Sudan

In the Darfur region, where the violence has taken an ethnic dimension, most health facilities are no longer functioning due to the lack of critical supplies and medical staff. There is a widespread shortage of supplies such as vaccines, nutrition commodities, and HIV medications, as well as a poor disease surveillance system. At the same time, overcrowded and dire conditions in gathering sites and camps exacerbate the risk of disease outbreaks, while people with chronic conditions are struggling to access the care and medicines they need to survive.

In Khartoum, fierce street fighting, shelling, and airstrikes took place. Those who were able to flee the city did so, but many were trapped in their homes because of the intensity of the fighting. Most hospitals in the city quickly ceased to function, and the facilities that were able to remain open were rapidly overwhelmed.

MSF teams who lived in the city took advantage of any lulls in the fighting to donate medical supplies to hospitals and to assess those we could potentially support. By early May, we had brought in a full surgical team to Bashair Teaching Hospital. By June, we were fully operational in the Turkish Hospital, originally a small maternity and pediatric facility with no surgical capacity that we converted into a facility capable of responding to mass casualty events.

That same month, we began supporting Al Nao Hospital in Omdurman, treating patients with injuries caused by gunshots, stabbings, and shrapnel from explosions, as well as non-trauma related conditions. In July and August, our teams started working in the pediatric and maternity wards at Umdawanban Hospital in Khartoum state, and Alban Al-Jadeed Hospital—the sole public hospital still functioning in the east of Khartoum state.

In June, we also started activities in White Nile state. Our teams working in some of the overcrowded camps for refugees and displaced people were overwhelmed with daily cases of suspected measles and malnutrition among children.

The vast region of Darfur was again, as it had been in the early and mid-2000s, an epicenter of violence. Although relative calm was established in North Darfur after several weeks of intense fighting, in Nyala, South Darfur, an MSF compound and warehouse were attacked and looted early in the conflict. This led to the suspension of all our activities in the city and surrounding areas.

In West Darfur, the MSF-supported El-Geneina Teaching Hospital was also looted and extensively damaged during the violence. The city became so dangerous that for many months, no access was possible. Two major massacres took place in West Darfur during the course of the year; it is estimated that between 10,000 and 15,000 people were killed amid ethnically targeted violence in El Geneina alone.

As the fighting continued to escalate around the country, the looting of health facilities and attacks on health premises and health personnel became a hallmark of the conflict, with the World Health Organization documenting a total of 63 incidents during the year. Many took place in MSF facilities and premises.

Although we worked hard to scale up our response in Sudan, we faced innumerable obstructions. Visas for our experienced emergency teams were delayed on multiple occasions. In September, the Sudanese authorities implemented a ban on the transportation of medical and surgical supplies into Khartoum, with the intention of preventing wounded RSF soldiers from receiving lifesaving treatment. They also implemented a ban preventing humanitarian staff from traveling into RSF-controlled areas. These limitations led to the withdrawal of our surgical team from Bashair Teaching Hospital.

Notwithstanding these challenges, we continued to offer medical assistance in Rokero, in a mountainous area of Jebel Marra, and Kreinik. We also maintained our medical activities throughout the year in several states in the east of Sudan, including Blue Nile, where we treated malnutrition and supported mobile clinics in and around Damazin.

By December, the RSF had taken control of all major cities in Darfur except El Fasher, where South Hospital had become the main referral facility for all Darfur states. By then, we had also re-established our support to El Geneina Teaching Hospital.

At the beginning of the war, hundreds of thousands of people had fled south to Wad Madani, in Al-Jazirah state, seeking refuge from the fighting in Khartoum. Between May and November, our teams provided medical consultations in existing health facilities and via mobile clinics, at least 40 percent of them for children. However, in December RSF took control of the state and an estimated 500,000 people became displaced once more as they fled the violence. In an effort to meet their needs, we expanded our existing interventions in Gedaref and Kassala states.

By the end of 2023, almost 6 million people had become displaced within Sudan, while 1.4 million had become refugees in neighboring countries, and the health system was on the edge of collapse. To date, a sustained ceasefire has not been achieved and the fighting continues.