In two weeks, the number of people testing positive for COVID-19 in South Sudan has jumped from six to over 200 (203 as of 13 May). South Sudan has one of the most fragile health systems in the world and an estimated 7.5 million people in need of humanitarian aid.

The country hosts nearly 1.5 million internally displaced people, with an estimated 188,000 of them living in Protection of Civilians camps (PoCs), created to shelter vulnerable communities fleeing violence and conflict. In the past days, two of these PoCs, including the largest one in Bentiu where MSF runs a hospital to support the population of over 118,000, and another one in the capital of Juba, have registered cases of the new coronavirus.

“This sharp increase in COVID-19 patients is very worrying,” says Claudio Miglietta, MSF's head of mission in South Sudan. “What is even more concerning is that now COVID-19 has started spreading among the population of some of the largest and most congested displaced persons camps in the country.”

Tens of thousands of people living in the Protection of Civilian sites in South Sudan, such as Bentiu or Malakal, face a precarious existence in an overcrowded environment, living in dire conditions with flimsy small shelters where up to 12 family members live together, and with poor access to water and soap. Maintaining physical distance and adequate hygiene levels in these settings is nearly impossible.

“If we add the fact that many people – not only in the camps but around the country in general – are at a higher risk not only due to poor living conditions, but also potentially due to co-morbidities such as malnutrition, respiratory tract infections, malaria, tuberculosis and HIV, it is easy to see how the spread of COVID-19 could have catastrophic consequences in South Sudan,” says Miglietta. “The pandemic is having a significant impact on our ability to provide key lifesaving services.”

Other diseases, as well as conflict and violence, have not been put on hold because of COVID-19. Malaria, measles, pneumonia and acute watery diarrhoea still kill tens of thousands of people, chronic patients continue to need medication, war wounded need surgery and mothers are still delivering babies every day. Just now, a resurgence of violence around Yei, in the south of the country, has caused the displacement of around 12,000 people.

“With active transmission of COVID-19 in the area, addressing their needs while keeping our staff safe with the global shortage of surgical masks and other personal protective equipment, becomes very challenging,” says Miglietta. “We fear this kind of situation will become more and more common as the virus spreads across the country.”

Since the pandemic was declared, MSF has been working with the South Sudanese authorities to strengthen infection prevention and control measures and to train healthcare workers on how to screen patients and work safely. We have also been reaching out to communities to share advice on how to prevent the spread of COVID-19.