By Pojanee Fleury, Staff Writer January 29, 2025
January 2025 brought fresh challenges to South Sudan’s struggling healthcare system as security threats forced one of the world’s leading humanitarian organizations to cease operations in two counties
In a stark reminder of the dangerous conditions facing humanitarian workers in South Sudan, Doctors Without Borders (MSF) announced the suspension of its operations in two counties in Upper Nile State following a harrowing attack on its staff in January 2025. The incident, which forced aid workers to jump into a river to escape gunfire, underscores the deteriorating security environment that continues to plague the world’s youngest nation more than a decade after its independence.
A Deadly Encounter on the River
The attack unfolded on January 15, 2025, when six MSF staff members were traveling by boat along a river in Upper Nile State after completing a routine mission to deliver essential hospital supplies to remote communities. What began as a standard humanitarian operation quickly turned into a life-or-death struggle when unidentified gunmen opened fire on their vessels.
The suddenness and intensity of the assault left the aid workers with no choice but to abandon their boats and leap into the river to escape the barrage of bullets. Swimming desperately toward the safety of a nearby village, the staff members managed to reach shore, though one colleague sustained injuries during the chaotic escape.
The attack represented more than an isolated incident of violence; it symbolized the broader challenges facing humanitarian organizations attempting to provide essential services in a country where security remains elusive and armed groups operate with impunity across vast territories.
Upper Nile State’s Strategic Importance
Upper Nile State, located in the northeastern region of South Sudan, has long been a focal point of conflict and humanitarian need. The state’s strategic location along major river systems and its rich oil reserves have made it a contested area since South Sudan’s independence in 2011, with various armed groups vying for control over territory and resources.
The region’s geography, characterized by seasonal flooding and limited road infrastructure, makes river transport essential for delivering humanitarian aid to isolated communities. This dependence on waterways, however, also creates vulnerabilities that armed groups have increasingly exploited to target aid operations and control access to remote areas.
MSF’s operations in Upper Nile State were crucial for providing healthcare services to communities that would otherwise have no access to medical care. The organization’s mobile clinics and supply missions served as lifelines for populations affected by conflict, displacement, and natural disasters in an area where government health services remain extremely limited.
MSF’s Difficult Decision
The decision to suspend operations in two counties within Upper Nile State was not taken lightly by MSF, an organization renowned for its commitment to providing medical care in the world’s most dangerous and challenging environments. The attack on their staff crossed a red line that made continued operations untenable given the organization’s responsibility to ensure the safety of its workers.
MSF officials emphasized that the suspension was a direct response to the security incident and the broader deterioration of conditions that made safe humanitarian access increasingly impossible. The organization had previously worked in the area despite significant challenges, but the targeted nature of the attack and the apparent impunity of the perpetrators left them with little choice but to withdraw.
The suspension affects not only immediate medical services but also longer-term health programs, including vaccination campaigns, maternal health care, and treatment for malnutrition—services that are desperately needed by vulnerable populations who now find themselves cut off from essential care.
A Pattern of Violence
The attack on MSF staff fits within a broader pattern of violence targeting humanitarian workers throughout South Sudan. Since achieving independence in 2011, the country has consistently ranked among the most dangerous places in the world for aid workers, with frequent incidents of kidnapping, assault, and murder affecting both local and international staff.
The perpetrators of such attacks often remain unidentified and unpunished, creating an atmosphere of impunity that emboldens further violence against humanitarian operations. Armed groups across the political spectrum have shown little respect for humanitarian principles, viewing aid organizations as potential targets for robbery, extortion, or political intimidation.
This systematic targeting of humanitarian workers has far-reaching consequences beyond the immediate victims. Each attack sends ripples of fear through the humanitarian community, leading to restricted movements, reduced programming, and ultimately, fewer services for the populations most in need of assistance.
South Sudan’s Ongoing Crisis
The MSF suspension comes at a time when South Sudan faces multiple, overlapping crises that have pushed the country to the brink of humanitarian catastrophe. More than a decade after independence, the nation continues to grapple with the legacy of decades of civil war, weak institutions, and limited infrastructure development.
Political instability remains a defining feature of South Sudan’s governance landscape. While a peace agreement signed in 2018 officially ended the most recent phase of civil war, implementation has been slow and incomplete. Armed groups continue to operate outside government control, while ethnic tensions and resource competition fuel localized conflicts across the country.
The economic situation has deteriorated dramatically in recent years, with hyperinflation, currency devaluation, and widespread corruption undermining the government’s ability to provide basic services to its citizens. Oil revenues, which should provide a foundation for development, have been diverted to military spending and patronage networks rather than investment in healthcare, education, and infrastructure.
Climate and Natural Disasters
South Sudan’s humanitarian challenges have been compounded by unprecedented flooding in recent years, which has displaced hundreds of thousands of people and destroyed agricultural land, livestock, and infrastructure. The country’s vulnerability to climate change has created cycles of flooding and drought that disrupt livelihoods and increase dependence on humanitarian assistance.
The 2023-2024 flooding season was particularly devastating, affecting over one million people and creating conditions that facilitated the spread of diseases including cholera, malaria, and measles. The floods also disrupted humanitarian access routes, making it even more difficult for organizations like MSF to reach affected populations.
These environmental challenges interact with existing conflicts and governance failures to create complex emergencies that require sustained international attention and resources. The withdrawal of humanitarian services due to security concerns only exacerbates these challenges.
Refugee Influx
South Sudan’s internal challenges have been complicated by a massive influx of refugees from neighboring Sudan, where ongoing civil war has displaced millions of people. Over 700,000 Sudanese refugees have crossed into South Sudan since fighting began in Sudan in April 2023, straining already limited resources and creating additional humanitarian needs.
Many of these refugees have settled in border areas where security is particularly precarious and where humanitarian access was already limited. The attack on MSF staff occurred in a region that has received significant numbers of Sudanese refugees, highlighting the complex security dynamics created by population movements and resource competition.
The refugee crisis has overwhelmed South Sudan’s capacity to provide basic services, with refugee camps lacking adequate water, sanitation, healthcare, and educational facilities. International humanitarian organizations have struggled to meet these needs while also addressing the requirements of South Sudan’s own displaced population.
Regional Security Implications
The deteriorating security situation in South Sudan has implications that extend beyond the country’s borders. The presence of armed groups, the proliferation of weapons, and the weakness of state institutions create conditions that can destabilize the entire region.
Cross-border movements of armed groups and criminal networks have created security challenges for neighboring countries, while the flow of refugees has strained regional resources and created potential sources of tension. The inability to provide adequate humanitarian assistance to affected populations only exacerbates these regional dynamics.
The attack on MSF staff also highlights the challenges facing international efforts to support peace and stability in South Sudan. Despite significant investments in peacekeeping, humanitarian assistance, and development programming, the country continues to experience cycles of violence and crisis that undermine progress toward sustainable peace.
Impact on Healthcare Access
The suspension of MSF operations in Upper Nile State has immediate and severe implications for healthcare access in affected communities. MSF was often the only provider of specialized medical care in remote areas, offering services ranging from emergency surgery to treatment for tuberculosis and other infectious diseases.
Pregnant women, children under five, and individuals with chronic conditions are particularly affected by the loss of MSF services. In a country where maternal mortality rates are among the highest in the world and child malnutrition is widespread, the absence of humanitarian medical care can literally mean the difference between life and death.
The psychological impact on communities is also significant. The knowledge that even international humanitarian organizations cannot safely operate in their areas sends a powerful message about the severity of local security conditions and the likelihood that conditions will improve in the near term.
Challenges for Other Organizations
The MSF suspension raises questions about the operations of other humanitarian organizations working in South Sudan. Many agencies are likely reassessing their own security protocols and operational areas in light of the attack, potentially leading to further reductions in humanitarian coverage.
Local organizations, which often have deeper community connections and may be able to operate in areas where international agencies cannot, face their own challenges including limited resources, capacity constraints, and security risks that can be even greater than those faced by international organizations.
The coordination of remaining humanitarian services becomes more complex as organizations adjust their operational areas and security procedures. This can lead to gaps in coverage and duplications of effort that reduce the overall effectiveness of humanitarian response.
The Path Forward
The MSF suspension highlights the urgent need for improved security conditions in South Sudan if humanitarian organizations are to continue providing essential services to vulnerable populations. This requires action from multiple stakeholders, including the South Sudanese government, regional partners, and the international community.
Government authorities must take concrete steps to investigate attacks on humanitarian workers and hold perpetrators accountable. The culture of impunity that currently exists creates incentives for further violence and undermines efforts to create secure environments for humanitarian operations.
International partners, including the United Nations Mission in South Sudan (UNMISS), must consider how their peacekeeping and protection mandates can better support humanitarian access. This may require adjustments to deployment patterns, rules of engagement, or coordination mechanisms with humanitarian organizations.
Lessons for Humanitarian Operations
The MSF incident provides important lessons for humanitarian operations in high-risk environments. The need for robust risk assessment, flexible operational modalities, and strong security protocols is evident, but these measures must be balanced against the imperative to reach populations in need.
The attack also underscores the importance of community acceptance and local partnership in humanitarian programming. While MSF had worked to build relationships with local communities, the presence of armed groups operating outside local control created risks that could not be fully mitigated through community engagement alone.
The incident highlights the need for sustained advocacy and diplomatic engagement to address the root causes of insecurity rather than simply managing the symptoms through enhanced security measures.
A Critical Juncture
The suspension of MSF operations in South Sudan represents more than an operational setback for one organization; it symbolizes the broader challenges facing efforts to address humanitarian needs in countries affected by protracted conflict and weak governance.
As South Sudan approaches the fourteenth anniversary of its independence, the country remains trapped in cycles of violence and crisis that prevent the realization of the hopes and aspirations that accompanied its birth as a nation. The attack on MSF staff and the subsequent suspension of operations serve as stark reminders that without significant improvements in security and governance, the country’s humanitarian crisis will continue to deepen.
The international community’s response to this incident will be closely watched by humanitarian organizations, government officials, and affected populations. The decisions made in the coming weeks and months will help determine whether South Sudan can break free from its current trajectory or whether it will continue to drift toward becoming a failed state where even the most basic humanitarian assistance becomes impossible to provide.
For the communities in Upper Nile State who depended on MSF services, the suspension represents a devastating blow to their hopes for accessing essential healthcare. Their plight serves as a reminder of the human cost of insecurity and the urgent need for action to create conditions where humanitarian organizations can safely serve the world’s most vulnerable populations.
The story of MSF’s suspension in South Sudan is ultimately a story about the limits of humanitarian action in the face of systematic violence and state failure. Until these underlying conditions are addressed, organizations like MSF will continue to face impossible choices between their mission to serve those in need and their responsibility to protect their staff from harm.
