Thousands at severe risk due to malnutrition and deadly diseases in Twic County

Sami Al-Subaihi is MSF’s emergency project coordinator in South Sudan. He shares his urgent concerns for more than 20,000 people who fled violent clashes and are now living in displacement camps. The lack of food and proper shelter, dismal water and sanitation conditions and impending rainy season, all spell disaster for the coming months. 

I hear from a community leader in Nyin Deng Ayuel camp that two children and an adult have died in the past two days. I find the mother of one of the children sitting by her five-year-old son’s small, freshly dug grave. Her three other children, all very thin and weak, sit at the entrance of the family’s improvised shelter.

Speaking with their mum, I can’t get an exact picture of what caused her son’s death, but looking over at his siblings, I’ve no doubt the lack of food contributed. 

Walking around the makeshift camps in Twic County, more than anything, this is what the community tells me they’re worried about: the lack of food. In one camp I see people collapsing, physically exhausted. They clearly haven’t had enough food for a while.

I don’t see anyone cooking or any food stored in any of the shelters. People tell me that there are almost no fish left in the drying river, forcing many to collect leaves to eat. The food shortages in the camps have been getting worse since February, when thousands of people first arrived here after deadly clashes forced them to leave their homes in Agok, 20 kilometres from here. 

The dire situation forced us to do something unusual and outside our regular medical activities. We’ve provided food to communities here – almost 500 metric tonnes of it in the past few months – to try to avert disaster. And we’re looking at organising more food drops in the coming weeks and months. 

This, in addition to running mobile clinics in six locations, where our medics regularly see very unwell kids with malaria and diarrhoeal diseases, and more recently, increasingly with malnutrition. The health issues we’re seeing reflect the dismal living conditions in the camps. 

For months, people have been surviving mostly out in the open, making do with bits of cloth and some plastic sheeting to shield them from the scorching sun and the constant threat of snakes and scorpions. I can’t see how these flimsy shelters will protect them from much if the seasonal rains are heavy this year. 

Our team has distributed blankets, mosquito nets, jerry cans and soap to around 10,000 families. We’ve also built more than 310 latrines, installed eight clean water stations, and are in the process of constructing some bore holes to provide even more clean water for thousands of people. 

But honestly, it’s not nearly enough. With the rains can come flooding, poorer living conditions, and less access to clean water and sanitation services, which will increase risks of disease outbreaks, like malaria, measles and cholera.  

Despite us sounding the alarm multiple times since the start of this emergency, I’m dismayed by the lack of a proper response from international organisations and government donors working in South Sudan. The response has been slow and inadequate.

And now, rather than scaling up, key organisations are being forced to reduce their activities because of funding cuts. At the same time, the skyrocketing cost of food globally is being felt acutely by already vulnerable communities hit by crisis after crisis in South Sudan.

Kneeling next to this grieving mother in Nyin Deng Ayuel camp, I wrack my brain to think of something meaningful to tell her. All of the usual offers of condolence I can think of just sound empty and hypocritical. Given the current conditions in the camp I know our prediction for the coming months isn’t bright and I worry for her three remaining children. 

For our part, we’re stepping up our activities – more food, clean water and latrines. We're also preparing the local health centres to care for an influx of malnourished kids and will do a preventative measles vaccination campaign with the South Sudanese Ministry of Health in the coming weeks. I hope we can avoid the worst and make sure other parents don’t suffer the same loss.  

MSF has been working in Abyei Special Administrative Area since 2006. MSF’s hospital – established in Agok in 2008 – was providing a wide range of health services for some 140,000 people. Following the initial violence that erupted on 10 February 2022 in and around Agok, we suspended services at the hospital and began providing medical and humanitarian assistance to people who had fled south to Twic County, Warrap State, and north to Abyei town in Abyei Special Administrative Area. From February to May 2022, our medical teams carried out more than 34,000 consultations for people from displaced and host communities in Twic County.