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“Post-apocalyptic” scenes from Sudan’s capital

MSF's head of mission describes people living in fear in a city still at war.

The city of Khartoum, Sudan.

A view of a suburb of Khartoum before the conflict started in 2023. | Sudan 2022 © Ikram N'gadi

Khartoum has been the epicenter of the war in Sudan for much of the past 11 months. While parts of the city are now experiencing some respite, the situation remains extremely precarious for the people who continue to live here. The majority of the population has fled what was until last year a bustling cosmopolitan city.

Jean-Guy Vataux recently returned from Khartoum, where he served as head of mission for Doctors Without Borders/Médecins Sans Frontières (MSF). For several months, the city has been under the control of the Rapid Support Forces (RSF), a paramilitary group that has been fighting the Sudanese Armed Forces (SAF) since April 2023. Here, Vataux shares an overview of the situation in Khartoum as people continue to face severe supply shortages and insecurity.

What is the current situation in Khartoum?

Khartoum is partly a ghost town. Around 20 to 30 percent of its population remains. The inhabitants fled en masse. However, some returned after RSF took control of neighboring Al Jazirah state in December. As a result, in some areas you can see ordinary scenes of life, such as children playing outside and parents going to the market. But the atmosphere remains very tense and extremely anxiety-provoking, even post-apocalyptic. Many buildings have been gutted and looted. There are large numbers of Rapid Support Forces fighters roaming the streets and regularly forming checkpoints.

So Khartoum remains a city at war. The Rapid Support Forces attack government enclaves with artillery on a regular basis, while the Sudanese Armed Forces respond with aerial bombardments. There is still an atmosphere of active war and a very strong fear of both parties to the conflict among the population. For example, some of the staff working at the MSF-supported Turkish Hospital never go outside, not even to run an errand in front of the hospital.

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What are the living conditions like for the civilians who have remained in Khartoum?  

Since RSF took control of neighboring Al Jazirah state, the markets in Khartoum have become better supplied with food, particularly fruits and vegetables. But the situation remains extremely difficult for people and will likely continue to deteriorate.  

There is a major economic crisis in Sudan, and not just since the start of the war. For the last five years, the economy has been shrinking and today it's very hard to earn a living in Khartoum. It's an economy that is heavily affected by looting, and eventually there will be nothing left to loot.

The overall indicators calculated by the United Nations teams are extremely worrying— they show that 3.9 million people face high levels of food insecurity in Khartoum state. However, we have not been able to verify these figures through our work. 

There is also the risk of an epidemic, which could lead to high mortality rates among a population that is particularly vulnerable in terms of nutrition. For the time being, Khartoum has been relatively spared, probably because of the low population density due to the mass departure of civilians. The cholera epidemic, which has developed mainly in the towns of eastern Sudan, has affected the capital, but at very low rates. Similarly, there have been a few cases of measles, but the outbreak has remained extremely limited. Khartoum has not seen any outbreaks of dengue fever either, although there have been major outbreaks in other Sudanese cities. But there is no guarantee that Khartoum will remain unaffected by future epidemic outbreaks.  

Can the people who are still in Khartoum access health care?

There are a few hospitals financed and run by the Rapid Support Forces, which do a bit of medical work in the city, but are mainly for their fighters. A highly specialized cardiac surgery program, set up by an international NGO, also continues to operate, but it does not meet the needs of a city at war. This leaves only four hospitals and a primary health care center supported by MSF.   

Even if Khartoum has achieved a degree of stability in terms of security, going to the hospital is still a major risk. So people delay going to the hospital for as long as possible and think twice before crossing the city. The only people who continue to come are those who have suffered trauma, whether from acts of war or accidents.

At the Turkish Hospital, we saw people taking great risks to come and get the treatment they needed, like crossing the Nile by boat when there were bombings and snipers everywhere.

How does the Turkish Hospital continue to function?  

The Turkish Hospital is one of the few hospitals where the staff stayed after the war broke out. Today, teams from the Ministry of Health tell us that if MSF hadn't come to support the hospital, whether by supplying medicines or paying salaries, they would have left the city—and therefore, their posts [at the hospital]—very quickly.  

The hospital was in a government zone when MSF began its collaboration. It then came under the control of the Rapid Support Forces when they took over the whole of the south of the town, including the hospital’s area. Despite this, the hospital was relatively spared from the fighting and bombing.

Since then, activity in the emergency room has been fairly constant, with around a hundred visits a day, mainly for non-war related surgeries, obstetrics, and road accidents. From time to time, war surgery is also necessary. During offensives or bombardments, we can treat up to 60 war casualties a day. In the rest of the facility, there is standard hospital activity, with a pediatric ward, a maternity unit, an internal medicine ward, and a small outpatient department.

How has the war impacted health care staff?  

The staff who work in the Turkish Hospital are under immense pressure. On the one hand, they are under pressure from the Rapid Support Forces, who are carrying out arbitrary arrests and brutal detentions of the civilian population, including Ministry of Health employees. As Ministry of Health staff are civil servants, the Rapid Support Forces consider that they may be spies paid by the Sudanese Armed Forces.

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From the government side, the staff also face growing suspicion. As the war goes on and civil servants carry out their work in RSF-controlled areas, the government's view of them is that they are now part of the Rapid Support Forces. There have been reports of incidents where civil servants have been arrested and ill-treated at Sudanese Armed Forces checkpoints on their way back to government zones, for example. So they're really between a rock and a hard place. But obviously, the fear is that the pressure will become too great and they will decide to flee abroad or to elsewhere in Sudan.  

How are medical supplies reaching the hospital?   

As with the other health structures supported by MSF, we have had problems at the Turkish Hospital since October, when the government decided to blockade the city of Khartoum. At that point, it was no longer possible to transport medical equipment and medicines to RSF-controlled areas from Port Sudan, where cargo ships arrive.    

So there was a serious shortage for a few weeks until the Rapid Support Forces took control of Al Jazirah state and in particular the town of Wad Madani, where our supplies were stored. The moment it was taken over by the RSF, we were able to go there and bring most of the medical stock to Khartoum.

That said, in two months' time, the shortage problem will arise again. We probably still won't be able to get the stocks and staff reinforcements through from Port Sudan, which remains under government control. We don't foresee that the government will change its policy. We are therefore in the process of trying to build a supply corridor from Chad.

Sudan crisis response