Grand corruption schemes siphoning billions in state resources to government-linked elites have crushed South Sudan’s health system as the country teeters between famine and a new civil war, UN investigators found.

The findings of a two-year investigation by the independent UN Commission on Human Rights in South Sudan published on Tuesday document how systematic corruption has created one of the world’s worst health crises, leaving the youngest nation in the world with just $7.9 million in health spending last year for 12 million people — comparable to what it spent on its 12-player men’s national basketball team.

South Sudan ranks second-to-last globally in universal health coverage. One in 10 children dies before age five, with three-quarters of these deaths being preventable with basic medical care and immunisation programmes.

Women and girls face the highest maternal mortality rates globally. Life expectancy remains frozen at 55 years, one of the lowest in the world and nearly 20 years below the global average, unchanged since independence in 2011.

Over 7.7 million people — 65% of the population — face acute food insecurity. Among them are 2.3 million acutely malnourished children and 1.2 million malnourished pregnant and lactating women. Several provinces and over 20,000 people are currently facing famine.

“Corruption is killing South Sudanese: preventable deaths from illnesses are due to available resources being diverted from government services,” the UN Commission found. “The country has been captured by a predatory elite that has institutionalised the systematic looting of the nation’s wealth for private gain.”

The health catastrophe is unfolding as political instability threatens renewed civil conflict. President Salva Kiir arrested former deputy Riek Machar in March and charged him with treason last week, effectively ending hopes for the 2018 peace agreement that halted the last civil war, which killed 400,000 people shortly following South Sudan’s independence.

“Unless it addresses corruption meaningfully, the Government will not be able to meet the most essential needs of South Sudan’s population, or its range of international human rights law obligations, nor prevent the escalation of armed conflict,” the UN commission concluded. “If these measures are not vigorously pursued, the human misery will continue, and South Sudan will risk failure.”

Diverted billions

The commission’s report, “Plundering a Nation,” found the Ministry of Presidential Affairs spent $557 million between 2020 and 2024, over 12 times the combined $43.7 million received by the ministries of health, agriculture, social services, and social welfare over the same period.

The Presidential Medical Unit, exclusively serving the president and his inner circle, received more funding in 2022-2023 than the entire national health system meant to serve 12 million people.

The men’s national basketball team received $6.5 million that same year, double the combined funding for humanitarian affairs, disaster relief and social welfare ministries, which include the arms of government responsible for children and women’s health.

“Corruption is not incidental, it is the engine of South Sudan’s decline,” said Yasmin Sooka, who chairs the UN Commission. “It is driving hunger, collapsing health systems, and causing preventable deaths, as well as fuelling deadly armed conflict over resources.”

South Sudan received an estimated $25.2 billion in oil revenues since achieving independence in 2011, including $8 billion since the 2018 peace agreement that currently governs the country. The UN Commission found “deliberate redirection” and “plundering” of these state revenues were the main culprits for the nation’s precipitous economic decline, which has seen GDP fall to a quarter of pre-independence value, resulting in a near total absence of government funding for public services.

Meanwhile, the “Oil for Roads” program diverted $2.2 billion to companies linked to Benjamin Bol Mel, appointed vice president in February. These companies, consuming 60% of government contracts in certain years, delivered less than $500 million in actual roads, leaving $1.7 billion unaccounted for.

“South Sudan’s political economy is constructed around an entrenched rent-seeking patronage network, through which elites convert public resources into private power,” the UN Commission said. “The ensuing cycle of grand corruption aided by total impunity has produced a devastating humanitarian and human rights crisis.”

A five-year plan developed by South Sudan’s own health ministry to provide basic health coverage to 65% of the population  by 2027 would cost $325.5 million in 2024. Current spending covers 2.3% of that, or $7.49 million for a whole year of the national health system intended to serve over 10 million people, 70 times lower than what the Presidential office has spent on expenses since 2020.

“These figures fall drastically short of policy targets, public health needs, and regional commitments, including the 15 per cent target committed to by African States in the Abuja Declaration,” the UN added.

Limited funds, when they reach the Ministry of Health at all, are also frequently misspent. In 2022-2023, the ministry spent twice as much on vehicles as on salaries and purchased no pharmaceuticals.

South Sudan’s government rejected the UN report, stating it was “meant to smear the good image of the people of South Sudan and its leadership.” Government spokesperson and information minister Michael Makuei Lueth also dismissed the UN’s findings: “They don’t consult the government. They just write whatever comes to their mind in their hotel rooms.”

Dying without medicine

At government hospitals visited by UN investigators, doctors described working without reliable salaries, medicines or basic supplies, effectively operating under “emergency” conditions year-round. Untrained midwives deliver babies without equipment. For survivors of sexual violence, access to health care is “practically non-existent,” the Commission found.

Lack of investment in core infrastructure further complicates the picture. Power outages cripple the few functioning hospitals. Where roads don’t exist, medicine must be flown in at costs no one can afford. Only 12% of rural households have access to improved sanitation. Most South Sudanese, 61%, practice open defecation, fuelling cholera outbreaks.

“Three-quarters of child deaths are preventable, yet funds go to patronage and private pockets, not medicine or clean water,” said Commissioner Carlos Castresana Fernández. “The diversions translate into preventable deaths, widespread malnutrition, and mass exclusion from education.”

The abdication of core government functions from health, to food, and infrastructure has led to a near-total dependence on international aid. Foreign donors fund 80% of South Sudan’s health system, with the United States providing health assistance worth 235% of what the government spends on its own people.

South Sudan now faces the spectre of over half its health spending evaporating under the Trump administration’s foreign aid cuts. It is the third most reliant nation on United States funding for its health services, second only to Afghanistan and Somalia.

“The Government’s expectation, if any, is that others will cover the shortfalls,” the commission found. “While a small group of powerful actors pillage and loot the country’s wealth and resources, enriching themselves, the state has effectively abdicated its sovereign responsibilities to its population, outsourcing critical services — such as the provision of food, health care, and education to international donors.”

“Individuals implicated in corrupt acts receive government contracts for their businesses, are retained as public officials, and even promoted to the senior-most State positions,” the UN added. “This collusion in corruption at the highest levels is reflected in the deliberate absence of all forms of accountability.”

Hunger by design

The crisis extends to food security. In 33 of 79 counties, food insecurity is at ’emergency’ levels, one tier below famine. Over 22,000 people are likely already starving, while nearly 60% of the population faces life-threatening food insecurity.

The Ministry of Agriculture received $11 million over four years, 7% of its promised budget. The Ministry of Livestock and Fisheries received only 20% of its budget allocation, amounting to 0.09% of total regular budget expenditure.

Beyond climate change and conflict, the hunger crisis is also driven directly by the government’s economic mismanagement. The government’s money printing to fund corruption drives food inflation at a one-to-one rate, according to the International Monetary Fund. Any depreciation of the South Sudan Pound is fully passed on as food inflation within six months.

“In practice, the Government’s official policy choices are fuelling inflation and directly driving up the cost of food, trapping families in a cycle where government action itself intensifies hunger,” the UN said.

Malaria, the leading cause of death, struck 2.8 million people in 2022. Médecins Sans Frontières warned in August of a “severe shortage of essential malaria medicines in public healthcare facilities across South Sudan,” noting the crisis would worsen with the rainy season and flooding.

“In some areas, supplies have been completely unavailable for months, even as malaria cases continue to rise,” MSF said. “With the rainy season approaching, we expect cases to rise sharply.”

Following MSF’s warning, massive floods displaced 100,000 people in recent weeks across Jonglei, Upper Nile and Unity states. Unity State is 70% underwater. Up to 400,000 people may be displaced by year’s end.

“On the ground, we have seen the widespread deprivation and the absence of basic infrastructure and services: direct outcomes of corruption,” said Sooka. “When public revenue becomes private fortune, peace cannot hold.”

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