The Joda border crossing between Sudan and South Sudan has become a site of constant movement as thousands flee violence in Sudan.

Located just 100 meters apart, the crossing features three flags welcoming newcomers on the Sudanese side, while a sign in Arabic and English marks entry into South Sudan.

Displaced families carry their belongings, with women balancing children and items such as bed frames, food, and chairs on their heads, while carts pulled by donkeys aid their journey into South Sudan.

Among them is Hamed Attaher, a 26-year-old technology student from the University of Khartoum, who expressed relief at reaching what he describes as a safe place.

Attaher fled Khartoum more than a year ago and is headed to Juba to reunite with his aunt.

The flow of refugees into South Sudan’s Upper Nile state has reached alarming levels, with more than 12.5 million people in Sudan displaced since the onset of hostilities in April 2023. In early December, an estimated 5,000 people crossed into South Sudan daily, escaping violence from clashes between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF).

At the border checkpoint, the International Organization for Migration (IOM) distinguishes between refugees and returnees.

Many recent arrivals are individuals returning to South Sudan after previously fleeing its civil war that began in 2013. A humanitarian worker noted that this region is informally referred to as 'North Juba' on the Sudanese side and 'South Juba' on the South Sudanese side, emphasizing a shared cultural connection.

The United Nations High Commissioner for Refugees (UNHCR) provides provisional shelter and emergency food via tents lined with resources such as BP-5, essential for disaster relief.

Health services are coordinated between the IOM and Médecins Sans Frontières (MSF), addressing various medical needs of the newly arrived.

Notably, a five-month-old infant was evacuated for urgent medical care, highlighting the critical health situation at the border.

For many, making the journey further into South Sudan involves navigating informal settlements that have formed along the route to Renk.

These makeshift communities are increasingly becoming self-sufficient, with businesses and makeshift mosques emerging.

Others opt for organized transportation to nearby towns facilitated by IOM.

As the situation at the Renk County hospital reveals, the consequences of the influx are significant.

The hospital is currently treating both refugees and South Sudanese nationals, having erected additional tents to accommodate an increase in patients.

According to MSF data, approximately 110,000 people have arrived in Renk County since the beginning of December 2023, with around 70,000 residing in informal settlements.

Among those in the pediatric unit is a mother named Bakhita, 22, who has recently given birth to premature twins in one of these settlements.

She expressed gratitude for their safe arrival in South Sudan.

The hospital staff are dealing with a high demand for services, as MSF’s Atem Deng Ajak indicated a need to provide care for both local residents and incoming refugees.

The psychological toll on the displaced population is also being addressed, with MSF providing support to families affected by trauma.

Reports indicate that many survivors face mental health challenges stemming from their experiences, including grief and anxiety over their situation.

As aid efforts continue, funding challenges persist.

A significant portion South Sudan's humanitarian budget relies on USAid, which has faced budget cuts and operational disruptions since previous political changes in the U.S. government.

As humanitarian organizations adapt to changes in funding and service delivery, the ongoing situation remains critical, with many vulnerable populations in urgent need of assistance.