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Insider Update: One year of war in Sudan

A message from MSF USA Chief Executive Officer Avril Benoît

Avril Benoît, Chief Executive Officer of MSF USA, helps carry supplies during a routine childhood vaccination campaign in the village of Wangmok near Old Fangak, South Sudan.

South Sudan 2023 © Samir Bol

Earlier this year, I wrote to you about my trip to South Sudan, where I saw firsthand the impact of nearly a year of fighting in neighboring Sudan.

So far, nearly eight million people have been driven from their homes, and an estimated 25 million are in need of humanitarian assistance. This human-made catastrophe is the result of ongoing fighting between the government-led Sudanese Armed Forces (SAF) and the paramilitary Rapid Support Forces (RSF).

With much of the world’s focus on the crises in Ukraine and Gaza, the fighting in Sudan—and its impact on neighboring countries like Chad—are not getting as much attention. That’s a big part of the reason I recently visited our Doctors Without Borders/Médecins Sans Frontières (MSF) teams in both countries.

One of the few organizations left

My colleagues asked me to make this trip to assess our needs on the ground and help raise awareness about the health and malnutrition crisis in the region because there are so few organizations responding to this emergency–leaving MSF as one of the sole responders, despite growing medical needs.

Chad, which borders Sudan to the west, has already taken in over half a million refugees from the Sudanese region of Darfur. But this huge influx has not been met with adequate aid. Instead, refugees are packed into cattle cars with barely enough room to move and transported hours away to camps without schools, medical care, or even enough water.

Thanks to the commitment of donors like you, MSF has been able to continue our work in a region that many other organizations now consider too dangerous. But despite our long-term experience here, and the trust we have built in the communities we work in, MSF is finding it more and more challenging to provide care for those in need.

Challenges of providing care amid conflict

In Sudan, just getting around is difficult, with frequent checkpoint stops controlled by armed groups on opposing sides of the conflict. It’s a constant negotiation for our team to move supplies and staff to where they’re needed most.

In addition, the lack of reliable access to food, clean water, sanitation, and medical care has created ideal conditions for the spread of disease. Cholera and hepatitis E are both in the camps I visited in Chad, and malnutrition is common.

Nyawal Chuit Riek
Nyawal Chuit Riek recently gave birth to her first child, a baby girl. People can currently only reach Old Fangak by boat, which makes accessing even the most basic health services like maternity care impossible for some. Delays in pregnancy-related care can increase the rate and severity of complications like obstructed labor.
South Sudan 2023 © Samir Bol

During my trip, I met refugees and MSF team members who have experienced these challenges firsthand. Something I heard again and again is that medical care is incredibly difficult to come by. Between 70 and 80 percent of hospitals in conflict-affected areas are no longer functioning.

One doctor’s story

I spoke with a project coordinator who shared the story of one facility, a hospital in Zalingei, the capital of western Sudan. Militants had already looted the hospital once. When they returned, it was to remove the building’s solar panels—the only source of electricity. They arrived during a cesarean section, and the surgeon begged them to wait until the operation was done. They refused—and with the electricity gone, the patient died.

I heard stories like these from far too many people during my time in Chad—in particular, from members of the Masalit ethnic group, who have been targeted with looting, burning of homes, beatings, and sexual violence.

But I also heard stories of bravery and compassion. I met people who, despite the terror and cruelty they faced, chose to go back to Sudan.

One of those people was Dr. Khadija Ismail, a Sudanese doctor whose Masalit heritage puts her and her family in particular danger. That’s part of the reason she decided to return to Sudan after initially crossing the border into Chad. “I need to go and reach my family in Al-Junaynah,” she recalled thinking. “I need to be with them.”

Dr. Ismail’s medical training meant that when she first returned to Sudan, neighbors began showing up at the family home looking for treatment. She didn’t have the medications or equipment she needed—but with most of the hospitals in the region shut down, people had nowhere else to turn. She took her neighbors into her home and provided the best care she could.

Dr. Ismail is now serving as a medical activity manager for the same hospital in Sudan where militants stole the solar panels, helping get the facility up and running again as we repair the damage, hire staff, and restock essential supplies. This is the only hospital providing care in the whole of Central Darfur, a region with a population of more than 1.6 million. Our aim is to reopen the operating room and the maternity, emergency, and pediatric departments.

Avril Benoît in Old Fangak
Avril Benoît, Chief Executive Officer of MSF USA, helps carry supplies during a routine childhood vaccination campaign in the village of Wangmok near Old Fangak.
South Sudan 2023 © Samir Bol

The importance of independent funding

You make projects like these possible. Your support means Khadija and so many other medical professionals have the supplies and support they need to continue providing care—even in the direst of circumstances.

While other organizations rely on designated government funding, forcing them to respond to political pressures, MSF is supported by individuals, which allows us to provide medical care based on need alone. That is why we are one of the only organizations still providing lifesaving care in Sudan.

Your generosity means we can remain independent, pragmatic, and able to work with parties on opposite sides of violent conflicts to ensure we can reach all people in need of lifesaving care.

It also means we can fulfill one of our central values: Témoignage, or “bearing witness.” We believe we have an ethical responsibility to share what we are seeing and doing wherever we work, and to speak out to prevent greater harm.

In writing to you today, I am exercising that same value of bearing witness. I hope I have been able to communicate both the urgent needs I witnessed and the confidence I have that our teams can continue to save lives.

MSF staff prepare a vaccination during a routine childhood vaccination campaign in a small village near Old Fangak.
MSF medical ward supervisor Gabriel Kalany Khalifa and vaccinator Buom Wal prepare a vaccination during a routine childhood vaccination campaign in the village of Wangmok near Old Fangak. Old Fangak has faced unprecedented flooding in recent years, cutting off people's access to health care and making vaccination and preventive efforts even more important.
South Sudan 2023 © Samir Bol

The needs are great—as are the challenges we face in meeting it. As the rainy season sets in this month, flooding will increase the difficulty of almost every aspect of our work.

But your generosity means we can support our teams, who remain committed to providing care despite the danger they face every day.

Thank you again for supporting MSF and doctors like Khadija.

Avril Benoît
Chief Executive Officer, MSF USA