South Sudan: MSF suspends medical activities in Pibor amid another round of intense fighting

New upsurge of violence could have a disastrous impact on children’s health

Mothers wait with their babies to be seen at the outpatient department of MSF's Primary Healthcare Clinic in Pibor in January 2019.
South Sudan 2019 © Laura McAndrew/MSF
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NEW YORK/JUBA, JUNE 25, 2020—A new and brutal rise in intercommunal clashes in the Greater Pibor Administrative Area of South Sudan has led Doctors Without Borders/Médecins Sans Frontières (MSF) to suspend its medical activities in Pibor after most staff sought safety in the surrounding remote bush area. They are among thousands of people who have fled as intense fighting over several days once again threatens the lives and health of entire communities, said the international medical humanitarian organization. This new upsurge of violence could have a disastrous impact on children’s health as MSF teams are already seeing worrying trends in malaria and malnutrition cases.

The violence, which appears to be a resurgence of intercommunal tensions that started in February, erupted on June 15 around Manyabol as armed groups moved towards the village of Gumuruk a few days later. It is reported that almost everyone who could flee did so as the fighting got closer. In Pibor, several dozens of miles from there, MSF received three patients with gunshot wounds in its primary health care center before suspending its activities on June 19.

“What I have seen is extremely traumatic,” said MSF nurse Regina Marko Ngachen. “The fighting has reached Lawo village, which is about two hours from Pibor town. The fighters are raiding cattle, burning houses, destroying property, and looting. I have treated patients with bullets still lodged in their bodies, but due to fear, they have been forced to flee to the bush before we could help treat them and we do not know their whereabout now.” 

The fighting is now approaching Pibor town, in the east of the Greater Pibor Administrative Area, with almost all residents choosing to seek refuge in the surrounding bush, including MSF staff.

“Our staff fled with their families, fearing for their lives and those of their loved ones,” said Ibrahim Muhammad, MSF’s head of mission in South Sudan. “Without staff, we can’t keep running the health facility. We are really concerned because people are left without access to health care when they need it most. If the clashes persist, we can expect more wounded. We will soon arrive at the height of the malaria season, and without proper shelter, people will further be exposed to life-threatening diseases. This further amplifies an already alarming nutritional situation, especially among children under five. As soon as the situation allows, we are committed to resume our medical activities in the area.”

This new upsurge of violence could have a disastrous impact on children as recent health indicators showed worrying trends. Specifically, the last health indicators showed that more than 70 percent of children under five treated in MSF’s primary health care center in Pibor had malaria, compared to 43 percent last year during the same period. Recent malnutrition rates indicates worrying and looming acute food crisis, as 6 percent of cases being treated in the center are severe acute malnutrition.

This new wave of strife hampers prompt and safe access for humanitarian organizations to a community recovering from the devastating floods that happened at the end of 2019. Now, following decades of war, the COVID-19 pandemic threatens an already fragile health infrastructure and people’s access to health care. If unmitigated, these factors frame a recipe for a dire humanitarian situation.

Since the beginning of the year, MSF has repeatedly raised the alarm about the deteriorating situation in the Greater Pibor Administrative Area after a series of brutal episodes of violence. In March, MSF teams treated more than 45 gunshot-wounded in Pibor after a new upsurge of intercommunal clashes, and 83 wounded patients were taken care of in Pieri and Lankien over five days between March 9-13. Only a month ago, another flareup of violence in Pieri killed an MSF staff member and left scores of others injured. MSF is deeply troubled that this pattern of violence might once again push this area of eastern South Sudan into a period of extreme violence, like that which was experienced in 2011-12.

“As the fighting keeps happening, the population is left each time more vulnerable,” Muhammad said. “Civilians are the ones paying the heaviest price of this cycle of fierce violence, pushed into repeated displacement, losing their homes and livelihoods, when not wounded or killed. Civilians must be protected, and humanitarian organizations need to have access to the area to be able to ensure an adequate level of care and assistance for the affected population and wounded people.”

MSF has been working in the region that today constitutes the Republic of South Sudan since 1983, and since 2005 in the Greater Pibor Administrative Area. In 2019, MSF treated more than 32,000 patients in the primary health care center in Pibor, most of them suffering from malaria, respiratory infections, and diarrhea.