Sudan crisis response

For a year, large parts of Sudan have been experiencing ongoing violence, including intense urban warfare, gunfire, shelling, and airstrikes. The health system, already fragile before the conflict started, is struggling to cope with existing and emerging medical needs while facing overwhelming pressure from the destruction and looting of health facilities, acute shortages of utilities and medical supplies, and under-resourced health staff who are overworked without pay. As a result, people face significant challenges accessing medical care throughout the country. By the time many are able to access care, their condition has become critical.

In Darfur, the violence has taken on an ethnic dimension. The accounts of refugees who have fled from West Darfur to Chad over the last six months paint a picture of an unbearable spiral of violence, with looting, homes being burned, beatings, sexual violence, and massacres. In a retrospective mortality survey conducted in August 2023, MSF found that refugees living in Ourang camp in particular—who mainly come from El Geneina, West Darfur—were hardest hit, with a 20-fold increase in mortality since April 2023. 

Between 70 to 80 percent of health facilities in the Darfur region are no longer functioning due to the lack of critical supplies and medical staff. There is a widespread shortage of critical 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. 

Immediate action and increased support are crucial to meet people's health needs and the strained health care system.

Since April 2023, MSF teams in Sudan have seen extremely high levels of medical need. In hotspots of violence, we have treated people injured by shrapnel, blasts, and gunshots, including stray bullets. We’ve received more than 22,800 cases of traumatic injuries and performed more than 4,600 surgical interventions.

Access to health care

The indirect health consequences of the war have been equally devastating. Between 70 and 80 percent of hospitals in conflict-affected areas are no longer functioning. Many people have to travel long distances to seek medical care, often amid extreme insecurity. More than half a million people have sought medical consultations from MSF and MSF-supported hospitals, health facilities, and mobile clinics.

Disease spread

Before the current war, Sudan had a high prevalence of non-communicable diseases and faced both seasonal and non-seasonal outbreaks of diseases like measles and cholera. Now, as the ongoing conflict has disrupted essential services such as water supply and the availability of medicine, the health situation has become even more dire.

People living with chronic illnesses such as diabetes, asthma, and heart disease need continued health care, medicine supply, and a controlled diet. Due to the conflict, many patients cannot reach the few functional health facilities, and medicines across the country are scarce, so many patients are facing serious complications or even death caused by chronic illnesses. Some patients delay seeking health care because it is too dangerous to move, and by the time they arrive at a facility, they are in poor condition. The referral system has also broken down, meaning patients often cannot reach facilities for secondary health care or must pay for transport, which many cannot afford.

Access to vaccination

Lack of availability of and access to vaccinations has left many children unvaccinated, creating a high risk of outbreaks of vaccine-preventable diseases, such as the measles outbreak the country experienced in 2023. MSF teams are providing primary health care, supporting vaccination campaigns, screening and rapid testing for communicable diseases, and supporting the Ministry of Health to respond to the emerging and increasing needs caused by the lack of access to health care and dire conditions. 

In the wake of severe vaccine shortages in Darfur, our teams have faced a dire situation, especially in regions like Jebel Marra, South Darfur, as well as in Central and North Darfur states, including in Rokero, Zalingei, El Fasher, and Zamzam camp. Despite our efforts to administer the last of the pentavalent, polio, and measles vaccines, stocks have been almost completely depleted. This scarcity has left children at high risk of contracting preventable diseases, with suspected measles cases already emerging in El Fasher.

MSF is calling for immediate, unconditioned access to humanitarian aid to prevent the outbreak of diseases and to support the most vulnerable segments of the population amid ongoing systemic barriers that hinder the delivery of life-saving supplies across Sudan.

Surgery and emergency care

The pressure on hospitals with surgery and emergency departments is intense. The majority of hospitals have closed, and those still functional are running out of supplies or no longer have supplies at all, are understaffed—with many Ministry of Health staff going unpaid for months—and in some cases, lack water and electricity. MSF teams are seeing war-wounded patients with catastrophic injuries caused by explosions, bullets, and stabbings, and are responding to mass casualty incidents. 

At our hospitals, we also treat people injured in road traffic accidents and women in need of emergency Cesarean sections. 

Maternal health

Pregnant women are particularly affected by the lack of access to maternal health care. Over the past year, MSF has assisted more than 8,400 deliveries and performed 1,600 Cesarean sections.

Malnutrition

Another critical and growing threat is malnutrition. MSF has supported treatment for over 30,000 cases of acute malnutrition in a year. A recent nutritional assessment in Zamzam camp for displaced people in North Darfur found that almost a quarter of children screened during the assessment were acutely malnourished, with 7 percent having severe acute malnutrition. Among children aged six months to two years old, the figures were even more alarming, with nearly 40 percent malnourished, including 15 percent with severe cases.

Obstruction of humanitarian access

The humanitarian response is just a drop in an ocean of incredible need in Sudan. Throughout the war, but particularly in the last six months, there has been a systematic obstruction of aid, humanitarian access, and supplies—particularly in RSF-controlled parts of the country. It has been difficult to get visas for humanitarian staff to enter the country and travel permits to move around Sudan. Permits to cross front lines, for example from Port Sudan to RSF-controlled areas, have been repeatedly denied. Attempts have also been made to prevent aid from entering the country across the border, including from Chad and South Sudan.

Overcoming these obstructions and navigating a situation of insecurity without adequate protection for civilians and humanitarian workers has been a constant struggle and remains a major focus for MSF. Despite the difficulties, MSF’s presence and the medical care we have been able to provide demonstrate that it is possible to carry out humanitarian work in Sudan. Yet very often, MSF teams find themselves the sole humanitarian actors in areas where we work. In the face of the immense needs, a massive scale-up of the humanitarian response is desperately and urgently needed.

Mental health

The war and violence continue to have serious mental health implications for people fleeing or stuck in the midst of the fighting. People continue to experience extreme trauma as they lose family members and loved ones; witness and experience violence, including sexual violence; and the deterioration of their own health or the health of loved ones. Many continue to fear for their lives with the continuous heavy fighting, especially in Khartoum, Darfur, and Al Jazirah states.

These are just a few medical indicators of the immense needs in Sudan based on the few areas MSF is able to access and respond. But we know that this is just the tip of the iceberg. The needs across the country are massive and largely unmet.

MSF currently works in and supports more than 30 health facilities in 10 states in Sudan: Khartoum, Al Jazirah, White Nile, Blue Nile, Al Gedaref, Red Sea, and North, Central, South, and West Darfur states. Our teams have also worked in Kassala state in response to the needs of displaced people.

We work with a team of over 1,000 staff, including over 930 Sudanese staff, providing emergency treatment, surgical care, mobile clinics for displaced people, treatment for communicable and non-communicable diseases, maternal and pediatric health care, including safe deliveries, water and sanitation services, and donations of medicines and medical supplies to health care facilities. We also provide incentive pay, training, and logistical support to Ministry of Health staff, and continue some of our medical activities that were in place before the start of the war.

MSF teams are providing primary and secondary health care for patients in various parts of Sudan in existing health care facilities in towns, cities, and camps. To support patients in remote places or places where health facilities have closed, MSF mobile clinic teams are providing primary health care and supporting the referral system to ensure that critical patients have access to secondary health care. 

In camps for refugees and internally displaced people, especially in the south and east, and in gathering sites that lack access to health care, humanitarian assistance remains inadequate. In camps, people are living without proper access to water and sanitation, and in unsanitary conditions, fueling possible outbreaks.

Malnutrition  

MSF teams are screening for malnutrition (mid-upper arm circumference, or MUAC) in children under five years old in health care facilities where we work across Sudan. MSF teams are also running inpatient therapeutic feeding centers at the Turkish Hospital and Umdawanban Hospital in Khartoum; Tanideba and Um Rakuba refugee camps in Al Gedaref state; Rokero in Central Darfur state; and we support the inpatient therapeutic feeding center in El Geneina Teaching Hospital as well as in Kerenik, West Darfur, and Al Kashafa Hospital in White Nile state. At Ad-Damazine Teaching Hospital in Blue Nile state, MSF teams are running both an inpatient therapeutic feeding center and an outpatient therapeutic feeding program.

In Zamzam camp in North Darfur, MSF has an outpatient therapeutic feeding center at the primary health care clinic we run in the camp and will open a second one along with a 50-bed field hospital in the coming days to help address the vast needs there. In January, MSF carried out a rapid nutritional assessment of 400 households that found a crude mortality rate of 2.5 deaths per 10,000 people per day in the camp, which is more than double the threshold of a humanitarian emergency. 

Note: MSF does not screen all children; only those with suspected malnutrition.

Disease outbreaks

MSF teams provide primary health care, vaccination campaigns, screening, and rapid testing for communicable diseases. We also support the Ministry of Health in its response to emerging and increasing needs. MSF teams have prepared for and are responding to the cholera outbreak in places including Alban Jadeed Hospital, Umdawanban Hospital, Bashair Teaching Hospital, and the Turkish Hospital in Khartoum; as well as in Al Gedaref, Al Jazeera, White Nile, and Blue Nile states.  

Surgery and emergency care

MSF teams carry out surgical and emergency interventions in the cities of Khartoum and Omdurman in Khartoum state, and El Fasher in North Darfur state.

Our teams are working in hospitals throughout Sudan, as well as providing support to Ministry of Health staff and volunteers. We provide and support emergency care and surgical interventions including trauma, obstetric, and general surgeries; donate essential items including medical supplies, generators, and fuel; provide incentives for Ministry of Health staff; rehabilitate and repurpose facilities; train hospital staff; and support triage, water, and sanitation systems.

Mental health

MSF teams are responding to the immense mental health needs by providing psychological first aid and mental health care to people fleeing the fighting. Mental health care is included in mobile clinic services, as well as sexual and reproductive health care in places where it is currently possible within the limits of our capacity.

We provide mental health counseling to refugees at Um Rakuba and Tanideba camps, which host mostly Ethiopian refugees, as well as host communities. Furthermore, MSF teams at Al Thowra Mobi primary health care clinic in Al Jazirah state and Al Kashafa Hospital in White Nile state are providing mental health support and sexual and reproductive health care. Our teams are also providing sexual and reproductive health care in Umdawanban, and in Khartoum state, we provide care for survivors of sexual and gender-based violence at Shaheed Wadaatallah primary health care center. Mental health and sexual and reproductive health services are also provided at El Geneina Teaching Hospital in West Darfur and Wad Madani Teaching Hospital in Al Jazirah state.

Medical supplies and other support

The destruction and looting of health facilities, acute shortages of utilities and medical supplies, and under-resourced health staff overworking without pay, are all factors increasing the overwhelming pressure on a health system struggling to cope with emerging medical needs that are exacerbated or caused by the conflict.

MSF is supporting Sudan's health system with medical and logistical donations, rehabilitation of damaged and looted health facilities, and by paying incentives to Ministry of Health staff, many of whom have not been paid since the start of the conflict. Many facilities face major shortages of medical supplies and, in some cases, lack essential utilities such as water, electricity, and fuel to continue functioning properly. Insecurity, delays, and the refusal of authorities to issue permits to transport supplies further exacerbate these shortages. 

To ensure the continuity of care, MSF teams are donating medical supplies when it is possible. We provide medicine, wound treatment, pediatric kits, and logistical support such as water tanks, fuel, and cleaning materials; as well as ambulances for hospitals, the Ministry of Health, and health facilities in Khartoum city and state as well as Al Jazirah, Al Gedaref, Kassala, Northern (Wadi Halfa), and North, South, Central, and East Darfur states. We also donate supplies to networks of medical volunteers in south Khartoum, who are providing critical services, such as trauma first aid, primary health care, mobile clinics, and logistical support for the distribution of supplies. 
In some places, MSF teams have supported the repurposing or rehabilitation of health facilities impacted by the fighting. In West Darfur, MSF teams are supporting El Geneina Teaching Hospital by providing donations such as pharmaceutical materials and biomedical equipment for the ICU after the hospital was looted. Other teams are also supporting Kreinik Hospital, which was also looted, by bringing fuel, medicines, cleaning materials, and other donations.

In North Darfur, MSF teams helped repurpose the maternity hospital so it can provide urgent trauma care after the hospital received a huge influx of wounded patients in the first weeks of the conflict, transforming it from a small maternal health facility into the main referral hospital for the whole of North Darfur, which has a population of 2.8 million people. 

In Khartoum, MSF did the same with the Turkish Hospital, repurposing it from a small maternity and pediatric hospital with no surgical capacity into one capable of responding to mass casualty events. MSF teams also rehabilitated a small health clinic that had been used to care for sick children after the pediatric hospital in El Fasher was looted at the beginning of the conflict. The health clinic, which is now known as the Babiker Nahar Pediatric Hospital, is now the only specialist hospital for sick children in the whole of Darfur, serving a population of over 11 million people.

Chad

Since the war broke out last year, an estimated 682,000 displaced refugees and returnees have crossed the border to Chad. Refugees and returnees from Sudan are now living in multiple camps in Chad and face difficulties securing even the most basic needs. MSF teams are responding to this crisis through their work in five different locations in eastern Chad: Adré, Ourang, Metche, Alacha, Daguessa, Andressa, and Goz-Aschiye, Kimiti province.

In June 2023, more than 850 war-wounded Sudanese, mainly with bullet wounds, were received in the MSF-supported hospital in Adré in the space of just three days. Hundreds of thousands of people previously trapped in West Darfur joined them en masse from June onwards. We heard horrific stories of violence, including sexual violence, from survivors. After the first episode of violence, we conducted a retrospective mortality study in refugee camps, asking families about relatives who have died, when, and why. The refugees from West Darfur’s capital El Geneina were particularly affected, with a mortality rate 20 times higher compared to before the conflict began. More than 80 percent of those deaths were men, consistent with accounts of systematic targeting of men, and 82 percent of the deaths were caused by violence, mostly gun violence. 

In the camps of eastern Chad there is currently an outbreak hepatitis E, which has been exacerbated by poor sanitation and a desperate shortage of clean water in the camps. In Adré camp, there is just one latrine for 677 people, while in Metché camp there is one latrine for 225 people. Without swift action to improve sanitation infrastructure and enhance people’s access to clean water, there is a risk that we will witness a surge in preventable diseases and unnecessary loss of life.

MSF is currently providing more than 70 percent of the drinking water available in Adré, Aboutengue, Metché, and Al-Acha camps. Despite this, people are receiving just 11 liters of clean water per day—well below the 20 liters per person per day recommended for emergency settings. Despite our efforts, the humanitarian response in eastern Chad has been hampered by insufficient funding for humanitarian organizations on the ground, leaving critical gaps in the provision of food, water, and sanitation.

South Sudan

Since the war started in April 2023, more than 625,000 people have crossed into South Sudan to seek refuge. Until now, the majority (more than 78 percent) are South Sudanese returnees—people returning to South Sudan after having fled to Sudan during South Sudan’s civil war, which ended in 2021. 

The influx of displaced people has further stretched an already overwhelmed system. In the transit centers, the situation is getting worse with increasing food insecurity and health issues such as severe malaria cases, eye infections, acute bloody diarrhea, and the rising risk of cholera.

In South Sudan, MSF is responding to the refugee crisis in Renk, Bulukat, and Wedweil refugee camp in Northern Bahr el Ghazal state, as well as in Abyei, which has also been impacted with a largely underestimated 17,404 returnees who have arrived through the Amiet point of entry.

MSF has been present in Sudan since 1979, witnessing historic changes and escalating needs in response to the rapid shifts in the country’s political and social dynamics, which in turn impact health needs. 

Our intervention began shortly before the Second Sudanese Civil War (1983-2005), which was fought primarily between the north and south of Sudan and was one of Africa's longest civil wars. MSF was actively involved in providing medical care to war-affected communities dealing with massive displacement, famine, and the outbreak of diseases. With the independence of South Sudan in 2011, MSF continued operations in both countries, adapting to the shifting dynamics of conflict and the division of resources. 

When the war broke out in April 2023, many activities were either stopped or shifted to respond to the emerging needs and emergencies across the country. Some activities continued—in Darfur, for example—thanks to the efforts of our locally hired MSF staff, who continued to work despite the extremely difficult personal and environmental circumstances. 

MSF provides medical care to anyone who needs it, regardless of race, religion, or political affiliation. We are calling on all parties to the conflict to ensure the safety of civilians, medical facilities, and personnel. Hospitals must remain a sanctuary for people seeking care.  

To facilitate our humanitarian and medical work, we speak to all parties to the conflict to request safe, rapid, and unimpeded access to civilians who require medical care and to ensure the safety and security of our staff. This is why our independence and impartiality are essential to our work in all the places we operate across the globe. 

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