As the fighting in Sudan between the Rapid Support Forces (RSF) and the Sudanese Armed Forces (SAF) began in April 2023, the displaced people of Hasahisa camp in Zalingei, capital of Central Darfur state in Sudan, found themselves caught in the crossfire.
By November, the camp had been besieged by RSF for months, according to the United Nations, leaving the injured unable to seek medical care outside the camp and blocking water and food supplies from reaching people.
Hasahisa camp once housed an estimated 50,000 people—most already displaced in the early 2000s—but eventually emptied as people managed to flee relentless bombing, leaving behind damaged brick homes and ghost towns. With nowhere else to turn, they’ve now been sheltering for months in looted and abandoned schools, banks, fire stations, and other camps across the city.
After over a year of war in Sudan, the fighting has left people's homes destroyed and looted. Sudan 2024 © Juan Carlos Tomasi/MSF
Surviving without assistance
On the night of November 2, Aissa and her family boarded donkey carts and fled Hasahisa camp. Most of Aissa’s belongings had been stolen, leaving her with only a mattress, which was later lost on the road. She followed her mother and children as they led the way.
“We were chased and forced to leave,” Aissa, 50, recounted. “Some of our men were killed. Others were detained. Our things were taken and stolen. As we were leaving, we were stopped [by armed men] and had to wait until the morning. They tied [people] up and beat the young boys.”
For over six months, Aissa and her family have resided in a single shipping container at the ravaged Zalingei fire station. Like 6.5 million other displaced people in Sudan, they primarily depend on humanitarian aid that remains unavailable in many places. Aissa and her family survive on unreliable jobs here and there, and don’t have proper access to water, food, or essential services, including medical care.
“There is no way to make any money,” explained Aissa. “We just go out and roam around the city. If you find someone you can do laundry for, you wash it and try to get some money.”
Across the street from the fire station, Najwa and her three children have taken shelter in the city’s looted bank with 30 other displaced people from Hasahisa camp. Najwa has created an illusion of home there: bank safes used as closets, bricked-up windows, and windowsills now holding a few tattered bags and wilted plants.
“We are living in these conditions without a roof, and we have no food,” said Najwa, pointing at the torn sheets draped above the lobby. “But we’ve never received any assistance, not even a bar of soap. Soon the rainy season is coming, and we don’t know where to go.”
Cut off from access to health care and medicine
In the heart of the city, the University of Zalingei—once a center for students of medicine, agriculture, and technology—now lies desolate. Bales of hay for donkeys are stored in the auditorium, while campus buildings are connected by laundry clotheslines.
The university has since been transformed into a makeshift shelter, with more than a thousand people are living in its classrooms and offices, mostly displaced from Hasahisa camp. Mainly farmers, they are now unable to regularly cultivate crops and make an income. The community relies on each other because of the absence of humanitarian assistance.
“We all make contributions and anyone participating can share [medication],” explains Mohammed, one of the first to flee to the university. “We share with the community and treat the patient.”
Scenes inside the University of Zalingei, where displaced people are sheltering. Sudan 2024 © Juan Carlos Tomasi/MSF
Only 10 minutes away, Khadija waits for her daughter Malaka to be discharged from Zalingei Teaching Hospital. It’s the first day MSF teams have re-opened the rehabilitated emergency room, and Malaka is one of the first patients. Displaced and forced to sell her remaining belongings to earn money, Khadija hasn’t been able to buy medication for her daughter.
“I traveled for over an hour to Zalingei Teaching Hospital to receive treatment for my child, who tested positive for malaria,” explains Khadija. “In Hasahisa camp, we would receive medication for free. Here in Zalingei, it’s not the same. But today we received free medication [for the first time].”
Supporting a collapsed health system
Amid the large-scale violence in Sudan, health care workers and facilities have been attacked and looted, leaving large portions of the health system damaged or non-functional. The sole remaining secondary health care facility in Central Darfur state, Zalingei Teaching Hospital, has also been looted multiple times during the war.
After another looting in May 2023, the Ministry of Health staff did their best to keep the hospital functional by mobilizing volunteers across the city. One of them was 21-year-old nurse Assma. A few weeks after a looting in May, the hospital was attacked once again: this time resulting in the death of a patient.
“I was bringing a patient to the hall of the operating theater when the doctor was shot in the neck,” recalls Assma. “He was doing a C-section. After this, the patient passed away in the hallway.”
Sudan 2024 © Juan Carlos Tomasi/MSF
To restore specialized care in the state, Doctors Without Borders teams are providing secondary care at the Zalingei Teaching Hospital and supporting the Ministry of Health by training and incentivizing staff, as well as rehabilitating the emergency, maternity, and pediatric departments. In April, MSF provided over 900 emergency consultations, nearly 400 pediatric admissions, almost 100 safe deliveries, and treated over 50 children for malnutrition in the inpatient therapeutic feeding center.
“The war has completely disrupted people’s access to health care in Sudan,” explained emergency coordinator Victor García Leonor. “Medicine and food prices have soared making it inaccessible for people—especially the displaced—and most health facilities are no longer functioning properly. At the same time, the country is facing a humanitarian void, which is further exacerbating the huge unmet health care needs.”
Despite Sudan being one of the world’s largest displacement crises, many humanitarian organizations have not returned since evacuating at the war’s onset last year. Today, after more than one year since the start of the war, Sudan continues to face a humanitarian void.
MSF continues to call on all warring parties and belligerents to respect the special protections that healthcare workers and medical facilities are provided under international humanitarian law, as well as to ensure safe humanitarian access to all areas of Sudan without exception, and to stop blockages of supplies and staff. To ensure humanitarian assistance reaches people, the United Nations must also urgently focus on clear results related to increasing access so that they actively contribute towards enabling a rapid and massive scale-up of humanitarian assistance.
About our work in Sudan
Doctors Without Borders currently works in and supports more than 30 health facilities in nine states across Sudan: Khartoum, Al Jazirah, White Nile, Blue Nile, Al Gedaref, Red Sea, and North, West, South, and Central Darfur. Our teams have also recently intervened in Kassala. We run activities in both SAF- and RSF-controlled areas, providing trauma care, maternal and pediatric care, and treating malnutrition alongside other health care services. MSF teams are also supporting Sudanese refugees and returnees in South Sudan and eastern Chad.
Our teams are providing medical care at the Zalingei Teaching Hospital in Sudan, and supporting the Ministry of Health with rehabilitation, training, and incentives for their staff. In April, our teams re-opened the emergency, maternity, and pediatric departments, as well as the inpatient therapeutic feeding center.
