A hospital in the heart of a warzone: Sudan’s Al Nao

“Before the hospital could treat anyone, we had to get the supplies in,” said a logistician for Doctors Without Borders/Médecins Sans Frontières (MSF), who was working at Al Nao Hospital in the early days of the war. “Every shipment was a gamble. The warehouse was in Khartoum, around 18 miles away from Al Nao Hospital, and each route had to be scouted in advance for safety.”

“One volunteer from Al Nao would drive toward us, scouting for clashes while avoiding the shelling and the airstrikes,” said the logistician. “He guided us through side streets, sometimes under fire, just to make sure the medicines reached the hospital. Without him, and without those shipments, we wouldn’t have stood a chance.”

Health at the heart of a warzone

For two years, until the Sudanese Armed Forces (SAF) regained control of Khartoum in May 2025, intense fighting raged in the cities of Khartoum and Omdurman. This violence was and remains part of the wider civil war between the SAF and the Rapid Support Forces (RSF), which has devastated much of Sudan’s capital region. Fighting has ended in Khartoum for now, but when the war began the capital and its sister cities across the Nile River, Omdurman and Bahri, were the sites of some of the fiercest fighting that Sudan has endured during this war.

MSF was forced to evacuate our teams from Khartoum state at the beginning of the war, and only a few of our local MSF colleagues remained to continue providing and coordinating care. Meanwhile, MSF planned for our full return once it was possible.

As front lines closed in and neighborhoods emptied, health care infrastructure crumbled. Hospitals were looted, shelled, or simply abandoned. Amid this devastation, teams of Sudanese health care staff and volunteers ensured Al Nao Hospital was able to provide care in its emergency room.

Al Nao became a critical node in a collapsing health system. Its proximity to the front lines made it both a target and a necessity. The Sudanese MSF staff who remained worked hand in hand with Ministry of Health employees and volunteers between May and July 2023 to restart the hospital’s full services.

The road from ruins to recovery

“When we first arrived at the hospital, it was full of rubbish,” said Siddig Omer, an MSF logistician from Sudan. “We had to clean it all up before we could even think about treating patients.”

The team got to work, fixing up parts of the hospital that had been neglected. They swept and scrubbed floors, repaired broken windows, and restored power.

Al Nao was only open four hours a day while it was being rehabilitated. In three months, the hospital was running 24/7 due to the work of Ministry of Health staff, volunteers, local MSF colleagues, and MSF’s financial support.

“On July 27, 2023, the team working in the emergency room treated more than 150 wounded patients,” said Dr. Khalid Abd Rahman Abdelsalam, who was MSF’s project coordinator in Omdurman at the time. “Al Nao Hospital didn’t even blink. Like a beehive, every department, from the emergency room to the blood bank, moved in perfect harmony.”

“The emergency team was composed and highly professional, managing to absorb the overwhelming influx of patients, as if they had rehearsed for this very moment,” he said.

It was a day like many others for staff at Al Nao. The shelling and bombing were persistent; so much so that people learned to recognize different projectiles based on their sound. The front line in Omdurman, located in the Khartoum metropolitan area, where heavy fighting became a daily reality, was only a mile from the doorstep of Al Nao Hospital. Outside, the city roared with chaos, but inside, the hospital moved with purpose.

MSF support from then to now

From 2023 to 2025, MSF’s support to Al Nao Hospital evolved from emergency rehabilitation to a comprehensive partnership with the gradual return of a full MSF project team. Today, MSF is providing clinical training, essential medical supplies, fuel, water and sanitation services, and food for patients. We have also trained Ministry of Health staff on mass casualty response, and have provided financial incentives so the staff could continue to carry out critical, lifesaving work in their community.

As the circumstances surrounding the hospital changed, so did the hospital’s role. Al Nao's service area expanded beyond Omdurman as front lines shifted to include parts of Bahri and other districts of Khartoum state. With other hospitals damaged, destroyed, or not yet functioning, Al Nao became the only functioning emergency facility in Omdurman. Since July 2023, more than 48,000 trauma patients have been treated in the emergency room of Al Nao Hospital.

A hospital on the front line

On February 1, 2025, an explosion struck a market in Omdurman. Within minutes, Al Nao’s emergency room was overwhelmed.

“I can see the lives of men, women, and children torn apart,” said Christopher Lockyear, MSF’s secretary general, who happened to be at the hospital on that day. “There are dozens and dozens of people with devastating injuries. The morgue is full of dead bodies. What I see in front of me is a scene of utter carnage.”

The hospital teams treated 158 injured patients that day. Just three days later, another shell struck within 300 feet of the hospital, killing six people, including a local volunteer who had been providing meals through an initiative at the hospital. Although Al Nao has been hit three times since the war began—in August 2023, October 2023, and June 2024—the staff kept going, no matter what.

Local staff keep Al Nao afloat

The strength of Al Nao Hospital lies in the unwavering dedication of its Sudanese staff. It was Sudanese doctors, logisticians, nurses, and technicians—from both the Ministry of Health and MSF—who kept the hospital alive through bombardments, blackouts, and unbearable pressure.

Local volunteer initiatives were equally vital for the survival of the hospital. Some volunteers had a pharmacy inside the hospital, which offered free-of-charge medicines to people who could not afford them, while others were helping in the emergency room during mass casualty events. Other volunteers prepared food for patients and caretakers through community kitchens.

The unshaken sense of duty demonstrated by each staff member and volunteer is what kept Al Nao Hospital open when so many others had to close. Their courage made all the difference.

“In October 2024, a truck carrying over 30 cholera patients crossed the front line and arrived at Al Nao at midnight,” said Mohammed Nadim, a member of the MSF project team. “Only about 20 survived the trip. The cholera treatment center wasn’t ready, and we were low on supplies. MSF assembled a team past curfew and got what we needed from the warehouse in the hospital. That instant reaction saved lives.”

Holding the line

As front lines kept shifting across Sudan, waves of displaced people arrived in Omdurman, many of whom were returning to the neighborhoods they had initially fled. This led to more people seeking care at Al Nao, so it was essential to bring in more supplies.

MSF’s logistics teams worked tirelessly to ensure the hospital was stocked and operational.

“We had to transport supplies in buses instead of trucks to avoid becoming a target,” said Omar Mhmed Elnour, MSF’s supply chain manager. “And the buses had to take the longest routes to avoid active battle zones. We even managed to send four fridges full of insulin in buses to address the shortage in the city to help save lives of diabetic patients.”

Despite these challenges, Al Nao maintained operations. MSF support allowed the Ministry of Health to redirect its limited resources to other facilities, strengthening the health care system in Omdurman.

“Al-Nao kept health care alive in western Khartoum despite enormous difficulties and harsh conditions,” said Dr. Jamal Mohamed, the General Director of Al Nao Hospital.

The hospital’s ability to manage mass casualty events without compromising other health care services became a model of crisis resilience. “Al Nao sets a powerful example on how trust and solidarity can sustain health care, even in the darkest hours,” said Tuna Turkmen, MSF head of mission in Sudan.

One step forward, but the journey is not over

Al Nao Hospital has become an example of what is possible when dedicated humanitarians collaborate, whether from MSF, the Ministry of Health, or the local community.

The story of Al Nao is not over. The fighting in Khartoum may have ended, but the war continues in other parts of Sudan, and people’s health care needs are growing. The hospital is resilient, but it cannot respond alone. Continuous support is needed to help Al Nao and other health care facilities in Khartoum state and beyond.