Indiscriminate attacks on civilians and civilian structures – including bombing hospitals – forced recruitment, sexual violence, access constraints and shrinking humanitarian space are realities for people in South Sudan, as described by Doctors Without Borders (MSF) in their report on escalating violence in the country, “They Killed Them While We Were Running”. The report details that a total of 12 attacks on MSF staff and facilities left an estimated 762,000 people without access to healthcare between January 2025 and April 2026.
MSF calls on the government of South Sudan, the Sudan People’s Liberation Army – In Opposition (SPLA-IO), and all parties to the conflict to protect and respect civilians and civilian infrastructure. Civilians and civilian infrastructure, including healthcare, must never be targeted; direct attacks against them constitute serious violations of international humanitarian law (IHL). Under IHL, all parties have an obligation to respect and protect civilians and to avoid the use of indiscriminate or disproportionate force, including the use of airstrikes and incendiary weapons in populated areas.
“I ran away with my child. I could see the village burning from afar,” says a woman who was displaced and treated at an MSF facility in Chuil, Jonglei state. “They set houses on fire. They burned my grandmother inside the tukul [traditional house]. The elderly stayed behind, they could not run with us. They killed the elders.”
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Both targeted and indiscriminate attacks conducted by the government and opposition forces and other armed actors are increasingly harming people and undermining access to lifesaving care. Since January 2025, MSF treated an average of 16 people per day for violence-related injuries, across six states – Jonglei, Upper Nile, Central Equatoria, Lakes, Warrap, and Western Equatoria – and two administrative areas, Abyei and Greater Pibor.
“Across these areas, civilians are facing airstrikes and ground attacks, forced recruitment, abductions, and widespread sexual and gender-based violence [SGBV],” says Zakaria Mwatia, MSF head of mission in South Sudan. “Populated towns and villages are being hit, resulting in civilian casualties, mass displacement, and the destruction of civilian infrastructure.”
MSF Car in Lankien, Jonglei State was vandalised and shot at by unknown assailants following the Bombardment on 03 February. One MSF staff member suffered minor injuries. Photographer Stephen Pejovic | Date: 23/04/2026 | Location: South Sudan
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The impact of violence is evident in MSF’s medical data and through the fact that 138 air strikes occurred in the country during 2025, compared to only two in 2024. In 2025, MSF treated 6,095 people for violence-related injuries, including gunshot wounds, blast injuries and SGBV, compared with 4,765 people in 2024. Treatment of gunshot wounds alone increased by 77 per cent compared with 2024. From January to April 2026, MSF already treated over 1,800 people wounded by violence, including 885 survivors of SGBV, highlighting the accelerating toll on civilians.
“On Friday night she had been gang raped by a group of men in Yei,” says an MSF staff member speaking about a patient at the Yei civil hospital in Central Equatoria state in March 2026. “She did not know by how many. She came to us for treatment. After the treatment, her grandmother took her to the village, as she thought that she would be safe there. On the next Monday, she went to collect firewood alone. Then, she was raped again by an unidentified armed man. She was back to our clinic on Tuesday.”
