NEW YORK/JUBA, AUGUST 20, 2020—Intercommunal fighting has repeatedly erupted in Jonglei and the Greater Pibor Administrative Area of South Sudan this year, where thousands of displaced people are living in the open without health care, adequate food, shelter, water or sanitation following the latest cycle of violence from June to mid-August, Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

MSF teams are now running clinics in the heavily affected towns of Pibor and Pieri, after violence in June forced MSF to suspend activities in Pibor. Josh Rosenstein, MSF emergency coordinator in Pibor, gave the following account:

"We have witnessed mass displacement in the last two months, and we hear of large-scale violence against civilians. To see our patients and our staff suffer so much in such a short time period is heartbreaking and enraging. We are relieved to be providing primary health care at a time in the year when normally this community suffers from malnutrition, waterborne diseases and malaria, but we are disheartened and disturbed to hear testimonies from our patients and our staff about the impact the violence.

"Our current strategy is to provide basic health care to as many people as possible. We started with an emergency primary health care clinic in the center of town so that it could be easily accessed by both the host community and displaced people. We intend soon to reach people in areas around Pibor who might not have access to health care in the town center. The needs remain massive as this community was hit by floods late last year and two serious rounds of conflict this year. The timing could not be worse right now in the middle of the rains and during the lean season."

Sebit Burane, MSF nursing team supervisor in Pibor, gave the following account: "It is not the first time we have had such intercommunal clashes and violence. In the past it was about cattle raiding... It is now more seriously affecting our community. We are seeing the loss of property, the loss of life. We lose our cattle. We lose our children."

Marta, a 19-year-old woman from Pibor, said: "We have been living a miserable life. This all started in February, and we would have never expected this situation to last for long. … I ran into the bush with my three-month-old daughter. She was sick and died in July. Today is the first time that I have had access to a health care facility since February."

In Pibor, MSF treated 11 patients for gunshot wounds after opening its clinic, the youngest of whom was three years old. In Pieri, MSF treated more than 100 wounded people in a week from July 29 onward.

Reaching the MSF clinics from the outlying areas can be an arduous process.

"I lost five members of my family," said Peter, a 43 year-old-man from Modit, Jonglei State. "After I [was] injured I was transported on a stretcher carried by different men. It took us 11 days to reach Pieri. There were heavy rains that slowed us down."

There are very few hospitals in South Sudan with the capacity to manage mass influxes of patients requiring surgery. As a result, dozens of patients from Pieri were evacuated for urgent surgery to the MSF hospital in the Bentiu Protection of Civilians site, while those in Pibor needing complex treatment were referred to South Sudan's Juba Military Hospital.

"The numbers of patients were staggering, putting significant pressure on our medical teams," said Tila Muhammad, MSF head of mission in South Sudan. At that moment our hospital in Bentiu, where the most serious patients were being referred, was already stretched for bed capacity due to a peak in malaria cases."

In recent weeks heavy rains have hampered such referrals. Dirt roads turn to mud and become impassable, and unpaved airstrips have become unusable. Many patients who were referred earlier to Bentiu are stuck there. The already complex situation is further hampered by travel restrictions due to COVID-19.

MSF has so far conducted more than 1,500 medical consultations in and around Pibor, distributed mosquito nets, and provided antenatal care to nearly 300 pregnant women.

A timeline of violence

Since February 2020, the Jonglei-Pibor region has experienced extraordinarily high levels of violence.

February – the MSF team in Pibor set up an emergency clinic in response to large numbers of displaced and wounded arriving.

March – MSF's clinic in Pieri received 68 wounded patients in just 12 hours. In that same wave, we treat 15 people in Lankien and 45 wounded people in Pibor.

May – fighting reaches Pieri. Among those killed is an MSF staff member. Local authorities estimate that 200 people died in total, around 300 were wounded. MSF staff had to evacuate and operations were suspended for two days.

June – MSF suspends activities in Pibor town following localized clashes, and MSF's ability to restart is hampered by ongoing violence and restrictions imposed by COVID-19.

July – Fighting continues with MSF teams in Pieri receiving more than 100 wounded people in just one week from July 29 onward.

August – MSF relaunches an emergency response in Pibor town on August 11, treating 11 gunshot-wounded patients in the first week.