South Sudan Border Crisis: Equipping Local Groups for Life-Saving Care

The Rev. Paul Lueth Kat Deng had spent years helping people flee war.

Since 2008, the South Sudanese pastor had worked in refugee camps, including in Sudan's Darfur region during the genocide there, supporting displaced families with food, prayer, and medical aid. He had seen children wounded by conflict before. But last year, the crisis took a personal turn.

His teenage nephew, Ajak, told him he had been abducted and forced to fight as a child soldier in Sudan by paramilitary forces. The boy eventually escaped, but not before being shot multiple times in the leg.

By the time Ajak reached medical care in South Sudan, doctors feared the leg might need to be amputated unless he received emergency surgery.

"They called me and said, 'We cannot do anything for his leg unless he gets surgery right away," said Rev. Paul, executive director of the South Sudan-based nonprofit Transformation of the World in Christ or TWIC, which is also the name of the county where it operates.

"If you lose your leg there, it can end your life," said Carrie Martin, a project facilitator for South Sudan with the MAMA Project, a U.S.-based nonprofit that has worked in tandem with TWIC in South Sudan since 2023.

After Rev. Paul contacted the MAMA Project, funds were raised to transport Ajak to the capital, Juba, where he underwent three surgeries that ultimately saved his leg.

Local Ministries Step in Where Aid is Limited

The account is emblematic of the widening humanitarian crisis unfolding along the South Sudan-Sudan border, where local church networks and small medical organizations are responding to tens of thousands of displaced people fleeing Sudan's civil war. The crisis faces even further deterioration due to the Ebola outbreak in the neighboring Democratic Republic of the Congo.

"Ebola is absolutely impacting our context right now," Rev. Paul said. "Because of our porous borders and high cross-border population movement, South Sudan health authorities and partners are heavily focused on emergency preparedness," he said.

Due to the war in Sudan, in South Sudan's Twic County, near the border, aid workers say families are sheltering under trees in informal camps with little access to food, clean water, or medicine.

"Some people are using leaves from trees for food," Martin said. "There are families making soup from ashes from fire pits in the most extreme cases."

Large international organizations have limited presence in some of these displacement sites, Rev. Paul said, leaving much of the response to small local groups and church-led organizations already embedded in the communities.

"The only hope for the community is faith organizations," he said. "The people trust us because we are living with them. We know their suffering."

Maternal Mortality and Malnutrition at the Border

The humanitarian situation has worsened as fighting in Sudan pushes more refugees across the border into areas already strained by limited healthcare, food insecurity, and weak infrastructure. The region has also faced displacement from violence inside South Sudan, including a recent armed assault in Ajak Kuac that local officials said killed at least 180 civilians and security personnel. Hundreds of families fled to Twic County, many arriving without food, shelter, or medical care. TWIC said it provided tents, food, medical assistance, and counseling to displaced families

An acute shortage of local healthcare workers has exacerbated the crisis.

"There are only a handful of obstetricians in a country of more than 11 million people," said Dr. Priscilla Benner, president and executive director of the MAMA Project. "Most maternal care is done by traditional midwives."

Aid workers say maternal mortality, malaria, malnutrition, and cholera remain among the most urgent threats.

"Malnutrition is the foundation of a lot of pediatric and maternal death," Benner said. "Women are anemic because of a lack of nutrition and much more likely to die during childbirth."

TWIC, supported by a shipment from Direct Relief, recently distributed emergency medical supplies, tents, and medications across Twic and Gogrial counties and border regions in Warrap and Unity states. A Direct Relief shipment that arrived in January and one currently in transit totaled 2,687,900 defined daily doses, primarily essential medicines to support patient care and health services.

Overcoming Shortages to Deliver Life-Saving Care

At Mother Teresa Hospital in Turalei, which received some of the donated medications, hospital director Dr. Mabith Ring said in a recent update that staff had completely run out of medicine and surgical supplies.

"Our stock was completely exhausted; we didn't have a single tablet left in the hospital," Ring said in the aid group's report. "We had run out of surgical gloves and all other life-saving medications in both the theatre and the hospital."

Joseph Makuach, a health and nutrition coordinator with Rev. Paul's TWIC, said stockouts are pervasive in the region. These shortages have had life-or-death consequences.

Benner described women dying during childbirth from complications that could have been treated with basic surgical care or timely cesarean sections. Now, she said, there are also stories of survival.

At Mother Teresa Hospital, Rev. Paul and the hospital staff said recent support has helped provide over 300 emergency cesarean sections for hundreds of mothers and babies.

One recent patient safely delivered triplets after arriving at the hospital.

"I truly believe that without the support from doctors and the provision of life-saving drugs, neither I nor my three babies would be alive today," the mother said in a statement included in the organization's report.

In rural displacement camps, clinics are often operating under tents or trees. Rev. Paul said tens of thousands of people had crossed the border in recent months, including many women and children.

Benner said the response effort has included hiring nurse practitioners and nurses work in the refugee camps as well as paying the salaries of doctors and nurses in the local hospital, as they had gone without pay for weeks. Some staff had to forgo paying their own children's schooling fees as a result.

"We don't rest," Makuach said. "We do our best because you are supporting our people, and we cannot keep quiet."

Training the Next Generation for Peace

Beyond emergency aid, Rev. Paul said his group is trying to prevent another generation from being consumed by war.

TWIC has been training youth peace ambassadors, supporting schools, and helping former child soldiers transition into vocational programs rather than armed groups. They have also hosted nine peace conferences aimed at easing intertribal and interreligious disputes.

"We want children from different tribes to play together," Rev. Paul said. "Twenty years from now, people can change their bad behavior and have peace."

The efforts are starting to gain recognition. Rev. Paul said one of the reasons that so many refugees now come to Twic County is because it has become known as a peaceful, safe area.

Asked why he continues the work despite hardship, Rev. Paul, who was battling malaria during the interview, said it's because he understands the suffering firsthand.

"I was born in war. I grew up in war," he said. "Somebody lifted me up when I was suffering. I know what it means because I grew up in that condition."

Analysis contributed by Alycia Clark, Shailja Joshi, and Alexandra Kelleher