In South Sudan, poverty, violence, and displacement can sometimes overshadow mental health issues. Neglected by the health system and confronted by deep-rooted stigma, many people face their mental health struggles in silence, enduring a daily battle that goes unseen and unheard.
Doctors Without Borders/Médecins Sans Frontières (MSF) is one of the few organizations providing mental health services in South Sudan. “We receive many patients with post-traumatic stress disorder (PTSD), depression, and postpartum depression affecting new mothers,” says Germando Kagomba, MSF mental health activity manager in Lankien. Between January and July 2024, MSF provided more than 9,600 mental health consultations and facilitated group discussions for 54,000 people across South Sudan. However, these efforts only scratch the surface of a dire need.
When she was just 12 years old, Mary Nyanhial Kiel had to escape her home in Paguir, South Sudan, when armed groups attacked her village. “We were forced to flee, and many people were killed,” Mary recalls. Her parents managed to escape with her and her siblings, but their ordeal was far from over. “A year later, during a cattle raid, my father and elder brother were killed while trying to guard our cattle. We were hiding in the bush—they tried to protect us.”
Some years later, Mary had to face the loss of a loved one once again. Mary’s husband, who had gone to Sudan to work as a cattle herder to support his family, never came back, leaving her as the sole caregiver for her six children. “Now I am all they have,” she says. “I work at a tea shop, but it’s not enough. We only eat one meal a day and I can’t afford to send my kids to school.”
The silent crisis of mental health
You don’t have to look far to find a story like Mary’s. Just a short distance from Mary’s home, Nyayong Puol Lam had also experienced an episode of loss some years back. She was forced to flee her village after seeing her brother and many people she knew killed.
During the 2016 conflict, her husband was killed, and just recently she buried her sister. “My sister was killed by her husband who was mentally ill,” says Nyayong. “And now I’m taking care of her six children and two of my own. With no husband or brother to support me, it is difficult. The children are too young, and they don’t understand … I have lost all hope. I am hopeless.”
The widespread violence has not only displaced families but has also stripped people of their livelihoods, crops, and any sense of stability. “We are not the only ones,” explains Mary. “This is happening to everyone in South Sudan. Everyone is suffering. My mother has no hope; she still thinks that we are going to die. She thinks my brothers are going to die every day.”
While primary health care is scarce in South Sudan, mental health services are even more limited. There are many people like Mary and Nyayong who have been left to fend for themselves with little to no access to food, education, or health care.
Continuous cycles of conflict, displacement, food insecurity, and extreme poverty have created overwhelming stress, while the stigma around mental health remains strong. This stigma is one of several reasons mental health is not talked about. "I only talk about it during the MSF mental health sessions because here, everyone is going through the same thing,” says Mary. Yet amid everyone’s suffering, Mary adds, “if you complain at home, they call you weak.”
Three out of four patients seeking mental health support through MSF have endured intercommunal violence, sexual violence, or gender-based violence. Mental health issues are often complex, and the patients’ initial need for help might stem from other sources of trauma or stress.
Impossible choices
When a loved one struggles with mental health issues in South Sudan, caregivers are often forced to make impossible choices due to lack of access to treatment. Many lock their family members away out of fear of the stigma and the violence it might provoke. In extreme cases, they even resort to chaining them. People suffering from mental illnesses are often left to languish by the broader society. Instead of receiving care, they are often confined to prisons or other unsuitable environments, worsening their condition and deepening their suffering due to lack of sufficient resources and infrastructure, and because there are no trained mental health professionals.
“With limited infrastructure, some patients take up to four days just to reach the hospital,” Kagomba adds. “So when you have a mental health condition, people don't really take care of you as they do for others, and the patients who make it to the hospital do not come back for follow-up.”
Long-term consequences of untreated mental health issues
Untreated mental health conditions may lead to long-term harm, including the deterioration of physical health, and can affect not only individuals but entire generations.
The significant gap in mental health treatment means that people lacking care are more vulnerable in their communities, which can further entrench them and their families in poverty. Limited participation in community activities and restricted employment opportunities diminish their quality of life. This situation may also lead to higher rates of teenage pregnancy and domestic violence. Untreated mental health conditions can also result in higher mortality rates.
To break the cycle of neglect, mental health care must be integrated into the broader health care system, so people in South Sudan can begin to heal from the deeper scars left by displacement and poverty. Without this change, families like Mary’s and Nyayong’s will continue to struggle, and hope for recovery will remain out of reach.
