The speed and scale of the violence over the past six weeks in South Sudan has been unprecedented, according to Médecins Sans Frontières (MSF).

Earlier this week, the UN’s humanitarian agency called for $1.27bn (£780m) to help the 3.2 million people estimated to be affected by the humanitarian consequences of the crisis in South Sudan. To date, aid agencies have only been able to help 300,000 people according to the UN Office for the Co-ordination of Humanitarian Affairs (Ocha).

MSF operations manager Chris Lockyear said the sheer numbers of people being forced to leave their homes and livelihoods has meant that as well as meeting urgent health needs, displaced people need fundamental support such as shelter and water.

"What's happened is massive. The situation is changing rapidly and so we've had to be dynamic and scale up in how we've responded," he said.



About 865,000 people have been displaced since violence erupted on 15 December in Juba – 740,000 within South Sudan and more than 123,000 in neighbouring Ethiopia, Kenya, Sudan and Uganda, according to estimates by Ocha and the UN refugee agency, UNHCR. Donors have pledged approximately $246m so far at a time when crises in Syria, the Philippines and the Central African Republic also require significant support.

"The forthcoming rainy season is a big worry with the hunger gap and extreme level of displacement. The scale is huge, even with our capacity and long experience working in the region, we are concerned for the people we cannot yet reach," said Lockyear.

The country’s UN humanitarian co-ordinator, Toby Lanzer, has warned that by June, remote villages are likely to be inaccessible by road and the risk of further disruption to the agricultural cycle is raising concern over increased food insecurity.

Refugees wait to board trucks at Dzaipi transit centre in Adjumani, Uganda, to be transferred to the Nyumanzi resettlement camp. Photograph: Isaac Kasamani/AFP/Getty

Agencies reported that thousands of people have been wounded or killed in the conflict and, despite the ceasefire agreement signed 23 January, there is little sign of people returning home.

In towns such as Juba, Bentiu, Bor and Malakal, where the conflict has been intense, displaced people have gathered in UN peacekeeping bases (an estimated 80,000), but many more have sought refuge in community spaces such as churches, hospitals or schools in areas less monitored by international media and agencies. In Awerial county in Lakes state for example, about 84,000 people are reportedly congregating in open areas.

UNMiss, the UN's mission in South Sudan, was praised by many for allowing displaced people to shelter in its compounds at the height of the crisis, becoming involved in the humanitarian response in a "situation of last resort". Given the fluid political situation, concerns have been raised that humanitarian assistance is given on an impartial basis.

Children pray at an outdoor church service in Minkamen in Awerial county. Photograph: Phil Moore/AFP/Getty Images

South Sudan’s recent violence has destroyed many town markets and, Lanzer says, up to 5,000 tonnes of food and other aid has been stolen during the instability.

Where the security situation has been most precarious, it has been difficult for agencies such as the World Food Programme (WFP) to move as much food aid as they want by land and instead it is having to be delivered by air. In Malakal, some civilians raided a warehouse storing aid before agencies were able to organise distribution.



Tens of thousands of people have reportedly fled from violence across the city. Most of those displaced are thought to be being hosted by residents in less insecure areas.

A rocket fired by government forces soars over a burning hut in Mathiang, Jonglei. Photograph: George Philipas/Reuters

Last week in Unity State MSF staff based in Leer were forced to flee into the bush fearing for their safety. "We have sporadic contact rather than regular communication with our staff who are split into groups in the bush. We know that one group has taken patients with them from the hospital," said Lockyear.

"We have experienced a number of lootings to our facilities. What we require of all parties is respect for our medical and health aid facilities and unimpeded access, and 90% of our staff are local staff. In Leer they've all fled and therefore the basis for our operation there needs rebuilding. We do have a strong position but due to the insecurity, we have to rebuild. We need a guarantee from all sides for safe access."

According to the WFP's South Sudan director, Chris Nikoi, the agency has suffered setbacks while trying to help those in acute need of food. “Three of our offices have been looted, completely ransacked and we’ve lost thousands of tons of food stocks," he said. "But even in those places – Bor, Bentiu and Malakal – we are still managing to carry out food distributions and have provided food for more than 200,000 people throughout the country since the crisis began. We’re doing what we can to protect existing stocks and planning to scale up to reach more than 1 million people.”



WFP analysis published on Tuesday has found that states most disrupted by fighting – including Jonglei, Upper Nile and and Unity – had the highest levels of food insecurity before the conflict.

Nikoi said: “The conflict has done so much damage that we’re concerned many people will continue to need food assistance for months or longer as they try to rebuild their lives."



Food prices in the region are high and are likely to become further out of reach of many of those whose livelihoods have been disrupted by the political instability. Since December, prices of essential cereals such as sorghum and maize have risen by up to 30% in markets in Juba and Rumbek, while in Jonglei, parts of Unity state and the west of Upper Nile many markets remain closed, with some roads cut off. Planting is likely to be hampered by the insecurity.

People receive aid from the International Committee of the Red Cross in Minkammen. Photograph: Nichole Sobecki/AFP/Getty

Eric Marclay, head of east African operations at the International Committee of the Red Cross (ICRC), explains that humanitarian needs were urgent in South Sudan before the fighting, which has "exacerbated an already very difficult situation".



In response to the conflict, the ICRC has boosted its resources, moving up from one to five surgical teams in the country and with plans to recruit further national staff. They are looking to support reconstruction and at how best to assist food production with seeds, tools and fishing material as well as the vaccinating of cattle, a key asset in the country.



Marclay emphasises that there is good co-operation between agencies responding to the crisis, especially since the "logistical constraints are huge".



“The priority is to save lives now, and ensure that we have food, medicine and other lifesaving supplies prepositioned in the field, in easy reach of aid agencies before the rains hit and the roads become impassable,” said Lanzer.

“We have revised the South Sudan crisis response plan to reflect the deterioration of the humanitarian situation, to prioritise frontline relief and pre-positioning, and to take necessary actions now to prevent food security deteriorating later in the year. To achieve this, I ask the international donor community to stand with the people of South Sudan and the aid agencies working here to help them before the situation gets even worse.”