The war in Sudan began in April 2023 and has since created the world’s largest displacement crisis, with more than 10 million people forced to flee their homes. More than 680,000 people  have arrived in South Sudan since last April, at a time when the country’s health system and existing humanitarian assistance can barely meet local needs. In the coming months, the pressure on health services and aid organizations is likely to increase, with an estimated 7 million people predicted to be without access to sufficient food by July.   

Renk in South Sudan’s Upper Nile state is located about 37 miles from Joda, the official entry point for people fleeing the war in Sudan. Some 13,000 refugees and returnees are currently stranded in and around the town’s transit center. The number fluctuates depending on whether they wait to be able to continue their journeys across South Sudan, or return home to Sudan. Living conditions are dire, with limited food, water, shelter, sanitation facilities, and medical care.

Malnutrition admissions have doubled

Many of those who arrive at the border are injured and acutely malnourished, having walked for weeks to reach safety. Currently, aid agencies provide them with money to buy food for seven days, but many people find themselves stuck at Renk transit center for weeks or even months while they wait for transport to continue their journeys. 

“Sometimes we manage to eat twice a day, but usually we only eat breakfast and we go to bed at night with empty stomachs, even the youngest ones,” said Dak Denj, a 70-year-old cattle herder who has been staying at Renk transit center since December 2023.

About 186 miles from Renk, thousands of refugees and returnees are living in Bulukat transit center, near Malakal town. Shortages of food, water, shelter, and proper sanitation have led to increases in illnesses such as diarrhea and respiratory infections, according to MSF medical teams.

The continuing influx of refugees and returnees to South Sudan is likely to worsen already acute shortages of food and water among both new arrivals and host communities and make it even harder for people to access medical care. 

Before April 2023, 30 to 50 severely malnourished children were admitted each month to the inpatient malnutrition treatment center at MSF’s hospital in Malakal town. Since the outbreak of war in Sudan, the number of severely malnourished children admitted to the facility has doubled. 

Children who are malnourished are more vulnerable to other life-threatening diseases. “Malnutrition increases the risk of infection, particularly among children under five, who are more likely to die from diseases such as meningitis, measles, yellow fever, cholera, and malaria,” said MSF medical coordinator Dr. Eltigani Osman.

Water shortages compound risks

Water shortages across the region are forcing people to collect water from rivers. Drinking untreated water, which may be contaminated, poses additional health risks, particularly in a region prone to cholera outbreaks. These risks are likely to increase with the approaching rainy season, which is expected to cause serious flooding across the region, contaminating wells and boreholes and hindering the humanitarian response. Flooding on the Sudanese side of the border could push even more people to flee to South Sudan. 

We urgently call on international donors to allocate funding to address the needs of the returnees, refugees, and host populations in South Sudan. This must include the provision of food, water, shelter, sanitation, and medical care, as well as the means for people to continue their journeys. 

Aid organizations are currently struggling to respond to the crisis and assist everyone in need. Since April 2023, MSF has been running a clinic at the main border crossing and two mobile clinics around Renk and Bulukat, which treat around 190 patients each day, as well as supporting Renk Hospital. However, this is not enough, and the scale of the crisis demands a much larger international response.  

“The humanitarian response remains inadequate to the reality of the needs, in a context where there is already considerable strain on the health system,” said MSF head of mission Iqbal Huda.

“We urgently call on international donors to allocate funding to address the needs of the returnees, refugees, and host populations in South Sudan. This must include the provision of food, water, shelter, sanitation, and medical care, as well as the means for people to continue their journeys.”  MSF