between life and death.” The team visits each village weekly to follow up with volunteers and bring supplies. “The community takes a lot of pride in being able to do this for themselves,” says Smith. “One chief told me, ‘Thanks for bringing a small hospital to us.’”

At Aweil state hospital, MSF teams manage the pediatric and maternity wards, expanding the number of beds as needed, resupplying the pharmacy, and training staff to prepare for severe cases.

Providing humanitarian aid in many areas of the country can be complicated and dangerous. In April 2017, intense fighting around Kodok, in the Upper Nile region, forced our team members to flee alongside some 25,000 people from the area. MSF suspended activities, but the team continued to provide medical care even while on the run, travelling on foot to a camp on the border of Sudan. Within days, MSF supplied “runaway bags” full of vital tools and medicines to 29 staff who accompanied the local community. “With the bag, we were able to help people on the way,” says Kor Wharal, MSF’s community health promotion supervisor. “I provided asthma medicines and oral rehydration solutions… People are hungry and thirsty.”

In July 2017, armed men broke into an MSF facility in Pibor and injured two staff members after threatening other team members with guns. The attack was just one among a series of violent incidents that have forced MSF to reduce activities for periods of time.

MSF runs the only hospital in the Malakal protection of civilians (PoC) site, one of several such camps for displaced people established at UN bases across the country. In February 2016, that hospital was attacked, leaving more than 25 people dead, including two staff members. MSF published a report on the events and launched an advocacy campaign calling on the UN to provide credible security to civilians under its care and improve conditions in the PoC sites. Determined to provide needed care in the region, we built a new 60-bed hospital in Malakal PoC site in June 2016 and opened a medical center in Malakal town to serve the area’s growing population.

In the war-torn Fangak area, we reorganized our presence in 2016 to provide health care to those who need it most. We handed over outpatient activities in Old Fangak and began operations in New Fangak, where only a few other humanitarian organizations are present.

MSF first worked in the region that is now South Sudan in 1983.

MSF in South Sudan

Photo essay: Enduring Bentiu