South Sudan: Violence 'jeopardising MSF work' Published duration 26 February 2014

image copyright AFP image caption The hospital in Leer, Unity state, which was opened 25 years ago, was the only secondary healthcare facility in the region before its destruction

Medical charity MSF has warned its work in South Sudan is being jeopardised as a result of "brutal" attacks on medical facilities in which patients and its hospital staff have also been targeted.

Hundreds of thousands of people have been effectively denied lifesaving assistance, MSF says in a new report.

Fighting between the government and rebels since mid-December has displaced about 860,000 people, the UN says.

The sides have accused each other of violating a January ceasefire.

"As entire towns in South Sudan suffer devastating attacks, medical care has also come under fire, with patients shot in their beds, wards burned to the ground, medical equipment looted and, in one case, an entire hospital destroyed," the MSF report released on Wednesday says.

image copyright AFP image caption The MSF report says that Leer is now empty of civilians who have fled continued insecurity and are living in terrible conditions in the bush, too terrified to return home

image copyright AFP image caption In the first 10 weeks of the crisis, MSF carried out more than 40,000 consultations of children aged under five

image copyright AFP image caption Assaults on medical facilities and patients are part of a broader backdrop of attacks on towns, markets and public facilities, MSF says

MSF mission head Raphael Gorgeu said hospitals are "now targets of attack and brutality" rather than "safe havens for treatment".

He said: "Assaults on medical facilities and patients are part of a broader backdrop of brutal attacks on towns, markets and public facilities.

"These attacks show a complete lack of respect for medical care and deprive the most vulnerable of lifesaving assistance just when they need it most."

The report lists numerous recent "gruesome attacks", including:

Patients murdered in their beds in the town of Malakal, Upper Nile state

A hospital in Leer, Unity state, was "thoroughly looted, burned and vandalised"

The MSF compound in Bentiu, capital of Unity state, was looted amid heavy fighting

On 22 February, MSF teams discovered at least 14 bodies at the Malakal teaching hospital compound, scattered among 50 to 75 patients who remained in the facility, too weak or elderly to flee for safety.

"Several patients showed signs they had been shot dead while lying in their beds," it said.

"Many of the hospital wards, including the therapeutic feeding centre for malnourished children, had been burned, and general looting had clearly taken place throughout the hospital."

Malakal, a dusty market town that serves as the gateway to the oilfields of the Upper Nile region, has been at the centre of clashes and has repeatedly changed hands.

Local MSF emergency co-ordinator Carlos Francisco said he can "find no words to describe the brutality in Malakal, which has left in its wake a ransacked city and a thoroughly traumatised people".

Last month the army said that it had recaptured the town after days of heavy fighting.

What started as a political dispute between President Salva Kiir and his former deputy Riek Machar escalated into full-scale conflict, with some of the fighting along ethnic lines.

Although both men have supporters from across South Sudan's ethnic divides, fighting has often been communal, with rebels targeting members of Mr Kiir's Dinka ethnic group and government soldiers attacking Nuers, Mr Machar's people.

MSF has 333 international staff working in its projects alongside 3,330 South Sudanese staff.

image caption Fighting erupted in the South Sudan capital, Juba, in mid-December. It followed a political power struggle between President Salva Kiir and his ex-deputy Riek Machar. The squabble has taken on an ethnic dimension as politicians' political bases are often ethnic.

image caption Sudan's arid north is mainly home to Arabic-speaking Muslims. But in South Sudan there is no dominant culture. The Dinkas and the Nuers are the largest of more than 200 ethnic groups, each with its own languages and traditional beliefs, alongside Christianity and Islam.

image caption Both Sudan and the South are reliant on oil revenue, which accounts for 98% of South Sudan's budget. They have fiercely disagreed over how to divide the oil wealth of the former united state - at one time production was shutdown for more than a year. Some 75% of the oil lies in the South but all the pipelines run north.

image caption The two Sudans are very different geographically. The great divide is visible even from space, as this Nasa satellite image shows. The northern states are a blanket of desert, broken only by the fertile Nile corridor. South Sudan is covered by green swathes of grassland, swamps and tropical forest.

image caption After gaining independence in 2011, South Sudan is the world's newest country - and one of its poorest. Figures from 2010 show some 69% of households now have access to clean water - up from 48% in 2006. However, just 2% of households have water on the premises.

image caption Just 29% of children attend primary school in South Sudan - however, this is also an improvement on the 16% recorded in 2006. About 32% of primary-age boys attend, while just 25% of girls do. Overall, 64% of children who begin primary school reach the last grade.

image caption Almost 28% of children under the age of five in South Sudan are moderately or severely underweight. This compares with the 33% recorded in 2006. Unity state has the highest proportion of children suffering malnourishment (46%), while Central Equatoria has the lowest (17%).

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