Ebola threat puts South Sudan’s lifesaving trauma care on alert

South Sudan has not reported any cases of Ebola, but an outbreak in neighboring Democratic Republic of Congo is prompting the International Committee of the Red Cross (ICRC) to strengthen preparedness amid concerns that cross-border transmission could disrupt care for people wounded in conflict.

“The threat of Ebola is very serious,” Daniel Bunnskog, head of the ICRC delegation in South Sudan, said.

“The Congolese border is very close to where we are standing right now, where people move on a daily basis to meet families and friends. The risk of transmission and the importation of cases remains very high in South Sudan.”

For the ICRC, the concern is not only the potential spread of the virus, but also what an outbreak could mean for treating weapon-wounded patients.

The scale of the operation reveals what is at stake.

During the first half of this year, the ICRC evacuated 266 wounded patients from conflict-affected areas across South Sudan. This represents an increase of more than 50 percent compared with the same period in 2025. Since 2014, more than 5,000 patients have been evacuated for emergency surgical care.

“Ebola, if it were to spread into the country, remains a key risk,” Bunnskog said. “It could lead to complicated access and also make it impossible to treat certain patients and bring them to the hospital.”

Preparing Juba Military Hospital

At Juba Military Hospital, where the ICRC supports surgical care for weapon-wounded patients, screening, handwashing facilities and staff training have been strengthened. An isolation tent has also been established for suspected cases.

The hospital is already under pressure. During the first half of 2026, the number of surgeries at the institution surged by nearly 30 percent compared with the same period last year, leaving the ICRC-supported surgical department operating at more than 100 percent capacity.

Papy Lunduluka Nyimbata, the ICRC hospital project manager, said 15 counties had been identified as high-risk because of their proximity to the DRC and porous borders.

“This means that we have to plan better at our level on how, maybe, to reduce the risk, not only for the patient, but also for the staff,” he said.

The ICRC has developed a phased response plan that would scale up measures depending on the level of threat.

“We worked on some kind of scale-up plan starting from the green phase, where there is no Ebola in the country and only in the surrounding countries,” Nyimbata said.

A suspected case in South Sudan would trigger the yellow phase, while a confirmed case in the country would move the response to the orange phase.

A confirmed case at Juba Military Hospital would trigger the red phase, bringing additional infection prevention and control measures.

Protecting patients and health workers

Patients being evacuated from high-risk areas are now screened before being transported to the hospital.

“We cannot rush to take a patient if we have not screened them,” Nyimbata said.

He said the additional procedures could create delays in transferring wounded patients. The consequences could be more serious if a case were confirmed inside the hospital.

“If we are not able to protect our team... that means we cannot take a patient to the OT,” Nyimbata said, referring to the operating theatre.

He said the ICRC could then have to consider whether to “reduce the number of patients, reduce the movement to the affected places or stop our activities temporarily.”

Bunnskog said the risks would be particularly difficult to manage in conflict-affected areas, where insecurity and poor roads already make access challenging.

“Many of the places that would potentially be affected in South Sudan are areas affected by insecurity, violence and armed conflict,” he said.

“The security of health workers is paramount to ensuring they can access and respond. Access for Red Cross volunteers is also paramount.”

The ICRC is drawing on lessons from its Ebola response in the DRC, where Red Cross and Red Crescent teams worked with communities on prevention, safe behavior and dignified burials.

“There’s a lot of collective action right now to prepare for a potential Ebola outbreak in South Sudan, but more needs to be done,” Bunnskog said.