“I have lived through many wars, but this kind of displacement has never happened before,” says Moses, who, at 77 years old, fled his home in Lankien, Jonglei state, South Sudan as conflict intensified. “I have never seen civilians’ homes burned to ashes on such a scale. We are now living under the trees.”

An escalation of violence between government forces and opposition groups in and around Lankien and along the Sobat River in Upper Nile state, in South Sudan’s northeast, has forced tens of thousands of people from their homes. Many families fled on foot, walking for days, to escape attacks and burned villages.

At least 25,000 people have sought refuge in Chuil, Jonglei state, and thousands more are scattered across surrounding villages and swamps. Others have moved to Nyangore and Barmach in Upper Nile, and an additional 28,000 people have arrived in Minkaman, Lakes state. Many have had to flee multiple times. People arrive with nothing and are now living outdoors without any shelter, or in makeshift settlements without adequate food, clean water, or healthcare.

“This situation is about life and death,” says Nyamai, a mother of three who is living in an informal displacement site in Chuil. “At one point, we survived by boiling leaves from the trees and eating them.”

“We had nothing else. The needs go beyond hospital care and medicine,” she says. “We need food, water, and shelter. Without these, survival here will not be possible.”

Scaling up activities to support thousands left without care

Médecins Sans Frontières (MSF) is scaling up medical and humanitarian support for people displaced in Chuil and in Ulang county. In Chuil, MSF has upgraded the healthcare centre, increasing capacity to 60 beds to provide emergency care, treatment for malnutrition, maternal health services, and stabilsing trauma cases. Since late February, our teams have provided 2,200 consultations, admitted 172 patients to Chuil healthcare centre, and referred 16 patients for further treatment.

Our teams also distributed relief items – including mosquito nets, blankets, soap, jerry cans, sanitary pads, plastic sheeting, and empty sandbags – to more than 1,500 families to help them cope with the harsh living conditions. More distributions will follow. To help with water and sanitation services, MSF is building 300 latrines and constructing a water purification plant. 

Our teams also travel by boat through swamps and rivers to run mobile clinics in Yakuach, Tanakuacha and Pathiel, areas around Chuil. We have provided 1,349 medical consultations and have referred some patients needing higher-level care. More than 70 MSF staff members who were also displaced from Lankien are now supporting the response in Chuil. In the coming weeks, we will establish a health post in Tanakuacha, while our teams will continue running mobile clinics in Yakuach and Pathiel, providing referrals, mental health activities, outpatient consultations, and sexual and reproductive health activities.

Since early March, in Minkaman, Lakes state, MSF has provided 2,210 consultations to new arrivals from Jonglei through mobile clinics. We have also made donations of medical items to Minkaman healthcare centre, and are reinforcing their capacity to respond to disease outbreaks. Our water and sanitation teams have also drilled two boreholes, repaired broken hand pumps, and are renovating the surface water treatment plant and constructing emergency latrines.

Displaced by violence, left without protection

“Humanitarian organisations are increasing activities in Chuil area and in Minkaman, but the response still falls short, and many remote communities remain without lifesaving assistance,” says Zakaria Mwatia, MSF head of mission in South Sudan. “We call for an urgent and coordinated scale-up of other humanitarian groups, to reach people in the hardest-hit areas — especially those still cut off from aid.”

“Without sustained support, the risk of disease outbreaks and further displacement could rapidly escalate into catastrophe,” says Mwatia.

Major gaps remain, particularly in nutrition and water, sanitation, and hygiene, raising the risk of cholera and other waterborne diseases. Screenings in Chuil show alarming malnutrition levels: of 1,263 children under five screened, 54 percent were acutely malnourished. A further 21.5 percent of 609 screened pregnant and breastfeeding women were also acutely malnourished. Referrals of complicated cases remain a challenge as well.

Continued attacks on civilians and health facilities

The crisis is unfolding in a region where access to health care was already limited. In 2025, the MSF-supported hospital in Ulang was looted and destroyed, and just last month, Lankien hospital was bombed, closing the two main referral hospitals for the region.

“We are seeing a deeply alarming pattern of attacks on health facilities and health care workers, alongside violence against civilians,” said Tuna Turkmen, MSF emergency project coordinator. “Chuil now hosts a large number of civilians who have fled fighting, including women, children, and elderly people.”

“The town also provides one of the few functioning health facilities in the area, and many aid organisations are coordinating their medical and humanitarian activities from there,” says Turkmen. “It is essential that communities can access these services, and that humanitarian and medical workers can carry out their work safely and without restriction.”

“In swampy areas around Lankien, thousands remain in dire conditions, still waiting for assistance,” continues Turkmen.  “People continue to arrive every day. Displaced MSF medical staff there are doing everything they can, but patients die due to lack of medicine. We have requested access from local authorities, so far without success.”

Humanitarian access remains limited and irregular; safe, sustained, uninterrupted access must be guaranteed. MSF calls all parties to the conflict to take all feasible measures to spare civilians from the effects of hostilities. Civilians and civilian infrastructure, including healthcare, must never be targeted; direct attacks against them constitute serious violations of international humanitarian law. Any further escalation of fighting in or around Chuil would have devastating consequences for civilians sheltering there, severely disrupting lifesaving medical and humanitarian assistance.