South Sudan has one of the weakest health systems in the world, marked by a severely degraded public health system, shortages of qualified health workers, and restricted access to care. These problems have been shaped by decades of conflict, poverty, low literacy, and the country's largely rural economy, in which much of the population depends on subsistence farming or animal husbandry.
Even before independence, South Sudan had some of the worst health indicators in the world, a situation that has persisted since then.Ross, Emma (28 January 2004). Southern Sudan has unique combination of worst diseases in the world. Sudan Tribune.Moszynski, Peter (23 July 2005). Conference plans rebuilding of South Sudan's health service. BMJ. Neonatal and maternal mortality rates remain among the highest globally, while life expectancy is low. In 2016, South Sudan had the second-lowest expected human capital among 195 countries, with people expected to live the equivalent of 2 fully healthy, educated, and productive years between ages 20 and 64, up from 1 year in 1990.
The country's health burden includes widespread malaria, recurrent cholera outbreaks, food insecurity, and undernutrition. Conflict and insecurity have further weakened the health system, damaging facilities, reducing access to basic services, and restricted humanitarian access.
Health system Structure and administration South Sudan's health system is structured into three main service tiers: Primary Health Care Units (PHCUs), Primary Health Care Centres (PHCCs), and hospitals operated at the state, county, police, or military level.
Health service delivery operates across four levels: community, primary, secondary, and tertiary. Community-level services are provided in villages by trained local personnel. The primary level includes PHCUs and PHCCs, which deliver the Basic Package of Health Services (BPHS). The BPHS encompasses preventive, curative, health promotion, and basic administrative services. The government finances it, the Multi-Donor Trust Fund (MDTF), and various NGOs. These services are intended to be free and accessible to the majority of the population at both the primary and secondary levels.
The Ministry of Health (MoH) administers a decentralized healthcare system in line with the Interim Constitution of South Sudan (2005) and the Local Government Act (2009). This system is organized across four administrative levels: national, state, county, and community. The national Ministry is responsible for policy development, strategic leadership, funding, and monitoring and evaluation. State governments oversee the implementation and coordination of healthcare services at the county and community levels.
In 2021, South Sudan's domestic general government health expenditure was 2.1% of general government expenditure, unchanged from 2020. In 2022, the country had 0.41 medical doctors, 6.9 nursing and midwifery personnel, 0.03 dentists, and 0.15 pharmacists per 10,000 people. The density of nursing and midwifery personnel had increased since 2018, while the density of pharmacists had declined. Furthermore, healthcare workers in South Sudan are unevenly distributed, with Central Equatoria having the highest concentration. Rural areas, where most of the population lives, remain especially underserved and have limited health resources.
Effects of conflict on the health system At independence, the country's public health system had been severely weakened by prolonged violence and instability, and effective health service coverage remained below 25%. After independence, efforts were made to move away from emergency oriented, health systems largely run by international NGOs toward more sustainable services overseen by the Ministry of Health in South Sudan. Despite these reforms, two years later, international NGOs still provided more than 80% of available healthcare. As of 2022, armed conflict continued to severely reduce access to basic health services for much of the population in South Sudan. The impacts included damage to health facilities, the killing of health workers, widespread malnutrition affecting children, rising mental and psychosocial conditions, and recurrent disease outbreaks and public health emergencies. Despite humanitarian assistance, prolonged conflict continued to erode and exhaust the skilled health workforce, limiting the country's capacity to deliver care. Humanitarian operations were also constrained by insecurity, attacks on aid workers, looting of supplies and equipment, and major logistical obstacles.
Aboko County In Akobo County, 7 of the 15 health facilities were out of service because of conflict-related damage. These included Walgak PHCC, which was reportedly struck in an air attack, and Tangnyang PHCC, which was vandalized during recent clashes. Another major concern was declining immunity to disease, as ongoing conflict had delayed or disrupted vaccination campaigns while the risk of measles, cholera, meningitis, and severe acute malnutrition remained.
Akobo was facing a growing water crisis after solar panels were looted and destroyed at the town's main pumping station, leaving it out of operation and sharply reducing access to safe water while many people had been displaced and conditions had become increasingly precarious.
Médecins Sans Frontières evacuation Since March 2025, facilities supported by Médecins Sans Frontières (MSF) in Akobo County have faced 12 security incidents, leading to the closure of three hospitals, with three more attacks recorded in the opening months of 2026. On 7 March 2026, MSF announced that it was evacuating its team from Akobo County following a government order, a move that disrupted malaria season preparations, routine vaccinations, and basic health services for displaced people and local residents. MSF said the evacuation reflected a wider pattern of attacks on health care and warned that the closure of Akobo Hospital would leave thousands without primary care, including around 200 women each month without skilled delivery services, among them an estimated 30 cases requiring emergency obstetric care.
USAID US assistance has accounted for more than half of total foreign aid received by South Sudan. In early 2025, health services in South Sudan suffered a major setback following cuts to United States Agency for International Development (USAID) funding initiated under President Donald Trump's "America First" policy. These cuts led to the closure of seven out of 27 Save the Children-supported clinics in Jonglei State and forced 20 others to reduce services, resulting in the layoff of roughly 200 health workers. In April 2025, Save the Children reported that five children were among eight people who died after walking for hours in extreme heat to reach medical care for cholera. A US-funded patient transport service had also been shut down. USAID had previously supported critical interventions for cholera, malnutrition, malaria, and HIV/AIDS, but over 90% of its contracts were reportedly canceled. While the US State Department maintained that some humanitarian projects were still active, it cited widespread corruption in South Sudan's government as a barrier to continued support.
Apart from the United States, other major donors to South Sudan have already reduced funding or indicated that cuts are forthcoming. In the second half of 2024, the UK announced significant reductions, and the Swedish government shut its Cooperation Office in South Sudan. In response, international organizations have withheld funds to preserve their own viability, further constraining national actors working on the front lines.
Sudanese and South Sudanese civil society actors responded to the international aid cuts with strong concern over their immediate humanitarian consequences, particularly worsening food insecurity, strain on health systems, and rising preventable deaths. At the same time, the cuts coincided with increased reliance on, and visibility of, existing grassroots response mechanisms, which these actors describe as both an established reality and a potential model for the future.
Health indicators The health situation in South Sudan is far from ideal. More than 50% of the population lives below the poverty line, and the adult literacy rate is 27%. The under-five mortality rate (U5MR) is 99 per 1,000 live births, while the broader under-five infant mortality rate is estimated at 135.3 per 1,000.
South Sudan's human resources for health are significantly below the minimum threshold recommended by the WHO. Between 2009 and 2010, there were only 189 doctors across eight states—an average of one doctor for every 65,574 people. The number of midwives was 309, or one per 39,088 population. However, estimates vary; other sources suggest a ratio of one midwife per 125,000 women.
In September 2018, The Lancet published a new measure of expected human capital for 195 countries from 1990 to 2016. For each birth cohort, it was defined as the expected years lived between ages 20 and 64, adjusted for educational attainment, learning or education quality, and functional health status. South Sudan had the second-lowest level of expected human capital, with 2 years lived between ages 20 and 64 after adjustment for health, education, and learning. This was an improvement over 1990 when its score was 1 year.
In South Sudan, life expectancy at birth increased from 51.9 years in 2000 to 58.6 years in 2021, with most of the improvement occurring between 2000 and 2012. Whereas life expectancy increased globally and in Africa between 2011 and 2021, it remained largely unchanged in South Sudan, at around 58–59 years.
Compared with other East African countries, in 2020-2024 South Sudan had a higher health facility burden from malaria, pneumonia, diarrhoea and malnutrition.
Maternal health In 2011, access to antenatal care (ANC) was limited, with 47.6% of women attending the first visit and only 17% completing the recommended four visits.
South Sudan has one of the world's highest maternal mortality rates. The estimated number of maternal deaths in South Sudan was much higher in the late 1980s and 1990s, with several years above 10,000 and peaks of around 20,000. It fell sharply after the late 1990s, declined more gradually during the 2000s, rose again during the mid-2010s, and then decreased after 2017. In 2023, the estimate was 2,271 maternal deaths. Prolonged conflict has been cited as a factor contributing to maternal mortality in South Sudan, partly through its impact on maternity services. Most maternal deaths occur during labour, delivery, or the immediate postpartum period. These deaths are largely preventable with adequate infrastructure and the presence of skilled personnel during childbirth.
Child health Since independence in 2011, South Sudan's infant mortality rate (the number of infants dying before reaching one year of age per 1,000 live births) initially declined slightly, from 76.1 deaths per 1,000 live births in 2011 to 72.9 in 2013. It then rose sharply during the civil war years, reaching 172.9 in 2017, before falling again. By 2025, it had declined to 56.75 deaths per 1,000 live births, below the level recorded at independence. The under-five mortality rate followed a broadly similar pattern, with the rate estimated at 99.3 deaths per 1,000 live births in 2023.
Around 75% of child deaths in South Sudan are attributed to preventable diseases, including diarrhea, malaria, pneumonia, and malnutrition. From 2020 to 2024, children under five accounted for more than 90% of inpatient admissions for communicable diseases. Infectious causes had an inpatient mortality rate of about 5 deaths per 100 hospital discharges. Malnutrition accounted for 2% of under-five admissions, with 4 deaths per 100 discharges among admitted children, and the combination of malnutrition and infection increased the risk of death.