Blurb: Following global funding cuts, two-thirds of primary healthcare facilities in South Sudan's Northern Bahr el Ghazal State have closed, leaving 1.4 million people without access to care close to home. Pregnant women, children, and critically ill patients are now travelling for hours or even days to reach the MSF-supported hospital in Aweil, the only secondary hospital in the state.
Abuk Thiek Malek delivered her sixth baby easily at home. Seven days later, however, her newborn boy developed swelling on his body. “I went to the local health centre, but there was no medicine there,” says Abuk. Leaving her five children with their father, with the eldest (an eight-year-old girl) in charge of their care, Abuk travelled four hours on a boda-boda [motorbike taxi] to the Aweil East county hospital. But staff there were unable to treat the child. After an overnight stay, she took another boda-boda for three hours to finally reach Aweil State Hospital, where Médecins Sans Frontières/Doctors Without Borders (MSF) runs a neonatal intensive care unit.
Abuk’s baby, named Rou, was diagnosed with necrotising fasciitis, a rare, life-threatening bacterial infection, and severe septic wounds. MSF teams administered antibiotics and performed several surgeries to debride and drain abscesses on his head and back, and he still needs dressing changes. “I am happy because now he is eating well,” says Abuk. Rou has gained 200g since arriving at the hospital.
It cost 300,000 South Sudanese Pounds for each boda-boda trip [around US$100 for both] for Abuk to bring Rou for care. Her husband is the village chief, and he was able to borrow the money for her transport. Many cannot afford transport, and those who find a way often present in very advanced stages of illness. “Families should not have to go into debt to get the essential medical care they need to survive. Women need to be able to access primary healthcare. This would prevent the increased risks that delays in getting care bring, it would prevent the need for emergency hospitalisations,” says MSF’s head nurse in Aweil, Felicia Ochedikwu, who oversees nursing care for the 245-bed hospital.
Skilled care out of reach for complicated births
Ayen* arrived at Aweil State Hospital after labouring for two days. “She had been fully dilated for five hours by the time she reached the maternity ward,” says MSF obstetrician-gynaecologist Dr Harizah Hatim. “As her labour was obstructed, we performed an emergency caesarean-section, which was very difficult as the baby’s head was very low (known as impacted foetal head).” Immediately the baby was resuscitated and sent to the neonatal intensive care unit, but sadly, baby passed away the next day. “We live very far away and the journey here was very difficult,” says Ayen’s mother, Adau*. Even though she sought help when she went into labour, Ayen was not met with the skilled care she needed. “The outcome would likely have been very different if antenatal and birthing support had been available closer to their home,” says Harizah.
Growing needs
MSF estimates that about 6,000 women will seek maternity care per year at Aweil. That was true for 2024, but in 2025, teams received more than 8,000 women. In the first six months of 2026, teams had already assisted 3,500 women to deliver. Not only are teams seeing more women coming to the facility to deliver, they are also seeing more women in a critical condition. Last year from January to June, there were 740 complicated deliveries (including caesarean-sections, vacuum deliveries, hypertensive crises, and eclampsia); and in the same period in 2026, teams managed 900 complicated deliveries.
“The data speaks for itself: it is very difficult to access healthcare if you are in Aweil,” says Dr David Kahindi, MSF’s medical coordinator for several projects in South Sudan, including Aweil. “Basic emergency obstetric and newborn care (known as BEmONC) is desperately needed in communities. Without it, we’re seeing more complicated deliveries, more severe acute malnutrition, and more patients who are way sicker [than they would be if they had primary healthcare],” says David. Because MSF’s collaboration with the Ministry of Health in Aweil is the only functioning service in the state, it means we are creating more access for people, that’s the role MSF fulfills in the community. But for 1.4 million people, you need a minimum of 14 health facilities that assist with deliveries, based on the WHO standard of one BEmONC for 100,000 people.
Gaps cost lives
As international funding support previously relied upon by the South Sudanese Ministry of Health dwindles, healthcare workers’ salaries remain unpaid, medicines and essential supplies run out, supply chains are broken, referral pathways destroyed, and primary healthcare centres close. At the start of 2025, there were 180 primary healthcare facilities in the state, now there are 61. This represents a massive gap in the health system. “People are dying because of this gap in primary healthcare,” says David. He adds that a few years ago, MSF provided around 15,000 emergency consultations in Aweil State Hospital per year, the number was more than 26,000 in 2025, and so far in June 2026 it’s a similar trajectory: before the malaria season has even begun, teams have already done 13,000 consultations. “A massive increase in secondary care admissions is a sign that primary healthcare is not functional. “The types of admissions also tell us that people are traveling very far to access care, and are at higher risk of complications, and death,” says David.
In addition to the increase in complicated births, Aweil State Hospital has seen a 30 per cent increase in neonatal admissions this year, compared to the same time last year. By June 2026, MSF teams had admitted 500 more babies than in June 2025.
Food is the foundation of health
The number of new admissions to inpatient therapeutic feeding centres is also increasing. Without local clinics to treat early symptoms such as diarrhoea and vomiting, common childhood illnesses can rapidly worsen and contribute to severe acute malnutrition.
This was the case for Akok Wol Manyuol and her twin girls, Akok and Abuk. When the babies developed diarrhoea and vomiting, Akok could not find assistance at her local heath unit. “I found the place closed, there was no one to help me. I could not afford the transport, so I walked here [Aweil State Hospital]. It took me six hours.”
In the first six months of 2026, MSF admitted 1,065 new children for severe acute malnutrition to the inpatient therapeutic feeding centre, an 87 per cent increase compared to 569 admissions during the same period in 2025.
“Over the last five years we have never seen malnutrition numbers so high,” says David. The surge is compounded by severe inflation, climate shocks destroying crops, and reduced food aid. Furthermore, a lack of funding for treating moderate acute malnutrition means children only receive care once they become critically ill. This all drives relapse rates after discharge.
What was once a predictable three-month malnutrition peak, from May to July, has extended into a permanent crisis, with admissions remaining at peak levels through October. “We have not seen the seasonal decline that depicts the end of the lean season,” says MSF project coordinator Denis Mbae.
As wards overflow, MSF teams create space on floors and in corridors to ensure all those who need treatment can receive it.
“This cannot become the new normal,” says David.
The scale of need in South Sudan far outweighs what any single organisation can cover. Restoring primary healthcare and emergency food support in Northern Bahr el Ghazal is urgently needed to protect mothers and children from preventable deaths.
