Dr. Gabriel Lual Atem

Dr. Gabriel Lual Atem is one of South Sudan's most experienced general surgeons, practising at Juba Teaching Hospital — the country's only functioning national referral hospital. His 16-year career spans the full arc of South Sudan's journey from independence in 2011 through the civil conflict that followed, and represents an extraordinary commitment to surgical service in one of the world's most underserved surgical environments.

South Sudan has been identified by the Lancet Commission on Global Surgery as a country with one of the largest surgical workforce deficits on the continent. The number of qualified surgeons serving the country's population of approximately 12 million is a small fraction of the WHO-recommended minimum, meaning that the vast majority of South Sudanese who need surgery cannot access it. In this context, Dr. Atem's continued practice at Juba Teaching Hospital is not merely a professional choice — it is a critical public health contribution.

His surgical practice is dominated by emergency and trauma surgery, which reflects the epidemiology of South Sudan: road traffic injuries, conflict-related wounds, and obstetric emergencies account for the majority of surgical need. He also manages the full range of common elective conditions — hernias, appendicitis, bowel obstruction — which in the absence of surgical care often become emergencies. He holds COSECSA associate membership and has completed ATLS training, bringing a more formally credentialled approach to trauma surgery than is common among general physicians who have informally taken on surgical roles in low-resource settings.

Dr. Atem completed his MBChB at Makerere University in Uganda, where he undertook clinical training across all major specialties before settling on surgery as his field of practice. Following graduation, he returned to South Sudan and began practising at Juba Teaching Hospital, where he quickly became involved in emergency and surgical care given the acute shortage of surgical capacity at the facility.

Recognising the need for formal surgical training, he enrolled in the MMed Surgery basic surgical training programme offered by the College of Surgeons of East, Central and Southern Africa (COSECSA) — the primary postgraduate surgical training body for East and Southern Africa. COSECSA's training programme is specifically designed to build surgical capacity in low-resource settings and is recognised across the region. Completion of the MMed Surgery gave Dr. Atem a structured framework for his operative practice and connected him to a regional network of surgical colleagues.

He also completed Advanced Trauma Life Support (ATLS) training through the American College of Surgeons, which provides a systematic, evidence-based approach to the initial assessment and management of trauma patients. ATLS training is particularly relevant to Dr. Atem's practice given the high proportion of trauma in his surgical caseload. He is an associate member of COSECSA and is committed to achieving full fellowship through continued operative experience and examination, which would make him one of a very small number of COSECSA fellows practising in South Sudan.

Dr. Atem's surgical expertise has been built on a foundation of high-volume emergency operative experience in conditions that most surgeons in high-income settings encounter only rarely. Conflict-related penetrating injuries — gunshot wounds, blast injuries, and stab wounds to the abdomen, chest, and extremities — form a significant part of his operative caseload. He performs emergency laparotomy for penetrating abdominal trauma, managing bowel perforations, mesenteric injuries, and solid organ damage with the damage-control surgical principles appropriate to resource-limited post-operative care.

Road traffic injury is another major component of his trauma practice, reflecting Juba's growing vehicle density and limited road safety infrastructure. Dr. Atem manages long bone fractures (within his scope of practice), soft tissue injuries, and abdominal trauma resulting from road crashes, and coordinates with the hospital's limited anaesthetic team to manage operative risk in haemodynamically compromised patients.

Obstetric emergencies constitute a substantial portion of his work. South Sudan's maternal mortality rate is among the highest in the world, and Dr. Atem performs caesarean sections for obstructed labour, placenta praevia, and other indications when obstetric surgical cover is unavailable — a frequent occurrence given specialist shortages. He also manages bowel obstruction (including strangulated hernias), appendicitis, and large abdominal wall hernias, which are extremely common in the South Sudanese population and cause significant morbidity when left unrepaired due to lack of surgical access.

Dr. Atem has contributed operative data to COSECSA's regional surgical outcome databases, which support assessments of surgical quality and training across East and Southern Africa. His facility's operative volumes and case mix data have contributed to Lancet Commission on Global Surgery country profiles for South Sudan, which document the surgical burden of disease and the workforce gap.

He participated in an MSF operational research study examining patterns of injury and surgical outcomes in conflict-affected areas of South Sudan, which was published in a humanitarian medicine journal. His contribution included operative case records and clinical observations about injury patterns and post-operative complications managed in a resource-constrained setting. Dr. Atem regards participation in such studies as an important part of building the evidence base needed to advocate for increased investment in surgical training and infrastructure for South Sudan.

Juba Teaching Hospital does not offer planned surgical services for international patients, and the facility's post-operative care infrastructure is not comparable to hospitals in Uganda or Kenya. Dr. Atem is direct about these limitations when speaking with foreign patients or their advisers.

For foreign nationals in South Sudan who sustain acute injuries or develop conditions requiring emergency surgery, Dr. Atem provides surgical assessment and emergency operative intervention when required and when medical evacuation is not possible or not safe to delay. He works closely with medical evacuation services and UN medical advisers to triage cases accurately — determining whether immediate surgery in Juba is the safest option versus stabilisation and transfer to Nairobi or Kampala. He provides detailed operative notes and clinical handover documentation to facilitate continuity of care following transfer. He communicates in English and is experienced in managing expectations regarding both the clinical environment and the realistic outcomes achievable at Juba Teaching Hospital.

Dr. Atem has not received formal individual awards, but his associate membership of COSECSA represents a credential of recognised surgical training that is held by very few surgeons practising in South Sudan. COSECSA has acknowledged the contribution of its South Sudan-based members to the regional surgical workforce at its annual scientific meetings.

Within Juba Teaching Hospital, Dr. Atem is regarded as a foundational figure in the surgical department — a clinician whose continued presence and willingness to manage a high-risk, high-volume operative caseload is the difference between having a functioning surgical service and not having one. International partners including MSF and the WHO South Sudan office have recognised his collaboration and his contribution to the emergency surgical response during periods of conflict in and around Juba.