When 13-year-old Mamouch suffered a convulsive seizure at home one night, he fell into his family’s cooking fire in their village in Lankien, Jonglei State. Since the MSF hospital in Lankien was bombed and destroyed in February 2026, his family had to travel more than 50 kilometres to the nearest functioning healthcare facility supported by MSF in Chuil. Given the severity of Mamouch’s burns, he was referred by boat to Malakal Teaching Hospital for specialised treatment. The family had been displaced twice by violence, eventually moving from Lankien to Chuil.
“Life is very tough for us,” says Mamouch’s mother, Nyareu. “Some people in our community are dying from hunger, attacks by wild animals, by violence, and our children are being kidnapped. Those who arrived in Chuil are lucky to be alive.”
Mother and son travelled for seven hours in an MSF boat to reach Malakal Teaching Hospital — the only possible mode of transport in an area where roads are inaccessible, particularly during the rainy season.
Reaching remote communities
Outreach teams and boats run by MSF are essential for communities living along the rivers in Upper Nile and Jonglei states to access lifesaving healthcare.
“We have been receiving many patients from different locations along the South Canal, Akoka, and Baliet routes within the Sobat River Corridor, due to gap in primary healthcare, particularly referral pathways,” says Prisca Okoro Orji, community engagement and health promotion manager.
In Jonglei and Upper Nile states, MSF runs a decentralised model of care, supporting primary healthcare centres to provide basic care while helping refer patients who need specialised treatment to Malakal.
MSF currently has 18 community outreach team members at six sites, covering a population of around 50,000 people. Three more teams are being trained in August 2026 to provide care in Fashoda County.
Each team consists of three community health workers chosen by the community and trained by MSF: a traditional birth attendant, and two healthcare workers. “The primary healthcare units do not always have capacity or medications – that’s why we are expanding our support in the region,” says Prisca.
Decentralised care is essential to open access to care to all those who need it in a wide and difficult-to-reach geographic area.
“In some cases, we see the number of consultations is 10 times the population of a town, this shows us that people are coming from much further away to access care, medication and therapeutic food because the primary healthcare unit has nothing,” says Alim Halidou, MSF’s nursing activity manager for outreach in Malakal.
When someone needs specialist care, MSF refers them to Malakal Teaching Hospital, where MSF teams together with the Ministry of Health, provide neonatal, paediatric, nutrition, emergency, chronic care, and surgical services including caesarean-section.
Surgical care needed across the region
Malakal is now the only secondary hospital with surgical capacity across large parts of Upper Nile and Jonglei states.
In the male surgical ward, Dak* is recovery slowly from gunshot wounds.
When he and some others from the community started moving their families and their cattle from Lankien to Chuil in search of food, they arrived at a forest. There, they were attacked by armed men. Ten people of Dak’s group were killed, and six were shot and left to die in the forest. The attackers kidnapped many of the group’s children, including seven of his nieces and nephews.
When his family came looking for him days later. They carried him on foot for seven hours to the MSF-supported facility in Chuil. When Dak was stable, he was transferred by MSF boat to Malakal Teaching Hospital for surgery. Surgeons were able to remove bullets from his chest, lower limbs and pelvis.“I only have pain now in my upper body and around my heart,” he says. “I don’t feel my legs, and I can’t move my toes.” Dak will receive post-operative care as long as it’s needed, including mental health support.
Boats bringing people to care
For referrals to be possible, boats are needed to navigate the three river systems in the Upper Nile State. MSF teams have provided canoes to each outreach site so people can get to primary care locations. Outreach is having a positive impact. The teams have seen reduced mortality, and increased health knowledge.
“It is really important that we have decentralised care activities running, because otherwise there is no treatment available for most of these patients. We are continuing to engage communities in these activities so we can build trust with families, and so that relatives will bring their loved ones to outreach locations when they need healthcare,” says Joana Pires Borges, an MSF paediatrician working in Malakal.
Nyawarka, a three-month-old baby was transported by the MSF boat after she was bitten by a snake while sleeping in the family’s tukul [traditional thatched hut] one night in their village along the White Nile River.
Nyawarka’s crying woke the neighbours, who came to help. First, they tried traditional medicine, but the next morning when she was no better, they contacted the MSF outreach team who sent a boat to pick up the little patient.“I am very happy the boat came,” says the mother, Nyanyuem.
Outreach activities and boat referrals are proving a lifeline for families along the rivers in Upper Nile and Jonglei states, but MSF teams cannot reach everyone. Primary healthcare services must be made functional and properly supported across Jonglei, Upper Nile, and the rest of South Sudan. This requires deploying enough healthcare workers, ensuring regular supplies of essential medicines, therapeutic food, vaccines, and medical equipment, and maintaining referral pathways so patients can move safely from primary care to specialised treatment when needed.
