JUBA, South Sudan >> Sick patients in South Sudan have been shot to death in their beds and medical facilities have been looted and burned to the ground, a dangerous level of disrespect for the country’s strained health care system that is forcing the aid group Doctors Without Borders to examine its operations here.

Doctors Without Border said Wednesday that the extreme violence and lack of respect for health care workers shown by warring sides has made the group’s work almost impossible.

Members of the aid group, which is known by its French initials MSF, discovered at least 14 dead bodies in a hospital in the contested city of Malakal over the weekend. Several of the dead bodies had been shot while lying in their beds, the group said. Rebels have been fighting government forces for control of the city, the capital of an oil-producing state.

Group leader Raphael Gorgeu said Doctors Without Borders’ facilities in the towns of Leer and Bentiu have been looted and completely destroyed. He said Doctors Without Borders does not want to leave South Sudan but must look at the safety situation of its workers.

The men carrying out the fighting have shown “absolutely no respect for health care workers,” he said.

“How do you want us to stay to the very last moment with the guarantee that our staff and patients will not be targeted?” he said.

Goregeu said MSF was not planning on pulling out of South Sudan, where 800,000 people are displaced and 3.2 million in immediate need of food due to fighting that broke out in mid-December. Thousands have died in the violence.

At the end of January thousands of residents fled as fighting broke out in Leer, the home town of rebel leader and former Vice President Riek Machar. MSF, which has worked in Leer for 25 years, evacuated staff while 240 others fled into the bush. They returned this week to find their hospital — a facility that serves 300,000 people — destroyed.

“We don’t want to leave South Sudan, definitely not, but we have to look at things very carefully now,” he said. “It is not the investment we put in but the trust and the respect we put in that is actually put into question.”