South Sudan: Residents return to Akobo, a town stripped of services

On 6 March, the South Sudan People's Defence Forces (SSPDF) launched an offensive on Akobo. Almost all of the town’s residents fled across the border to Ethiopia, where they received no humanitarian assistance whatsoever. In mid-April, following further clashes, armed groups with the opposition retook control of the town. More than 100,000 people have now returned to find a town stripped of everything. The entire health system has collapsed: All 15 surrounding health facilities were looted and abandoned, and cold chain equipment was destroyed, bringing vaccination services to a complete halt.

“The humanitarian response in Akobo continues to fall far short of the scale of needs, despite repeated calls to action and high-level commitments,” says Jacob Granger, MSF project coordinator in Akobo. "Donors and humanitarian actors must urgently scale up across the board — water and sanitation, food assistance, the full restoration of Akobo Teaching Hospital, and protection services, including the distribution of mosquito nets — ahead of the peak malaria transmission season. MSF's return has helped restore critical, lifesaving care in Akobo, but this alone is not sufficient."

Akobo Teaching Hospital had been completely looted and left without electricity, fuel, beds, medical equipment, or essential medicines. When MSF resumed activities at the hospital on 11 May, the team was immediately overwhelmed: In the first five days alone, teams treated over 600 patients, and by 14 June, 684 patients had been hospitalized in a facility with capacity for only 30 beds. By the same date, the hospital had provided 5,106 outpatient consultations and recorded 30 deliveries. The number of outpatient consultations in a single day is now equivalent to what the hospital ​ managed in an entire week before the conflict.

Akobo is currently classified as Integrated Food Security Phase Classification (IPC) Phase 5, on the brink of famine. Months without functioning health services have had a devastating impact on children: Between 11 May and 14 June, 36 per cent of children aged 6–59 months who were screened during consultations at the MSF facility were malnourished, including 15 per cent suffering from severe acute malnutrition.

“Since the start of activities, and until the beginning of June, all patients — including pregnant women — were sleeping on the floor,” says Elizabeth Nyachin Koang, MSF traditional birth attendant and midwife in Akobo. “We no longer have the equipment we once used to monitor pregnancies. We cannot properly assess how a baby is developing or whether it is doing well inside the womb. Women are giving birth under very difficult conditions. We do everything we can, but we lost much of the equipment that helped us provide better care.” ​

For weeks, injured people went untreated, patients with chronic diseases like HIV had their treatment interrupted, and families survived on wild leaves and fruits. ​

While United Nations agencies have initiated food distributions, including supplementary feeding for children and pregnant and lactating women, the overall response from other actors has not yet matched the urgency of the situation. MSF is currently providing outpatient consultations, maternal healthcare, malnutrition treatment, malaria diagnosis and care, wound management, and lifesaving referrals.

The collapse of water and sanitation systems has created an extreme risk of disease outbreaks. Before the conflict, 17 water towers and 35 boreholes supplied Akobo through an underground network, all destroyed or looted in the fighting. Today, only eight hand pumps remain functional — enough to serve around 5,000 people out of a population of over 100,000. The majority of people now rely on untreated river water, and open defecation is widespread. With malaria transmission already accelerating and the rainy season intensifying, there is extreme risk of waterborne disease outbreaks, including cholera, which has been spreading in Jonglei state since February. This risk will grow rapidly without an urgent, systemic scale-up of the humanitarian response.