Water scarcity
In northeast Syria, widespread water scarcity, driven by climate change, the weaponization of water resources, prolonged droughts, and excessive groundwater extraction have been made worse by frequent damage to water infrastructure, including Allouk and Tishreen water stations.
Since 2019, repeated interruptions to Alouk station, the main source of safe water for nearly one million people, have forced families to rely on unsafe and unregulated water sources. Survey results indicated only 37 per cent of households can consistently access sufficient water to meet basic hygiene and domestic needs.
“We bathe once every five days now. We have to choose between being clean and being hydrated”, says *Khalid, a 26-year-old man who has been displaced to Al-Hasakah during the years of the conflict.
The assessment highlights water insecurity disproportionately affects women, who are primarily responsible for securing household water, often walk long distances, facing physical exhaustion, harassment, and exploitation.
“I was collecting our household’s water allocation from the communal water tank. The man managing the distribution insisted I step inside so he could “help me”. As he leaned in, he touched me inappropriately. I was so shaken that I left without taking the water, since then, I’ve never gone back alone”, says *Fatima, a 27-year-old woman from Al-Hasakah.
Women reported some private vendors have offered water in exchange for sex, which is unacceptable and highlights the intersection of vulnerability, gender, and survival.
MSF teams have recently rehabilitated 12 boreholes in Al-Hasakah and supported the rehabilitation of two water stations (Al Aziziah and Al Hamma) in readiness for any potential startup of Alouk and ensure access to safe water for local communities.
Economic vulnerability, food insecurity
Economic vulnerability is widespread, with median household incomes reported at $150 US per month, ranging from as low as $15 US to $200 US. Food has become increasingly out of reach for lower-income families, with 77 per cent of households surveyed reporting food shortages multiple times per month.
Underfunding and Violence Fuel South Sudan Cholera Crisis
At the heart of this crisis is the fragile nature of South Sudan’s public healthcare system, which depends almost entirely on external support. With the government allocating less than two per cent of its budget to health in recent years, the system is incapable of catering to the routine needs of its own population, let alone a robust emergency response. Moreover, existing programs are on a precarious footing as a result of long-standing challenges, including insufficient domestic and international funding and critical implementation failures. The withdrawal of support from major donors—including USAID—has forced the closure of some health facilities, eliminating crucial lifelines. In Bentiu, for instance, we witnessed how the reduction in funding to organisations that run water and sanitation and primary healthcare have left major gaps in the response, leaving people at risk while desperately searching for care.
Added to this is the influx of people who have fled to South Sudan from Sudan, increasing the burden on limited services at a time the country was facing reduced services due to funding cuts. Since April 2023 when the civil war in Sudan broke out, more than 1 million people found refuge in South Sudan, equivalent to 10 per cent of the country’s population. These vulnerable, mobile populations are often cut off from essential services, including vaccination programs, increasing their risk of both contracting and spreading the disease. The situation in transit camps in Renk—where the camps now host more than three times their capacity—illustrates the crisis perfectly.
This overcrowding, combined with poor water and sanitation and limited access to clean water, creates the perfect environment for disease to spread. It’s no surprise that this has driven the rise in other new waterborne diseases such as hepatitis E – a severe threat, especially to pregnant women.
Attacks on Healthcare Deepen South Sudan Cholera Outbreak
Perhaps the cruellest obstacle is the pervasive violence, insecurity and attacks on healthcare.
A heart-breaking example occurred in March 2025, when fighting in Ulang forced tens of patients to flee from the MSF hospital, including more than 30 patients admitted for cholera treatment. These patients fled into the community, not only facing the risk of death themselves, but also fuelling the spread of the disease. The hospital would later be closed permanently because of looting. Since the start of the 2025, MSF has been directly targeted in more than eight attacks, closing another hospital in Old Fangak in Jonglei state, and reducing or suspending activities in others. The result is hundreds of thousands of people cut off from healthcare.
In an open letter addressed to heads of state, Dr Abdelmoneim, warns that the ceasefire alone will not end the ongoing medical and humanitarian catastrophe that Palestinians are enduring.
While more humanitarian assistance is starting to arrive, MSF is calling for it to be rapidly scaled up – including medical supplies, fuel, clean water, food, and shelter – to meet the staggering needs of two million people, many of whom are returning to the ruins of their former homes with winter fast approaching.
As of October 2025, the WHO has confirmed that only 14 out of Gaza’s 36 hospitals were even partly functioning. None are fully operational following systematic and direct Israeli attacks, including ground offensives, tank shells, and airstrikes.
According to the Ministry of Health, 1,722 health workers have been killed. Just a week before the ceasefire, two MSF colleagues – an occupational therapist and a physiotherapist – were killed by an Israeli airstrike while on their way to work. In total, 15 MSF colleagues were killed in the past two years. An MSF orthopedic surgeon, Dr Mohammed Obeid, has been detained in harsh conditions since October 2024. We are urgently appealing for his release. The loss of health professionals is devastating for patients in Gaza.
“While some countries such as Egypt, Qatar, the United Arab Emirates, Türkiye and Jordan have carried their share of the responsibility, others have done almost nothing,” says Dr Abdelmoneim. “This inaction is indefensible.”
To underscore the scale of this inaction, MSF has published a ‘Medical Evacuation Leaderboard’, comparing countries’ efforts to facilitate patient evacuations from Gaza. The data reveals a stark imbalance: while a handful of countries have accepted thousands of patients, many governments who have the capacity to do more have accepted few patients, or none at all.
According to testimonies from the community, since February 2025, Israeli forces conducted four mass demolitions, reducing more than 85 per cent of homes and shelters to rubble, forcing families to move into caves. Last week, Israeli forces returned and demolished seven shelters, nine tents, and six caves, along with over 14 water tanks and the village’s entire electricity system. Families are left with almost no options for safe shelter. Only the school and three houses are left standing.
The community, home to around 100 people, continues to resist displacement despite the scale of destruction. Families who have lost their houses have moved into caves, only to face settlers entering and attacking them inside. One resident described the constant expansion of settlements nearby, with caravans appearing closer to the village each day.
MSF teams who visited Khallet Athaba’ reported that the community urgently needs medical care, mental health support, hygiene items, food, and water and sanitation services. But above all, families stressed their need for protection, dignity, and access to essential services.
MSF delivers primary healthcare and mental health and psychosocial support through mobile clinics serving five villages in and around Masafer Yatta.
One resident told our teams that a month ago, nine settlers forced their way into her home, where she was alone with her four children. The settlers began beating the children with metal bars and attempted to strike her three-month-old baby on the head. Both the mother and the baby were then pepper-sprayed, and the settlers continued beating her while she was trying to protect her baby, fracturing a bone in her hand. One of her children, aged 13, suffered a broken arm, while another, aged 3, sustained a head injury and a bone fracture. The baby was later taken to hospital and remains under observation due to continued vomiting.
What is happening in Masafer Yatta is part of a broader policy of ethnic cleansing, aimed at forcibly transferring Palestinians from the area. Despite repeated demolitions and attacks, no one has left the village. Residents insist they will not become refugees in their own land.
