Nutrition assistant Abubakar Sediq prepares a prescription for a woman after examining her in MSF’s new hospital in Al Kashafa refugee camp, in Sudan’s White Nile state. © MSF/Musab Sahnon

Intense fighting in eastern South Sudan, forces thousands of people to flee

Thousands of people have fled into the bush in the Greater Pibor Administrative area in eastern South Sudan as intense fighting over several days yet again threatens the lives of entire communities, warns the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF). The new and brutal rise in intercommunal clashes has led MSF to suspend its medical activities in Pibor after most staff sought safety in the remote bush area.


The violence, which appears to be a resurgence of intercommunal tensions, erupted on June 15, 2020 around Manyabol as armed groups moved towards the village of Gumuruk a few days later. It is reported that almost everyone who could fled as the fighting got closer. In Pibor, several dozens of kilometres from there, MSF received three patients with gunshot wounds in its primary health care centre (PHCC).

“What I have seen is extremely traumatic, I have seen signs of fear and witnessed extreme feelings of sadness in people’s eyes due to the recurring violence. The fighting has reached Lawo village which is about two hours from Pibor town. The fighters are raiding cattle but also burning houses and 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 bushes before we could help treat them and we do not know their whereabout now,” says MSF nurse Regina Marko Ngachen.

The fighting is now approaching Pibor town, in the east, 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. Without staff, we can’t keep running the health facility. We are really concerned because people are left without access to healthcare when they need it most,” says Ibrahim Muhammad, MSF Head of Mission in South Sudan. “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 the children under five. As soon as the situation allows, we are committed to resume our medical activities in the area.”

In 2019, MSF treated over 32,000 patients in the PHCC in Pibor, most of them suffering from malaria, respiratory infections and diarrhea. This new upsurge of violence which has led to forced displacement of thousands could have a disastrous impact on children’s health status as last week’s indicators already showed worrying trends. Over 70% of the children under five treated in MSF’s PHCC had malaria, compared to 43% last year at the same period. Recent malnutrition rates, at 6% of Severe Acute Malnutrion (SAM) ,among children treated in the PHCC is an indicator of a worrying and looming acute food crisis.

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, and now the COVID-19 pandemic additionally threatens a community’s access to, following decades of war, an already fragile health infrastructure, and if unmitigated, these factors frame a recipe for a dire humanitarian situation.

Since the beginning of the year, MSF alerted repeatedly on the deteriorating situation in the Greater Pibor Administrative area after a series of brutal episodes of violence. In March, MSF team 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 the space of just five days between 9-13 March. 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 an epicenter of extreme violence, as described in a 2012 MSF report with horrors of intercommunal violence.  

“As the fighting keep happening, the population is left each time more vulnerable. 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 an effective access to the area to be able to ensure adequate level of care and assistance for the affected population and wounded people,” adds Ibrahim Muhammad, MSF Head of Mission.