South Sudan

Walkout over late payments comes as public health officials confirm that the virus has reached two more provinces.

Staff at a hospital treating Ebola patients in the Democratic Republic of the Congo (DRC) have gone on strike, alleging they have not been paid for months, bringing the facility to a standstill.

Dozens of employees at Rwampara General Hospital in Ituri province, the epicentre of the outbreak, walked off the job on Monday. The strike action came as authorities revealed that the virus has spread to two further provinces in northern DRC.

The striking workers included epidemiologists, case investigators, drivers and gravediggers.

“We don’t know how it is possible to not have been paid for two months,” Bahati Claude, a health worker at the centre, told The Associated Press.

The outbreak, concentrated in northern DRC, is the worst in Africa’s history and has already caused severe economic damage, pushing nearly one million people into poverty, according to the United Nations.

Efforts to hold back the spread of the virus have been complicated by the presence of paramilitary rebels, who control parts of the region in a bid to access its valuable mineral deposits.

The response to the outbreak has also been complicated by misinformation, deeply rooted burial practices and a lack of trust in health officials.

Health workers have been attacked by communities that believe the disease is a form of witchcraft, while bereaved families have ignored safety protocols by holding traditional burial ceremonies.

DRC’s National Public Health Institute confirmed on Sunday that the virus has spread to two new northeastern provinces: Haut-Uele and Tshopo.

The World Health Organization has warned that an accelerated response from local, national and international partners is urgently needed to bring the outbreak under control.

DRC Health Minister Roger Kamba said last week that the government was working to resolve the payroll issues and ensure employees were paid.

“We must ensure that these payments reach the right people,” Kamba said. “We have faced a few challenges, notably changes to the lists, which have led to complaints from people saying they are not being paid even though they are working. We have the means to sort this out.”

According to the latest figures, the number of Ebola cases in the DRC has risen to 1,926, with 702 deaths. The spread of the disease to Haut-Uele and Tshopo means five provinces now have confirmed Ebola cases.

The International Rescue Committee (IRC) has warned that the situation is worsening in areas already affected as transmission accelerates, while the risk of the disease spreading to neighbouring South Sudan is increasing as the outbreak expands into new areas.

Meanwhile, a second United States citizen infected with Ebola was admitted to a special isolation unit at Frankfurt University Hospital in Germany on Monday. Timo Wolf, head of the special isolation unit, said the patient’s condition was “currently stable”.

The man, who is in his 60s, was confirmed to have contracted the disease on Friday while working for a Christian aid group in the DRC.

South Sudan became the world’s newest country in July 2011 after nearly 99 percent of voters chose independence from Sudan.

Fifteen years later, most of the major promises that came with independence remain unfulfilled.

South Sudan remains one of the world’s most fragile states.

Oil finances nearly 90 percent of the government’s revenue, but the country remains wracked by deep inequality and violence: 82 percent of the population lives below the poverty line, and political jostling between rival groups has left the young nation in a perpetual state of conflict.

Elections have never been held since independence, millions remain displaced, and the country’s economy depends on pipelines running through Sudan, the very nation it fought to leave.

‘A failed promise’

Jok Madut Jok, 57, a professor and director of graduate studies at Syracuse University, is from Warrap, South Sudan, and still has family in both rural and urban parts of the country.

Jok says he recalls the joy of the time when South Sudan broke away to establish a new beginning. It was a moment of hope. Today, though, he feels as though he has been denied all that was promised at the time.

“South Sudan at the moment is a failed promise,” he says. “South Sudanese who had lived under brutal regimes in Sudan and had been excluded from money and development programmes, and were victims of security operations in the southern part, had hung their hopes on independence.”

Jok says people are now looking towards possibilities of political transitions to hold their government accountable.

Who controls what in South Sudan?

The country is technically governed by a transitional unity government created under the 2018 peace agreement.

But that peace remains fragile.

Violence continues across Jonglei, Upper Nile, Unity and Equatoria states with clashes involving government forces, opposition fighters and other armed groups.

Elections scheduled several times since independence have again been delayed, with the latest vote planned for late 2026.

Main political and armed groups:

Sudan People’s Liberation Movement (SPLM)

The ruling party which led the independence movement.

Sudan People’s Liberation Movement-in-Opposition (SPLM-IO)

Led by Riek Machar, it is part of the unity government. It still maintains armed forces in parts of the country.

South Sudan People’s Defence Forces (SSPDF)

The national army, formerly known as the SPLA, it is loyal to President Salva Kiir.

White Army

A loose network of armed youth, mainly from the Nuer ethnic group.

National Salvation Front (NAS)

It remains active, mainly in Equatoria province. The NAS never fully joined the peace agreement.

Who runs the government?

Salva Kiir – President since independence.

• Leader of the governing SPLM.
• Supported largely by influential sections of the Dinka, South Sudan’s largest ethnic community.

Riek Machar – Vice President.

• Leader of SPLM-IO.
• Historically backed by many Nuer supporters.
• His rivalry with Kiir triggered the 2013 civil war after political tensions exploded inside the ruling party.

Independence delivered, violence continued

Between 2011 and  2026, according to data compiled by the United States-headquartered Armed Conflict Location and Event Data (ACLED), there were 13,256 attacks in South Sudan, which means 883 attacks per year on average – or more than two a day.

The majority of the attacks have been led by:

• Various communal and clan-based armed groups. These constituted 6,168, or just over 46 percent, of all attacks.
• The armed forces and police, who were responsible for 3,278 attacks.
• Unidentified armed groups, behind 2,276 attacks.
• Sudan’s People’s Liberation Movement-in-Opposition, responsible for 900 attacks.
• National Salvation Front, behind 269 attacksForeign actors, behind 154 attacks.
• Others, responsible for the remaining 184 attacks.

Jan Pospisil, 52, a researcher at the Austria-based Peace and Conflict Evidence Platform, recently conducted a survey of more than 22,000 respondents in South Sudan.

Of them, 98 percent said they were proud of being South Sudanese. At the same time, more than 52 percent of respondents said in 2023 that they didn’t feel safe speaking up politically, and in 2025, the results were approximately the same.

Hunger persists after 15 years of violence

Hunger is worsening across South Sudan, where an estimated 7.8 million people are facing crisis levels of food insecurity between April and July 2026, about 280,000 more than projected last year, according to the Integrated Food Security Phase Classification.

Of those, about 73,000 people are living in catastrophic conditions, facing starvation, extreme food shortages and a heightened risk of death.

Another 2.5 million are in emergency conditions, while 5.3 million more are struggling to meet daily food needs without exhausting what little they have left.

The nutrition crisis is worsening alongside this.

An estimated 2.2 million children under five now require treatment for acute malnutrition, an increase of about 90,000 cases since the previous assessment.

Another 1.2 million pregnant and breastfeeding women also need urgent nutritional support.

The crisis is being fuelled by conflict, displacement and repeated shocks that have destroyed livelihoods, disrupted markets and cut communities off from aid.

“My family is living in rural areas, some in the cities but have no access to quality healthcare, no clean drinking water, no road infrastructure,” Jok says. “Even if they were to farm and raise cattle, and create their own livelihoods, they usually are cut off from markets and from basic services that are the responsibility of the state, especially a state that extracts public resources from underneath the people.”

“It’s a feeling that people are totally excluded from the gains of independence,” he added. “It verges on criminal neglect.”

Economic inequality

Pospisil says despite the riches of the 150,000 barrels of oil that are extracted, sold and mainly exported every day, broader economic gains are not a reality for most of the public.

In most rankings, South Sudan languishes as the poorest nation in the world.

South Sudan mainly exports crude to China, but also has Chinese and Indian companies invested alongside state-held organisations that own blocks in the oil fields.

Juba, South Sudan – In the days before Lankien was attacked, doctors at the local hospital rushed to evacuate patients. Some were women in labour. Others were being treated for gunshot wounds. By the evening of February 3, just hours after the last patients were carried out, a bomb struck the empty facility, ripping a crater through its warehouse.

Fighting was underway in surrounding areas as South Sudan’s military pressed forward with a counteroffensive aimed at retaking territory seized by opposition armed groups. As the army advanced eastward through Jonglei State, it captured town after town, pushing opposition fighters towards the Ethiopian border.

In the aftermath of the bombing, residents said they were forced to flee into surrounding marshland on the morning of February 7 as mortar fire struck the town. Some eventually returned and described extensive destruction.

The hospital had been looted and burned. Its cold-chain storage unit, used to preserve vaccines, was set on fire. Vehicles were sprayed with bullets and stripped for parts. Solar-powered water systems had been dismantled. The local market was reduced to twisted metal sheets, while homes on the outskirts appeared to have been burned.

“Anything that can support the life of human beings was deliberately destroyed,” said Emmerson Gono, deputy head of mission for Doctors Without Borders, known by its French initials MSF, who visited Lankien in April, adding that this was his assessment based on what he observed.

A counteroffensive across Jonglei

Since the start of what authorities refer to as “Operation Enduring Peace,” satellite imagery analysed by the Centre for Information Resilience (CIR), combined with verified videos, images and witness accounts, indicates widespread destruction across a swathe of Jonglei that has long been a stronghold of opposition groups.

Both the military and opposition forces have been accused of razing villages and attacking civilians in recent months. In this area of Jonglei, which is home to a section of the Nuer ethnic group that officials often cast as hostile to the state, more than a dozen residents who spoke to Al Jazeera said they believed the military was responsible for targeted destruction that experts say has pushed tens of thousands of people towards the brink of famine.

In most of the 23 incidents CIR documented between late January and February, civilian structures, including homes, health facilities and markets, appear to have been burned and looted. CIR said the destruction was “likely to be more widespread and potentially part of what it described as a deliberate military strategy”.

“Using satellite imagery, we were able to map how troop movements from west to east followed a path of burning and looting,” said CIR researcher Kiria Borak, stressing that satellite imagery alone cannot determine intent or responsibility.

Some officials and humanitarian actors have attributed the destruction in Jonglei to clashes between government troops and opposition forces. However, residents told Al Jazeera that opposition fighters were not present when their villages were attacked. Those accounts could not be independently verified due to restricted access to the area.

Government officials did not respond to requests for comment on the specific allegations described in this report. In earlier statements, authorities have said military operations are conducted in self-defence and that civilians are not deliberately targeted.

Political backdrop

Violence has escalated since 2025, when opposition leader and first vice president Riek Machar was arrested on charges of subversion, allegations he denies. Machar and President Salva Kiir were once on opposing sides of the country’s 2013–2018 civil war, which killed hundreds of thousands of people before a peace agreement brought them into a fragile unity government.

The implementation of that agreement stalled amid delays in unifying armed forces into a national military and repeated postponements of national elections.

Following Machar’s arrest, the government undertook a campaign of aerial bombardments to beat back a simmering rebellion in rural areas. Machar’s political group declared the peace deal dead and began launching hit-and-run attacks on military positions.

Between December and January, opposition fighters, buoyed by support from local armed youth, seized several military garrisons in Jonglei, prompting the government to announce a counteroffensive on January 28.

Then-army chief Paul Nang ordered forces, drawn from the national army, intelligence units, police and allied militias, according to UN investigators, to retake territory held by opposition groups.

Analysts say the involvement of allied militias operating alongside formal units has complicated the determination of command responsibility.

‘Burning homes’

Five individuals who fled Lankien told Al Jazeera they witnessed events unfold on February 7.

They said government-aligned forces reached the outskirts of the town after fighting in a nearby village. Around late morning, mortar fire struck the town, followed by the arrival of ground forces in armoured vehicles.

Gai Ket, 32, said he had been cutting firewood when explosions began. He rushed back to town to look for his wife and children.

“The first thing I saw was smoke. SSPDF was burning homes,” he said, referring to the national army.

When he reached his house, he found his wife dead, with a severe wound to her chest. Bodies lay scattered across the neighbourhood. “Everything was gone,” he said.

Another resident, Puoch Duol, said he returned at night to search for his grandmother, who had been too weak to flee. He said he found her body among several others near the ruins of burned homes.

Satellite imagery reviewed by CIR indicates significant destruction in Lankien between February 7 and 9. On February 7, the army announced it was in control of the town.

MSF has said government forces were in control of Lankien in the days after the attack but has not assigned responsibility for the destruction. It said the government is the only party to the conflict with the capability to carry out aerial bombardments.

Government-appointed officials told Al Jazeera that opposition fighters looted the town during their withdrawal. Opposition representatives deny this, saying their forces were not present at the time. Neither account could be independently verified.

A pattern of destruction

Residents described a similar pattern of destruction across towns and villages stretching from the Nile River to the Ethiopian border. Armed men in military-style uniforms arrived in armoured vehicles, often after opposition forces were reported to have withdrawn, according to residents.

Homes and markets were burned, while health facilities and humanitarian compounds were looted. Civilians took refuge in swamps and forests, while those too weak to flee were killed or went missing.

CIR geolocated social media footage from Pathai showing fighters moving among burning structures towards a road leading into the town’s western entrance. The identities of those in the footage could not be independently verified.

Jany, an aid worker based in the town of Walgak, described an attack on February 5.

“We saw smoke everywhere. They were firing guns and burning houses,” he said.

Satellite imagery shows significant structural damage in Walgak between February 3 and 7, shortly after the town changed hands.

Humanitarian sources tracking developments in the area reported that multiple villages in the vicinity of Walgak were burned or destroyed during the same period. These accounts could not be independently verified due to restricted access and ongoing insecurity.

Remote sensing data shows clusters of fire activity across the region during the same period. However, satellite imagery alone cannot determine the cause or responsibility for the fires.

Command rhetoric and discipline

From the start of military operations, remarks by commanders raised concerns over civilian safety.

A video circulated on social media shows Johnson Olony, a deputy army chief who is also head of the Agwelek armed group, telling troops not to spare lives or property during operations. The government later said the remarks did not reflect official policy, and Olony apologised.

In another video, a commander identified as Wal Nyak appears to threaten violence against perceived opposition supporters. “Whether you are a woman or a girl, we will kill you all … We don’t want supporters of Riek Machar here,” he says.

The authenticity and full context of the footage could not be independently verified.

Humanitarian impact

Aid agencies say the consequences of the destruction reported in the area are severe and likely to last for months or longer.

At least 28 health facilities in Jonglei were damaged or looted this year, according to the UN. Seventy percent are no longer functioning.

The Integrated Phase Classification (IPC), a United Nations-backed analysis body, says there is a risk of famine in multiple counties, while more than 70,000 people are already facing the highest possible severity of hunger.

Nicholas Kerandi of the UN Food and Agriculture Organization said the impacts on food security and public health “are likely to persist through the remainder of the year and potentially beyond”.

Others say the alleged abuses in Jonglei have pushed South Sudan’s already fractured state to breaking point.

“The tribes don’t trust one another, the citizens don’t trust the government, and the government doesn’t trust its citizens,” Ter Manyang Gatwech, a human rights advocate from Jonglei, told Al Jazeera.

“Unless there is a miracle, South Sudan will disintegrate,” he said.

On a modest bed inside his war-battered home in the Khartoum North neighbourhood of the Sudanese capital, Khartoum, Murtada Mohieddin, a diabetic patient in his early 50s, carefully counts his remaining doses of insulin. His search for medicine has transformed into a harrowing battle – not just to find the treatment he needs to survive his diabetes, but to ensure the medicine is not expired or ruined.

“Sometimes the insulin is spoiled,” Mohieddin tells Al Jazeera, inspecting his limited supply. “You wouldn’t know if it is ruined or expired. You can check the expiration date, but it could still be damaged from poor storage.”

More than three years of civil war have crippled Sudan’s healthcare infrastructure: hospitals, health centres and pharmaceutical factories have been shut and vital medical supply chains and storage across the country have been disrupted.

The war, which erupted as a power struggle between Sudanese Armed Forces (SAF) and the paramilitary Rapid Support Forces (RSF), has killed more than 50,000 people and displaced 14 million – nearly a quarter of the country’s population.

The devastating conflict has paralysed domestic pharmaceutical production and collapsed vital supply chains across the country.

According to a World Health Organization (WHO) news release dated April 14, 2026, Sudan represents the world’s largest humanitarian crisis, with 21 million people lacking basic healthcare services out of 34 million needing aid.

In the void left by the closure of pharmaceutical companies, smuggling networks have flourished, flooding the market with unregulated drugs locally known as “Boko” medicines.

These include critical intravenous malaria medications smuggled across borders. Because they completely bypass strict temperature controls and quality checks during transit, these drugs are frequently spoiled, rendering them either totally ineffective or lethally toxic to patients.

A double threat

Inside local pharmacies in Omdurman, located on the outskirts of Khartoum, the crisis is not just limited to scarcity. Patients now face the double threat of exorbitant costs and life-threatening quality issues, as these illicit medicines are often severely spoiled due to a lack of proper storage and refrigeration.

Mutawakil Hamza, a pharmacist based in Omdurman, said the reliance on unregulated channels is putting lives at immediate risk.

“Most malaria medicines are now brought in through smuggling,” Hamza said. “These are ultimately injections for intravenous use, and this is highly dangerous to a patient’s health.”

Because intravenous treatments bypass the body’s natural defences and require absolute sterility, administering improperly stored or degraded smuggled injections can rapidly cause severe bloodstream infections, systemic shock, or death.

The war has effectively dismantled local manufacturing, reversing years of medical self-reliance. Yasser Ahmed Youssef, a pharmaceutical industry expert whose factory is located in Khartoum, noted the stark contrast to the pre-war era, when local factories managed to produce “very large quantities of life-saving medicines, including drugs for blood pressure, diabetes, colds, and paediatric care”.

Now, the majority of those production lines are silent, leaving the population dependent on a shattered healthcare system. According to the October 2025 Health Resources and Services Availability Monitoring System (HeRAMS) report cited in a WHO Public Health Situation Analysis from January 6, 2026, 40 percent of health facilities nationwide are entirely nonoperational.

The situation is even more drastic regionally, with 87 percent of facilities shut down in Khartoum and 85 percent closed in North Kordofan, whose control is contested between the rival sides.

In active conflict zones such as Gezira, Khartoum, Darfur and the Kordofan regions, the shortages are particularly dire.

A United Nations Population Fund (UNFPA) emergency report from August 2025 highlighted that the only functioning maternity hospital in the besieged city of el-Fasher faces critical medicine shortages and risks imminent closure.

El-Fasher, the last SAF stronghold in the western region of Darfur, was taken over by the RSF in late October 2025, trapping approximately 700,000 civilians – mostly women and children. People have been cut off entirely from food and medicine and subjected to attacks.

Collapsed warehouses and supply lines

In the government-funded public sector, the National Medical Supplies Fund maintains that it is working to secure essential medicines despite the fighting, claiming to have achieved 75 percent availability for cancer medications and fully secured supplies for kidney patients.

However, officials admit the overarching infrastructure is in ruins, with the local health ecosystem almost destroyed.

“We have been massively affected by the ongoing war inside Sudan,” said Abubakar Salouha, a department director at the fund. “The medical supplies have been severely impacted; there has been a collapse at the level of the main warehouses at the headquarters.”

International aid deliveries from neighbouring countries also face enormous logistical hurdles.

The WHO’s January 6 situation analysis detailed that cross-border transit times for medical commodities can take up to 90 days to reach remote regions like Darfur from the Cameroonian city of Douala via Chad. Compounding these suffocating delays, armed groups have repeatedly targeted medical infrastructure, looting pharmacies and stripping remaining hospitals of their vital medical supplies.

Recent attacks highlight this systematic destruction by rival sides. On March 20, 2026, a drone attack on Al-Daein Teaching Hospital in East Darfur state killed at least 64 people, including medical personnel, and injured 89 others. Sudanese rights group the Emergency Lawyers reported that the army was behind the attack.

On April 2, another drone attack struck Al-Jabalain Hospital in White Nile state, killing 10 staff members, including the hospital’s director while he was performing surgery. That same day, the Family Hospital in el-Daein was looted, and patients and health workers were assaulted and expelled. Similarly, a hospital in Kurmuk, Blue Nile state, was looted on March 25, its equipment destroyed, and patients forced out. The RSF was blamed for these attacks.

“Sudan is confronting one of the gravest humanitarian and public health emergencies in the world today. The ongoing conflict has pushed the health system to the edge of complete collapse,” warned WHO Director-General Tedros Adhanom Ghebreyesus on April 4.

“These incidents are stark reminders of the urgent need for renewed international solidarity and decisive political and humanitarian action. Sudan cannot endure this crisis alone.”