The single-engine Cessna Caravan is flying over Nyirol county, in South Sudan’s Jonglei state. Its five passengers stare intently at the landscape streaking past below as the plane approaches the town of Lankien. On this hot day in late April, a team from Médecins Sans Frontières (MSF) is back for the first time since shutting down their hospital there, 10 weeks earlier.

They know what had happened shortly after the hospital’s closure: a bomb was dropped on it by a government plane on 3 February, followed by a ground invasion that turned Lankien into a ghost town. But discovering the level of destruction first-hand is shocking, even to humanitarians accustomed to war zones.

The burnt, roofless and partly collapsed tukuls (traditional mud houses) that could be seen upon landing offer only a glimpse of the devastation. At the airstrip, the presence of a small crowd led by traditional chiefs in uniforms and red sashes seems surreal.

They had gathered to welcome the visitors, after having themselves returned from weeks of survival in the bush. Women wearing colourful lawas (a long piece of cloth tied on the shoulder) sang and danced, an oddly cheerful performance amid the ruins.

“I saw the plane that came and bombed our hospital with my own eyes,” says Nyakeda, a deaf woman using sign language, who had been back in Lankien for a week. “The situation is worsening. There’s no medication in the area. We are suffering.”

The UN estimates that, since December 2025, more than 304,000 people in Jonglei have been displaced by fighting between the South Sudan People’s Defence Forces (SSPDF), the government army loyal to President Salva Kiir, and the Sudan People’s Liberation Movement In Opposition (SPLM-IO), the opposition group led by the now-suspended vice-president, Riek Machar.

“Civilians are bearing the brunt of a spike in indiscriminate attacks, including aerial bombardments, deliberate killings, abductions and conflict-related sexual violence,” said the high commissioner for human rights, Volker Türk, in late February. He noted that on both sides, “troops have demonstrated a near total disregard for civilian protection”.

After meeting local representatives inside a large tukul – one of the few structures still intact at Nyirol county’s headquarters – the MSF team proceeds to the hospital. Children run through the rubble behind them as a few dozen community members tag along.

The 80-bed facility was run by MSF for more than three decades. The only secondary healthcare centre in the region, it offered life-saving care including maternal and paediatric services, treatment for chronic diseases, severe malnutrition and malaria, and care for survivors of sexual violence. About 250,000 people depended on it.

“It’s all gone,” says Yashovardhan, MSF head of mission, on discovering the extent of the damage. The premises are littered with medical supplies and documents. Air conditioners, printers and oxygen concentrators have been thrown around and ripped apart. Electric panels have been smashed open and stripped of components.

Not a single bed, chair or desk remains in the wards. Three out of five MSF vehicles have been stolen. The two remaining are riddled with bullets, their engines and seats missing. The cold-chain room, a large metal warehouse, has been completely burnt, its supplies turned into ashes. “This is arson,” says Ben Greenacre, MSF’s humanitarian affairs manager. “People went in and purposely set it on fire.”

John*, a local MSF employee, was present during the hospital’s shutdown and the subsequent exodus of Lankien’s 20,000 people. He says MSF decided to evacuate after receiving reports of imminent military operations.

“It was on 3 February. It was a day of shock. Discharging patients, who were on beds for two, three weeks, a month … was very tough. By the afternoon we had managed to discharge our 48 patients, including 26 with gunshot wounds. At 6pm we closed the hospital and left. Then at around 7.30pm the airstrike came and hit our medical store.”

When government forces began a ground assault on 7 February, people fled into the surrounding bush. Not everyone made it. “We heard that people who were not able to run away, like the elderly and the youths with mental health problems, who drink alcohol, were killed in the market.”

The hospital was ransacked in the days that followed. MSF says it cannot establish with certainty who was responsible for it.

Samson*, a man from Lankien in his 30s, watches as Yashovardhan and his colleagues inspect charred metal containers that once held refrigerated stores. “I ran away when the SSPDF captured the town,” he says. “I didn’t see the burning. But it was happening when the SSPDF had taken control.”

When the bomb fell on the hospital’s store, the ground underneath collapsed and swallowed everything. Metal beams are now sticking out of a giant jagged pit.

“There is a crater in the middle of the hospital,” says Yashovardhan, as if it is hard to believe all of this is real.

“The hospital has been bombed, looted, burned; and whatever was left behind was vandalised. It was purposely done so that we would have no other choice but to close it down for good,” he says.

Six days after its visit to assess the extent of the damage in Lankien, MSF announced the permanent closure of the hospital. It is the fourth hospital MSF has been forced to shut down in South Sudan since the beginning of 2025. In its statement, the organisation said the attack on its Lankien facility was “part of a wider and deeply worrying trend of violence against healthcare in South Sudan”. The closure came a year after MSF denounced the deliberate bombing of its hospital in Old Fangak, Jonglei, that killed seven people.

According to the UN humanitarian agency (Unocha), 33 health facilities have been either looted or destroyed in Jonglei, leaving 1.4 million people with no access to healthcare.

The security situation across South Sudan deteriorated throughout 2025, as hostilities resumed between the SSPDF and the SPLM-IO, and the peace agreement signed in 2018 unravelled.

In March 2025, Machar was placed under house arrest in Juba, accused of orchestrating an attack on a government garrison in the north-east. His arrest did nothing to quell the unrest. The government-appointed Nyirol county commissioner was forced out. ​At the time the UN warned that South Sudan was on the brink of civil war, and called on all parties to uphold the 2018 agreement.

In late December, the SPLM-IO launched an offensive, in coordination with the White Army, a youth militia drawn from Machar’s Nuer community, in the northern part of Jonglei and captured several government outposts. The SSPDF mounted a counteroffensive in mid-January, calling it Operation Enduring Peace. With aerial bombardments and ground assaults, the SSPDF and allied militias recaptured lost positions, and hoped to dislodge the SPLM-IO from its strongholds, including Lankien.

The thousands of people displaced from Lankien in February had sought refuge in Nyirol county’s swampy forests, surviving on leaves and wild fruit. In April, the resumption of food aid by the World Food Programme (WFP) motivated some of them to return to the town. There they were confronted with scenes of devastation: burnt tukuls, destroyed crops, damaged boreholes, no hospital and no market.

In the tangle of scorched corrugated iron where the market once stood, two or three groups of men are putting up wooden structures.

Hoth Majok, 28, who returned to Lankien on 1 April, is rebuilding his shop. “My shop and my home were destroyed, looted and burned,” he says. “Once commodities are brought to the market, the community will return,” he adds, hopefully.

By the end of April, the WFP had stopped food distribution in Lankien. About the same time, it warned, alongside other UN agencies, of “a credible risk of famine” in four counties, with conflict-affected communities “cut off from food, markets, and essential services … These populations are experiencing extreme conditions marked by death, starvation and the collapse of livelihoods,” they said, as mid-year food insecurity projections showed 7.8 million South Sudanese (55% of the population) would face high levels of severe food insecurity between April and July. “Acute malnutrition is being exacerbated by lack of access to health and nutrition services where facilities have been damaged or closed due to conflict,” they said.

“I’m very sad about all this. Now I’ve returned to try to resettle, but we’re still lacking food and medicine,” says Nyanchiow Mabil, 35, who had come from Nyatim, a displacement site blocked from receiving aid by the central government and local authorities, where MSF reported 58 people had died from suspected hunger in March.

“Those who forced us to live in this horrible situation … who broke our borehole, burned down our hospital and our market … As women and mothers, we urge them not to ever return to Lankien,” says Mabil, as other women crowd around her and loudly agree.

* Names changed to protect identities