By midmorning on a recent Thursday at Juba military hospital, surgeon Slobodan Mirosavljev had already operated on two critically wounded patients. The Serbian doctor, deployed since August 2025, works in a facility where the ICRC supports surgeries for weapon-wounded victims of fighting between the South Sudan People's Defence Forces (SSPDF) and the Sudan People's Liberation Movement-In Opposition (SPLM-IO), loyal to former vice-president Riek Machar. His day starts before 8am. Surgeries can stretch deep into the night. The numbers tell the structural story. In the first six months of 2026, the ICRC evacuated 266 injured people from conflict areas to the facility. The surgical department at Giada military hospital hit 160% of bed capacity at its most recent peak. The hospital holds roughly 15 units of blood at a time, sometimes reaching 20 — and a single severely wounded patient can require half that supply. Emergency nurse Mubarak Jamal recalls receiving more than 93 patients in a single day during the last mass casualty event, against a normal daily flow of about 30. The political mechanics behind the surge are depressingly familiar. President Salva Kiir and Riek Machar — both former Sudan People's Liberation Army guerrillas who fought together for independence from Sudan, achieved in 2011 — have cycled through alliance, civil war, peace deal, and renewed conflict. The 2013-2018 civil war killed more than 400,000 people and displaced nearly half the population, fought largely along ethnic lines between Kiir's Dinka majority and Machar's Nuer community. The current round was triggered by a March 2025 attack by the White Army, a rebel group allied to Machar during the civil war, on a government garrison in Nasir county, Upper Nile state. Kiir responded by charging Machar with murder, treason, and crimes against humanity, and suspending him from the vice-presidency. Machar's supporters call the charges politically motivated. Observers warn the moves risk destroying the 2018 peace agreement entirely, with elections nominally due in December. The fighting has killed hundreds and displaced more than 200,000 people, intensifying particularly in Jonglei state, an opposition stronghold. The UN Commission on Human Rights in South Sudan, chaired by Yasmin Sooka, has expressed concern that civilians continue to bear the consequences of violence, displacement, and the failures of political and security actors. "Visit after visit, we continue to hear from people who bear the consequences of violence, displacement, insecurity," Sooka said. Inside the hospital, the damage is granular. Most cases are gunshot wounds; others include stab wounds, broken bones, and explosive injuries. Mirosavljev estimates one in 10 involve serious head injuries, including bullets entering the skull. Every week, at least two or three patients arrive with devastating chest and abdomen injuries requiring multiple surgeries. Physiotherapist Lotto Charles, working at the hospital since 2016, rehabilitates patients with multiple fractures, nerve injuries, lung collapse, and extensive soft-tissue damage. Blood supply coordination depends partly on patients' relatives and the national blood bank. The health coordinator for the ICRC in South Sudan, Rose Ochieng, names the structural problem plainly: "Demand is growing faster than the capacity of trauma services. And it is civilians caught up in the fighting who are paying the price." The ICRC has added overflow beds and recruited more physiotherapy staff. But the underlying dynamic — political elites cycling through violence while a single humanitarian organization backstops the surgical consequences — is not a system. It is a holding pattern.
