Overcrowded and substandard living conditions are jeopardising the health of people sheltering in the UN’s Protection of Civilians (PoC) site in Malakal, South Sudan, according to Médecins Sans Frontières (MSF). Patient numbers at MSF’s hospital in Malakal are three times higher than they were five months ago, while the number of sick children under the age of five has increased fivefold.

“The sickness of our patients is directly related to the overcrowded and deplorable conditions in which they are living,” says Monica Camacho, MSF programme manager for South Sudan. “More space must be immediately allocated to the people seeking shelter, and aid organisations must urgently improve the provision of basic services and necessities.”

Some 48,000 people are currently living in the Malakal PoC site, after more than 16,000 people arrived in July and August, fleeing conflict and hunger. Many came from areas where no aid had been available for months. Most people arrived with nothing.

In recent weeks, the MSF hospital has been filled beyond capacity with children suffering from life-threatening pneumonia, malaria and other illnesses. With the onset of the cold season, pneumonia is a particular concern given the crowded and unhygienic conditions. The number of patients treated for severe respiratory tract infections has already tripled since September. MSF fears these trends may worsen unless conditions are improved.

Those with the worst living conditions are the thousands of new arrivals, whose makeshift shelters are set up in marshy areas of the camp not designated for habitation. Access to clean water and sanitation are inadequate, and children play in the mud surrounded by barbed wire and rubbish.

Seven thousand new arrivals, mostly women and children, have been relocated to a ‘contingency area’. They are living in communal tents, shared by more than 50 people, with less than 4.5 m2 of living space per person, far below the 30 m2 required by international humanitarian standards.

Living conditions and sanitation are inadequate throughout the entire camp. The UN has designated about 0.5 km2 for the displaced people to shelter in, despite their numbers being equivalent to the population of a small city. The overall living space for the population is barely more than 10 m2 per person, which includes pathways and other spaces not used for habitation. In the most populated areas, there is just one latrine per 70 people, less than one third of the ratio required by humanitarian standards. Access to clean water is also below acceptable levels and many families lack access to essential items such as blankets.

People have been sheltering in the PoC site in Malakal since conflict erupted in December 2013. The population of the site has more than doubled this year, following an influx of 10,000 displaced people in April and a further 16,000 in July-August. MSF operates a 50-bed hospital in Malakal, including a 24-hour emergency room, as well as a separate emergency room inside the PoC site.