Doctors Without Borders/Médecins Sans Frontières (MSF) teams are recording a concerning rise in measles and malnutrition cases in the organization’s facilities in South Sudan, particularly among returnees fleeing the conflict in Sudan and host communities. MSF medical facilities in Upper Nile, Unity, Northern Bahr El Ghazal, and Warrap states are all receiving patients with these critical conditions. Many of the patients are children under five years old.
As more returnees arrive at various border locations, MSF calls on donors and humanitarian organizations to urgently improve monitoring systems and scale up the response to ensure dignified conditions for displaced people and host communities from points of entry to places of resettlement.
“Measles and nutritional responses must be reinforced immediately,” said Mohammad Ibrahim, MSF head of mission in South Sudan. “Screening and vaccination at points of entry must be provided 24/7. Equally, mobile vaccination teams must be deployed in transit, reception sites, and within host communities to ensure continuous care for new arrivals that have been missed at the border. Community monitoring must be strengthened to prevent the further spread of measles.”
From left: Dr. Ran Jal kuol examines a child in the measles isolation ward at MSF's facility in Leer County; Nyanhial looks on as her niece receives treatment at MSF's pediatric ward in Bentiu camp. South Sudan 2023 © Nasir Ghafoor/MSF
Accommodating the arrival of hundreds of thousands from Sudan
Since the eruption of the conflict in Sudan in April, over 200,000 people have been registered crossing into South Sudan as of the first week of August. Over 90 percent of them are South Sudanese returnees, arriving exhausted and extremely vulnerable. Most are women and children and are struggling to integrate into host communities throughout the country, or living at transit centers close to the border. In both cases, they require essential services such as health care, access to clean water and sanitation infrastructure, food and non-food items, protection, and shelter.
“We are in a terrible situation,” said Nyakiire Nen, whose two-year-old daughter is receiving treatment for measles at the MSF hospital at Bentiu camp in Unity state. “We want three things to survive: The first is food, the second is plastic sheets for shelter, and third, we need medications.”
In light of the alarming influx of measles patients in Renk and Bentiu, MSF teams have set up dedicated isolation wards while MSF facilities are expanding their capacity to treat more patients in Aweil, Leer, and Malakal. In Twic County, MSF supported the establishment of a 25-bed measles isolation center at Mayen Abun Hospital and helped to equip it, and also supports the training of frontline health care workers on case definition, identification, and management of measles across eight primary health care centers.
In Upper Nile state, Renk is the busiest entry point to South Sudan for those escaping Sudan. Many are originally from White Nile state, Sudan, where MSF teams have identified over 1,300 suspected measles cases in the past month. Since June 20, the isolation ward set up by MSF in Renk County hospital has received 317 patients, and more than 75 percent are returnees. The youngest are the most affected, with more than 80 percent of patients being children under four years old, of whom less than 15 percent have ever been vaccinated against measles. Because these returnees are living in congested transit centers and travel in large groups on crowded trucks or boats, the spread of the disease is enormous. In Paloich, MSF launched a three-week emergency intervention on July 27, focusing on addressing the health and nutrition needs of over 3,000 people residing in the returnees' camp.
Many arrive sick and exhausted in South Sudan
“My children were healthy when we were in Khartoum,” said Martha Nyariek of her one-year-old daughter Nyageng and three-year-old son Bol, who are among hundreds of patients MSF medical teams have been treating in Unity state. “But on the way, they started having diarrhea and becoming weak. When we were moving with the boat from Malakal to Bentiu, the children started showing symptoms of measles.”
In Malakal, the humanitarian situation of returnees in Bulukat Transit Camp remains dire and is exacerbated by a lack of sufficient food and limitations on movement to final destinations. Returnees arrive in large numbers, including many sick people and particularly children. MSF facilities are also seeing an increase in malnutrition cases. MSF is running a mobile clinic in the transit camp, while its hospital—the only secondary-level health care facility for children—is operating beyond its bed capacity. Similarly, the MSF hospital in Aweil has witnessed a 65 percent increase in malnutrition cases in the first six months of 2023, compared to the same period last year.
“If a child is malnourished, they are more susceptible to measles and there is a higher risk of death,” said Ran Jalkuol, an MSF doctor. “Most of our patients are children who are unvaccinated. To prevent measles from taking more lives, there is an urgent need to scale up food support and to conduct catch-up vaccinations to immunize everyone, especially returnees over six months old. Children between six months and four years old are the most vulnerable.”
South Sudan is already prone to regular measles outbreaks. In 2022, health authorities declared two measles outbreaks, the second affecting all states and administrative areas in the country. The influx of returnees and increasing number of measles cases among displaced people and host communities is another burden on a health care system that is already inadequate for growing needs.
