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Patients and doctors at the clinic in the town of Maiwut risked being caught up in an army offensive closing in on the nearby opposition-stronghold Pagak.

The United Nations said last week that about 5,000 people had fled into neighbouring Ethiopia to escape the fighting, and rebel spokesman Lam Paul Gabriel told AFP another 25,000 had fled over the weekend.

"I was shot and my leg was amputated in Maiwut Hospital where I was recovering until we were told to evacuate," said Thouk, lying under a blue sheet.

"It was a difficult journey. We were first driven to Pagak, then flown to Old Fangak and taken to the hospital across the river by boat."

Old Fangak is a small, spread-out town of mud huts on both banks of the White Nile, about 300 kilometres (190 miles) from Maiwut. With no access to the swampy area by main roads, the fastest way to get patients to a field hospital in the town is by boat.

Thouk was in Maiwut, about 25 kilometres from Pagak after being displaced a first time more than a year ago when his village came under attack. He has not seen his parents since and believes they may be dead.

I was shot and my leg was amputated in Maiwut Hospital where I was recovering until we were told to evacuate

Stopped mid-surgery

The arrival of Thouk and about 20 other patients has seen the Old Fangak hospital extended from a single tent into several treatment rooms lined with white metal beds and warm blankets, all covered with rainproof tarpaulins.

Operating theatre nurse Robbie Gray, working for the International Committee of the Red Cross (ICRC), recalls being told to "stop mid-surgery" to evacuate the Maiwut clinic.

"I was assisting an operation when we suddenly heard about gunshots outside Maiwut. We were told to immediately evacuate," he told AFP.

Now in Old Fangak, Gray, with a team of nine other ICRC doctors and medical staff, continues to treat patients who fled Maiwut, most of them suffering gunshot wounds.

In another part of the treatment facility lies five-year-old Nyachan Makuach with a gunshot wound to her abdomen. Lying in woollen blankets, she floats in and out of consciousness. Her eyes are swollen and sweat drips from her small forehead.

According to hospital staff she is traumatised by the memory of seeing her father being killed.

"She remembers everything," said the ICRC's surgical team leader Louise Humphreys.

Makuach's uncle, who came with her to Old Fangak, is losing weeks' worth of work as a farmer in the field.

"But we are glad to receive treatment here," he said.

Five-year-old Nyachan Makuach with a gunshot wound to her abdomen floats in and out of consciousness... She is traumatised by the memory of seeing her father being killed

'Fighting will continue' 

South Sudan's civil war erupted in December 2013 when President Salva Kiir accused his former deputy, Riek Machar, of plotting a coup.

Tens of thousands have been killed and millions forced from their homes in the years since as a series of peace deals have been abandoned. The latest UN figures say half the population – roughly six million people – will need emergency food aid this month.

With fighting ongoing around Pagak, the Old Fangak clinic has scaled-up its staff numbers, flying in additional doctors and nurses from South Sudan’s capital Juba.

The latest UN figures say half the population – roughly six million people – will need emergency food aid this month

"The last weeks have seen tens of thousands of people being displaced," the rebel spokesman Lam told AFP.

"If the army advances, the fighting will continue."

The loss of Pagak would be a major defeat to the already weakened opposition.

David Shearer, head of the UN Mission in South Sudan (UNMISS), said last week he was "gravely concerned" by the situation and called for both parties to stop the fighting.