When South Sudan emerged as the world’s newest nation in 2011, hope soared for a fresh start. But just two years later, the country plunged into a brutal civil war. The 2018 peace deal offered a fragile chance at recovery, but in 2025 that hope has been shattered.
Last year witnessed the most severe escalation in violence since the peace agreement. More than 300,000 people have been uprooted from their homes, and at least 2,000 killed, as fighting spreads from one state to the next. In the first half of 2025, MSF alone treated over 740 people for violence-related injuries in Jonglei and Upper Nile, including gunshot wounds and burns.
Funding is decreasing just as conflict is driving up needs
The surge in conflict is unfolding precisely as international aid, particularly support for health services, falls to its lowest level since independence. Across the areas where MSF works, health facilities are barely functioning or have shut down entirely. The Health Sector Transformation Project—the multi-donor initiative launched in July 2024 to support 1,158 facilities—is faltering with roughly 30 percent of the targeted facilities receiving no support at all. Many of those that do, remain crippled by stock-outs and understaffing. Compounding this, the government allocates less than two per cent of its national budget to health, far below its own 15 percent commitment.
The result is a perfect storm. Armed clashes now converge with flooding, acute malnutrition, disease outbreaks, and the near collapse of basic services. Millions of South Sudanese are being pushed into a catastrophe at a scale not seen since 2018.
It is not only a lack of resources or a poorly functional aid system that has led to the closure of facilities. Violence has involved direct and indiscriminate attacks on civilians and health facilities, in violation of international humanitarian law. MSF has suffered nine attacks on its hospitals or staff this year, resulting in the forced closure of two hospitals in Greater Upper Nile, as well as the suspension of essential primary care activities in Jonglei, Upper Nile, and Central Equatoria. None of this can become the “new normal.”
In many conflict-affected and hard-to-reach areas, medical humanitarian actors like MSF are the only ones providing lifesaving services. When facilities are destroyed, communities are left with nowhere to turn. The closure of two hospitals and suspension of services left more than 400,000 people without access to essential health care. When an MSF hospital in Ulang was attacked and looted, more than 100 patients—pregnant women, children, and survivors of violence—were receiving critical treatment at the time.
One MSF colleague describes fleeing Ulang and temporarily sheltering in a health centre in Nasir County. He witnessed a mother arrive in labour, but her baby died. When the mother developed a postpartum
infection, staff struggled to deliver care due to a lack of essential equipment and drugs, including antibiotics. Displaced again by aerial bombardments, the MSF team took the mother to the Ethiopian border—the closest place she could receive treatment.
The current health system is already unable to cope, and unacceptably high numbers of people, largely women and children, continue dying from treatable and preventable diseases. People arrive at facilities to find there are no drugs. On top of that, since the beginning of the war in Sudan, more than one million returnees and refugees have entered South Sudan seeking safety, adding further strain to an already fragile medical and humanitarian system.
Donor fatigue cannot define 2026
Donor support to the health system has dwindled in recent years. Major UK Aid Direct cuts in 2022 left around 200 facilities—including eight major hospitals—unsupported. In early 2025, the United States, which funded 55 percent of South Sudan’s humanitarian appeal, announced a suspension and subsequent termination of many humanitarian contracts.
What is needed now is a shift in response and renewed commitment from donors, not turning away. The scale of suffering is growing, and no single organization can fill the gaps alone. The international community must renew its commitment: funding cannot falter, and donor fatigue cannot define 2026.
At the same time, the country’s health system needs urgent, tangible support. Programs like the Health Sector Transformation Project are vital lifelines, but they cannot function on paper alone. Medicines must reach those who need them, facilities must be staffed and equipped, and care must extend beyond the basics to meet urgent, life-saving needs.
The children, families, and communities of South Sudan deserve more than plans and promises—the world must deliver. For this to happen, humanitarian access, protection of civilians, and respect for health facilities must be guaranteed. The Government of South Sudan must also scale up its national budget allocations for health, in line with its Abuja Declaration commitment of allocating 15 per cent to health. Without action, another crisis—worsening day by day—is taking shape in East Africa; a region already burdened by multiple emergencies.
The author, Mamman Mustapha, is the MSF Country Director in South Sudan. He joined MSF as a nurse in 2007, working in nutrition and measles programmes in northern Nigeria. He has since worked across several countries, including Nigeria, South Sudan, Yemen, Uganda, Afghanistan, and Libya.
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