Funding cuts in South Sudan: The Human Cost of Disinvestment

Every day in Médecins Sans Frontières (MSF)-supported secondary hospitals across South Sudan, from Aweil, in a stable area under government control, to Akobo in Jonglei, an unstable conflict zone held by opposition groups, our teams receive women and children in increasingly severe condition, dying from diseases that could have been diagnosed and treated weeks earlier. Across the country, thousands of mothers and children find the doors of their primary healthcare clinics shuttered. They must travel long distances, at a cost they cannot afford, to reach a hospital only after preventable conditions have become critical.

Abuk Athak did not plan to walk to hospital in labour. A year and a half ago, she walked for two hours from her village in Aweil West, already in labour, because the nearest health centre, in Ruangol, had been closed in February 2025: no staff, no medicine, no midwife. She arrived at Aweil State Hospital exhausted and in pain. Her baby, a boy named Rau, survived. She had made that journey, she says, because “There was no one there.”

Aweil: a primary care network that closed without announcement

South Sudan’s public health system depends almost entirely on external financing. Since independence, it relied first on the Health Pooled Fund (HPF) and, from 2024, on the Health Sector Transformation Programme (HSTP), a multi-donor mechanism funded by the World Bank, Canada, the United Kingdom, Sweden and the European Union. The HSTP covers medicines, staff incentives and basic service provision across Primary Health Care Centres (PHCCs) and Primary Health Care Units (PHCUs) nationwide.

Aweil, the capital of Northern Bahr el Ghazal, is a government stronghold and one of the most stable areas in South Sudan, largely untouched by active conflict. It is the kind of place where, in principle, the HSTP should work. ​

The HSTP faced a funding shortfall even before its launch in 2024, when the US and Sweden, both previous donors to the Health Pooled Fund (HPF), did not commit funding to the new programme. As a result, the HSTP launched with plans to support only 816 health facilities across 10 states and two administrative areas, rather than the 1,158 originally envisaged. ​

The crisis reflects not only insufficient funding, but also a failure to translate available resources into functioning healthcare services. By January 2026, the number of functional PHCCs and PHCUs in Northern Bahr el Ghazal alone had fallen from 131 to 63. Staff incentive payments were reduced or stopped entirely. Facilities remained nominally listed as open while their doors were locked and their shelves empty. The health centre near Abuk’s village was one of 71 that closed, quietly, without announcement and without replacement.

“Before our healthcare centre closed, we could receive antenatal care, give birth, and get our children tested at the first sign of a fever,” explains Abuk. “One day, it simply closed. We were told there were no more funds. Now, I am forced to wait until the very last moment to bring my children to the hospital, simply because I cannot afford the travel costs.”

Aweil State Hospital: the last door open

Aweil State Hospital is the only secondary healthcare facility for an estimated 1.4 million people in Northern Bahr el Ghazal. It is now absorbing the caseload of a state whose primary care network has collapsed. ​

Between January and September 2026, total hospital admissions rose 44% - from 14,8170 to 21,352 - compared with the same period in 2025. Admissions of children under five with severe acute malnutrition rose 47% from 1,227 to 1,801, the highest malnutrition trend the hospital has recorded in five years. Vaginal deliveries with complications increased 35%. A fifth of all patients admitted are now classified as critical, a 20% increase from January to September 2025 (10,426 patients) to the same period in 2026 (12,549 patients).

In the inpatient therapeutic feeding centre, another mother, Nyanut Akot, sits beside her severely malnourished child. She used to receive ready to use therapeutic food (RUTF) for moderate malnutrition at her local clinic in Titchok, Aweil East. Since April, the facility has only partially functioned and supplies have dried up.

“I didn’t know my daughter had become severely malnourished until we reached the hospital,” she says. “She developed a fever and convulsions, and I knew I had to find a way here.” Reaching help meant a five-hour walk followed by a one-hour motorcycle ride costing 15,000 South Sudanese pounds, a heavy price that she had to borrow and does not know how to pay back.

“This year, drought and a lack of rainfall affected my crops. Then, floods destroyed what was left, leaving me with nothing to harvest.” Nyanut used to grow okra, pumpkin and tobacco. Like many South Sudanese, she now faces a food crisis that El Niño is set to worsen. 2026 is so far the driest year on record in the country, and El Niño’s disruption of rainfall could deepen the damage. Crop failure, poor harvests and malnutrition are the main concerns, with a real risk of IPC 5 (famine) conditions among some populations. “Without a harvest, I have no income.” she adds.

“Every day I see mothers and their children lying on mats in the hospital compound for days after being discharged, unable to leave because they lack the money to return home,” says Dr Daniel Garang, MSF doctor in Aweil. “In my seven years working in Aweil for MSF, I have never witnessed a situation like this.”

A second blow: humanitarian funding falls

The HSTP’s failure to deliver from the outset was the first blow. The second followed quickly. In 2025, US funding for South Sudan’s Humanitarian Needs and Response Plan fell by 61% compared with 2024¹. The UK reduced its overall aid allocation to the country by 23% in 2025-26, with a further 39% decrease projected for 2026-27².

By October 2026, South Sudan’s Humanitarian Needs and Response Plan was only 36% funded³. Health allocations remain well below requirements. Declining bilateral donor funding to implementing partners, amid shifting donor priorities and reductions in development assistance, is further constraining the delivery of essential health services across South Sudan.

The effects are already visible around Aweil. In August, the World Food Programme (WFP) stopped food distributions in Wedweil refugee settlement, home to more than 35,000 Sudanese refugees, 45 km from Aweil State Hospital. The settlement’s only clinic, run by the International Rescue Committee (IRC), has also scaled back services following US funding cuts in 2025. Without further US funding, IRC was forced to close 21 healthcare facilities across South Sudan.

The most severe cases from Wedweil are referred by ambulance to Aweil State Hospital through IRC’s referral system. With food distributions having ended, healthcare services reduced, and UNICEF scaling back its activities, the MSF team expects more patients with severe health conditions to arrive at Aweil hospital.

Akobo: the same absence, compounded by conflict

Akobo lies one thousand kilometres to the east, in eastern Jonglei State, across a frontline and in a context already fractured by conflict. The town is under the control of opposition armed groups, and its health system relies heavily on humanitarian actors. The HSTP is meant to cover the whole country, but restrictions on access to opposition-controlled areas have significantly hindered its implementation there. ​

On 6 March 2026, South Sudanese government forces launched an offensive on Akobo, prompting the evacuation of the humanitarian community. Akobo Teaching Hospital, the only secondary health facility in the wider area, was subsequently looted amid the displacement and insecurity. Nearly the entire civilian population fled across the border to Ethiopia, where they received no humanitarian assistance. In mid-April, opposition armed groups retook the town. Around 100,000 people returned to find health facilities stripped of medicines, equipment and staff. ​

In July 2026, OCHA reported that government-imposed restrictions on the movement of cash, fuel and communications equipment into opposition-controlled territories were compounding the funding shortfall, affecting the delivery of essential assistance into Akobo and surrounding areas.

MSF resumed emergency activities on 11 May 2026 in a hospital stripped from electricity, fuel, and beds.

Short-term funding is expiring all at once

The emergency response that followed the return was real, but it was built entirely on short-term funding, and those timelines are now expiring progressively.

Save the Children, which ran 22 primary healthcare facilities in and around Akobo as part of the HSTP, has suspended its activities since late July. The organisation says the suspension will last until it completes an in-depth review of the security situation. Medair took over 12 malnutrition treatment sites, with international funding for these sites due to expire at the end of October. Finally, a new partner has been identified to take over all 12 sites and ensure their activities continue until December 2027.

Meanwhile, food assistance has ended: WFP distributions, which previously reached 80,000 people, stopped in July 2026 due to funding cuts. ALIMA has secured funding for its activities in Akobo only until December 2026, while CARE’s funding is secured until April 2027.

Emergency grants restore services for some months, then expire. The population that survived bombing, looting and displacement is likely to find itself, again, without healthcare, in a place where no structural system ever existed and where the international community is once again turning its attention elsewhere. Since the evacuation, the operating theatre at Akobo Hospital has remained closed, leaving Akobo County without access to surgical services.

The cost of a closed health unit

For 45-year-old Gatwech Biel Thiep, the sudden absence of medical care ended in a tragedy.

In late August, his 30-year-old wife, Nyamuoch Geng, was eight months pregnant when she developed severe abdominal pain. The Primary Health Care Unit, just a 10-minute walk from their home, had shut down permanently on 15 July after its supporting partner withdrew.

“We kept her at home for three days while she suffered, because we knew the health unit was closed,” Thiep recalls. “A year ago, women went there for antenatal checkups and primary care. Today, there is nothing. Women just stay at home and deliver without any assistance.”

As her condition worsened, the family placed Nyamuoch on a fabric blanket and carried her by hand for two and a half hours through the muddy road to reach Akobo Hospital. She delivered a baby girl, Nyakhan, but then suffered severe postpartum haemorrhage.

With no operating theatre, no blood bank and no specialised surgical care, medical teams requested an emergency medical evacuation flight. The aircraft failed to arrive in time. On 29 August, Nyamuoch died. Thiep carried his wife’s body back home on his shoulders and buried her in their family yard.

“The fact that our local clinic was closed, that there is no emergency surgery in Akobo, and that the plane did not come that day, it all played a part,” says Thiep. “Now I am left alone with four children, including a newborn.”

Two places, two causes, one outcome

Whether in government-controlled regions like Aweil, refugee settlements like Wad Weil, or opposition-controlled territories like Akobo, the withdrawal of international donor funding leaves treatable health conditions such as malnutrition, malaria and routine obstetric complications untreated until they become life-threatening.

In both Aweil and Akobo, MSF is the last organisation capable of providing secondary healthcare. In both, patients are arriving with conditions that should have been treated locally, weeks earlier. The difference is the cause: the withdrawal of donors from a national health programme in one, conflict layered on short-term humanitarian funding in the other. ​

“The funding cuts are a death sentence,” concludes Dr Daniel. “How many more lives will be lost to preventable causes simply because the funding to save them is no longer there?”