Inside Sudan’s escalating humanitarian crisis: A frontline doctor’s view (podcast)

AVRIL: Hello and thanks for joining us. I'm Avril Benoît, CEO of Doctors Without Borders USA. Today we're looking at Sudan through a humanitarian lens. More than two years of war have triggered the worst humanitarian crisis in the world. Violence has forced 13 million people to flee their homes, and more than 30 million people need humanitarian aid. All the while, Sudan's health system has been pushed to the point of collapse.

This is all happening amid unprecedented cuts to humanitarian aid, not only from the US government but other nations, causing a massive disruption to global health and humanitarian programs. We're going to discuss it with Dr. Mohamed Fadlalla, a physician who has taken assignments with MSF for the past five years, most recently in Omdurman, Sudan's second most populous city. And it's great to have you with us to describe what it's like there. Thanks for being with us.

MOHAMMED: It's my pleasure to be here and I'm honored to talk about it.

AVRIL: You've been to so many places and you grew up in the US, but your family background is Sudanese. Tell me about yourself and how you then show up in Sudan on assignment like this.

MOHAMMED: Like you said, I was born in Sudan, and I found my way to Ohio, when I was less than 2 months old. I grew  up here all my life. But when I was assigned that first assignment in Sudan in 2021, I really found that I had a deep, deep attachment to being there. The people there, the culture there, even though I never really lived there growing up. So subsequently, every time I've gone back, I've really felt that sense of home, that deep connection with the people, the country, with everything that's going on there. And I just attribute that to my parents and my friends and family who we grew up around and grew up with in Ohio.

AVRIL: And what did they say when you took the assignment?

MOHAMMED: I think, with many parents, I think there's a lot of nerves [over] working in difficult circumstances, especially in war times and things like that. But I think I really feel a deep sense of pride from my parents and in the rest of my family whenever I tell them I'm going back to Sudan to serve, because it's really something very personal for us and really affects our people.

AVRIL: Well, let's talk about Omdurman. Maybe you can describe the city for us. And what were the humanitarian needs you saw there?

MOHAMMED: So, like you said, Omddurman is one of the most populous cities. It's actually the sister city of Khartoum, which is the capital. You can tell when you arrive that it's huge, more or less kind of a metropolis.

But you also get a sense that a lot of parts of it have emptied from the two years of the war and the bombardment; people have left and fled to other, less conflict-affected areas of Sudan. Omdurman is a highly militarized city, at this point. You see a lot of weaponry everywhere in the streets.

If you know the geography and the conflict, it's right along the front lines, between the two warring army forces. So you see a lot of the effects of the war as well. You see a lot of buildings with bullet holes. You see a lot of bombed places.

And then I think the thing that really captures you and, you feel the most is the sounds that you hear. There's the background of shelling—that happens basically almost every day at all different times of the day, some closer, some farther, some bigger shells, some smaller shells.

But really, the background noise of the city of Omdurman is shells that are being lobbed from both sides across these front lines that surround Omdurman and the setting.

AVRIL: Then for the medical work you were doing, maybe describe the  actual medical needs that you were dealing with on a day-to-day basis and what a typical day was like for you.

MOHAMMED:  So as MSF, our primary work was supporting two different hospitals. We were supporting the emergency department in Al Nao Hospital in Omdurman, which has been more or less over the last two years the only functioning emergency trauma providing hospital [care]  in the city. We support the hospital through a lot of logistical intervention, helping them with repairs and things, helping them keep the facility moving.

We support them with water, sanitation, making sure that there's clean water. And we support the medical activities as well, through helping with setting up their mass casualty responses and things like that. So that was one of our primary settings. And the other setting that we work in is the malnutrition ward and Al Buluk Pediatric Hospital.

Again, one of the bigger pediatric hospitals in Omdurman. We support the malnutrition ward because I think one of the primary fallouts in and outcomes of war is food insecurity. And you see that manifest in primarily children who come into the hospital with a condition called severe acute malnutrition, where. It's a level of starvation where you start to see some physiological problems arise.

Patients get infections, patients have difficulty healing, patients have difficulty gaining weight, having energy. And that was the other bulk of our activity, as well as helping and providing for the malnourished children.

AVRIL: So on a day-to-day basis, you're moving between the two locations. You're working with Ministry of Health staff.

MOHAMMED: Yeah, absolutely. So both of these hospitals are fully run and managed by the Ministry of Health. And we worked in very close collaboration with the directorates of each hospital, as well as the doctors and the nurses in providing care. And we were lending our expertise. We had a pretty broad medical team. So in the morning, part of that team would go to another hospital, do some rounds in the morning, see what the patients’ situations were like, do somebedside teaching, bedside intervention, helping with dressing changes, wound care, all the things that need taken care of for patients who come in with war wounds and shelling victims, which was happening frequently almost. I think in January of 2025, for example, I think there were only four days in the whole month where no shelling victims arrived. So, really, it's a very constant thing. And then another bulk of the team would go to a hospital, participate in their morning rounds with the team, with the Ministry of Health team, discuss the cases, especially discuss the challenging cases and see what interventions, what medication adjustments we might have to make.

What  nutritional supplementation was suitable for each of the cases and things like that. Beyond that, it was meeting with the hospital directorates about what the hospitals need. What they need to keep their facility running, keep their capacity to take care of patients going. That's our typical day-to-day. We encountered some emergencies on top of emergencies while we were there.

There were two particular moments when the power supplies of Sudan were targeted, leaving Omdurman in a total electrical blackout, which had downstream effects of affecting the water sanitation services. So there were periods where we needed to act very quickly to obtain and supply clean water for these hospitals, as well as ensure the electrical capacity in the hospitals

AVRIL: So you've got generators running to provide for the for the oxygen machines and things like that.

MOHAMMED: So we had our schedule, but it was also affected by what was going on in the context.

AVRIL: This wasn't your first time in Sudan. How did it compare now being there at the height of a war compared to other times?

MOHAMMED: First time I was in Sudan was prior to the war, when we were actually taking care of Ethiopian refugees who were fleeing their own civil war from the Tigray region. I subsequently have come two times after the war started. And each of the times I've come back, I've really gotten to see very starkly the decline in the Ministry of Health's capacity to be able to provide medical services for the people there. You know, when I first got there in 2023, staff of the Ministry of Health were more or less not really getting paid for nine months by the time I got there in late 2024. That was a year and nine months.

When I arrived in Khartoum, we saw that over the duration of the war, much of the specialists had gone to other, more safe parts of the country to practice. So there was a little bit of a dearth of specialist care in the capital because of this migration.

And you really saw the physical effects of a war that's been going on for two years on the country, from infrastructure or from supply chains being disrupted and lack of availability for food and things like that. The one thing that you also saw was that the people's spirit wasn't broken. So despite them living in this war going on, even on the front line, you saw that maybe Sudan's been broken or been really affected, but the Sudanese spirit hasn't been broken.

AVRIL: I found the same thing when I was there last year. Just amazing to meet our own physicians, Sudanese colleagues. A doctor that I recall in particular, she was in Geneina  when it was attacked and her family was there. She fled with them into Chad, across the border, not too far away, and then came back to work for MSF again. She just couldn't bear the idea of just abandoning the possibility of helping her people with the skills she had.

MOHAMMED: I understand that even a little bit. Recently, you were in Darfur as well as Chad. What are some of the humanitarian challenges you found, in general?

AVRIL: Darfur is a region that is now almost entirely controlled by the main opposition, the RSF [Rapid Support Forces] and the conditions are horrific because what they've been through have been these targeted attacks on villages, targeted attacks on certain populations within those towns, depending on your ethnic group, your identity.

So the Masalit took it very hard. When I was in Darfur in 2008, the Zahara were the people that I was interacting with the most. And as with then, what I found this time is you had people displaced multiple times, you know, you'll have a family that literally has been displaced five times.

And maybe they make it into Chad if they have any more resources left, which often they don't. And you'll have women who have been separated from their husbands, husbands are either killed or conscripted or fled or nobody knows where they are. It's been so long since they've been out of touch. And then you have, you know, maybe four or five children you have to feed, you know, that you have to somehow manage to provide some safety for them without the social structures that you had around you because maybe even your own community, your extended family, you've dispersed, you don't know where everybody is.

And at times MSF, of course, has to withdraw, has to lay low. We try to go back, humanitarian workers and other health workers have been killed in these environments. And it's absolutely devastating to see when I compare it to my first time in 2008, how familiar it all felt in terms of the storylines.

They came into the village, maybe not on horseback this time, you know, as the Janjaweed were sort of known at the time. They come with motorcycles, they come with technical vehicles, they burn things, they contaminate the well, they take your animals, they shoot up everything. They leave the bodies on the side of the road, you know, all the same kind of stories of rape, which is not talked about as openly as is the reality of the lived experience. It's tragic on all grounds and then in the camps in Chad, there's just, the insufficient attention to the humanitarian needs. You've got hundreds of thousands of people there and not enough humanitarian assistance to help them through it. And it's probably long-term. That's the other part, because they don't want to go back under the current circumstances.

MOHAMMED: Yeah. It can be quite dangerous. You know, some of the really heartbreaking situations that we got to see, being so close to the front line, is some of these children who come in with malnutrition.

They're coming in to see a medical facility a lot later than their parents would want them to, because it's just so hard financially, physically to get across that front line. So you have patients that present much sicker much later than they would have normally. One particular kid, a child that really sticks out for me is, I think he was maybe 2.

He had presented to our facility, was treated for severe acute malnutrition, had his infections cured, was starting to gain weight, and was well enough to be discharged. But you know, unfortunately, you're discharging folks to the same socioeconomic, political conflict context that they're coming from. So he gets home [and] he's not able to get the continued care that he needs. He gets sick again. He starts to lose weight again. And then after difficulty, gets to come back to us a second time, and t[this] time, we just weren't able to have him recover. And that's just one of the stories of many that are like that, where there's just so many additional challenges for these folks who live there and in this war that's happening between two armies, but on top of them, on top of civilians.

AVRIL: The other group that we don't talk about much at MSF are the elderly. And there was one neighborhood in Zalengei in Central Darfur that we walked through—hHanyonethe bullet holes and  andit was so sad to see an elderly gentleman, as is often the case in war. He couldn't leave his whole life. His whole life was in that neighborhood, his whole world. And then everybody's gone. He still autonomous, but it seemed to me feeble, like he was at risk. He's walking around and showing us his abode, his where he was living with, you know, one little pod, a little jerry can, a mat on the floor—the simplest because everything was looted at the time of the attacks. And I've seen that again and again and again in different war zones. You know, it's definitely a feature in Ukraine where often,the ones who stay behind and suffer that tremendous sense of loss and loneliness, but they're still hanging on. Are the elderly in these more rural places?

MOHAMMED: You know the elderly that we encountered in my last project were the ones who would come into the emergency department following a shelling, following a bullet striking. And I think what that makes me think back to is, the majority of the war wounded patients that we saw were civilians—people going about their daily lives. And bombs, they don't really discriminate. Once they're launchedm  it's whoever they land on. And as this war is just taking place among the people, it's the people that are bearing the brunt of this war. At no fault of theirs, at no incentive to them. Men, women, children, young and old—we were seeing everybody.

And these bombs are indiscriminate as they get. I think one of the most tragic bombings that happened when we were there was, I think it was February 2 in one of the markets in Omdurman and in an instant, there was close to 50 deaths and 200 injured, who all came to a now hospital at the same time. And these bombs don't discriminate.

AVRIL: How do you handle so many patients coming in at once in a mass casualty event like that?

MOHAMMED: It's a tremendous undertaking. And for something like that, you really see the heroism of the staff at the hospital. The Sudanese staff who, who are there. The doctors and nurses, the surgeons, the floor cleaners who are cleaning the blood off and replacing the beds that just keep needing [to be] replaced because patients keep coming in.

How do you handle it? You handle it the best you can. I can't say that. You know, every one of those patients survived with a good outcome. But what you see is people collectively, doing every last bit that they can to make sure that everybody, that they can help and impact positively, they impact positively.

So you see cohesion, you see effort. You see empathy. And you see a lot of hard work on days like that, and then, you know, when it's over, after however many hours, you take a breath and you brace yourself for whatever [is] next. You see that there's an incredible resilience, an incredible, incredible bounce back of the folks that that, you know, as MSF [we] should be honored to call  colleagues from the Ministry [of Health] in Sudan.

AVRIL: So when you come home after an assignment like that—so intense, so meaningful, and you go back to the VA hospital, [or] a teaching hospital where you work—how do you convey to people who have barely read about Sudan? It's just it's not on people's minds, particularly here in the US. That's my impression. How do you how do you convey to them why they should pay attention?

MOHAMMED: I think we're all human. I think we can all put ourselves in the shoes of a parent trying to make sure that their child, gets the health care they need.

We all have children we know we need to feed. We're all struggling with inflation. You know, one of the problem in Sudan is there's massive inflation. We're seeing it here. Obviously, the scales are different, but I think there's a common humanity that everybody here can tap into. That when you describe what's going on there and personalize it and explain that these are the challenges that the people face, just like we have our challenges here.

Their challenges are synonymous. So I think people can relate to that. I think there's a human element of connection that we need to be able to tap into. And I think we can tap into [it] because I think humans are designed with an empathy component.

AVRIL: And the fact that they know you and you can talk about it personally, directly, must make all the difference.

MOHAMMED: Absolutely, yeah. It's not something you see on the news. It's not something you read. You know, you we're in an era now where you don't know what to believe when you read it, when you see it. But I think, if you talk to somebody, if I'm available to talk and to tell the stories and to tap into what I experienced, I think it can go a long way.

Especially in this time of, a lack of trust in in what we see, in what we consume.

AVRIL: Thank you, Mohamed, for sharing your experiences with us.

MOHAMMED: It was my pleasure to be here. I think it's really important that we continue talking about Sudan.