Making the difficult decision to leave Rokero as violence escalates in Sudan

An MSF team member in Sudan reflects on what it’s like to deliver aid during conflict—and the difficult decisions that arise when staff safety is compromised.

Sunset over Rokero near the MSF supported hospital

Sudan 2022 © Francois Dumont/MSF

Since the escalation of violence in Sudan started in April, Doctors Without Borders/Médecins Sans Frontières (MSF) has continued to provide medical humanitarian assistance throughout the country. Due to the ongoing fighting, many hospitals are no longer functional and roads are insecure, making it difficult to transport MSF staff and supplies, and to refer patients for higher levels of treatment.

Recently, MSF project coordinator Nkemju Rosevelt, together with some Sudanese and international colleagues, made the difficult decision to leave the project due to the violence. Below, Nkemju reflects on his dangerous journey home to Cameroon. 
By Nkemju Rosevelt, MSF project coordinator

I was in Rokero when the situation changed all over Sudan. We did not really expect this extreme escalation of violence. As a project coordinator, my team had put in place contingency plans to ensure the security of our staff and patients, and to be able to assist communities in times of violence and insecurity. But what happened was far beyond what we had anticipated.  

While Rokero remains stable, all the main cities in Darfur, like El Fasher, Nyala, El Geneina, Zalingei, Tawila and Kabila, as well as their surrounding areas, were caught up in heavy fighting. Hundreds have been killed, and many more injured. 

A tough decision to relocate and evacuate

It was a tough decision to relocate and evacuate members of our team from the area. Before we arrived, most areas in Jebel Marra had been cut off from health care and other essential services for more than a decade, and for almost two decades in some in rebel-controlled areas. It was a very emotional moment, as communities expressed how they did not want to lose our services.  

MSF medical team checking on malnourished child in ITFC, May 2023
A mother receives care for her malnourished child at the MSF-supported hospital in Rokero, Sudan.
Sudan 2023 © MSF

We left behind a skeleton team of dedicated and experienced Sudanese colleagues, some of whom are from Rokero, and others who are from parts of Darfur. They continue to do an incredible job, working hard to maintain hospital services in Rokero and primary health care activities in Umo, and working in remote villages through MSF-trained community health workers. 

In Rokero, we faced the indirect effects of this terrible escalation.  Although the area is calm, our team there is still dealing with multiple challenges as a result of the violence. Food, medication, and fuel to run generators or vehicles aren’t getting in easily. In addition, transporting staff and patients referred for surgery is extremely difficult, as the road out of town remains dangerous.  

Operating with limited capacity

As a project coordinator, it is difficult to deal with such an uncertain and fast-changing situation, as we don't know what is going to happen next and how best to plan ahead for our team in Rokero and for our patients and the communities we are there to assist. Thus, we had to evacuate our international colleagues and Sudanese colleagues who are from other parts of Sudan, though some Sudanese colleagues chose to stay and continue our work, despite the atmosphere of uncertainty and fear of the unknown.  

While we continue to operate with limited capacity, increasing numbers of people fleeing urban areas like El Fasher, Zalingei, and Khartoum are arriving in Jebel Marra. They come by commercial trucks, often without any possessions, having left everything behind to escape extreme violence. 

Health issues in fragmented Jebel Marra

People in Rokero and Umo still remember the pain they endured when sick and wounded people had to be carried on donkeys for days to Tawila and El Fasher to access health care. Many died of preventable conditions due to the long distances they had to travel. Rokero has experienced frequent flare-ups of violence, including in November 2022, when MSF treated more than 50 trauma patients amid the fighting. 

Women, men, community leaders and elders, and former patients pleaded for us to stay. Some community leaders came to me directly to say that they would guarantee our safety. Jebel Marra has always been fragmented by different rebel or armed groups, but they all committed to overcoming their differences, acknowledging that not having access to health care would be more harmful to the community than any violence itself.  

Jebel Marra has always been fragmented by different rebel or armed groups, but they all committed to overcoming their differences, acknowledging that not having access to health care would be more harmful to the community than any violence itself.

The number of deaths among pregnant women and new mothers is high in Darfur. Some women lose their babies in the first trimester of their pregnancy because they ride donkeys or have to work extremely hard, tending to both the fields and their children. Most people here are farmers, growing sorghum and millet, but years of conflict and the recent escalation have frequently disrupted farming activities, leaving families without their crops or with a poor harvest. Most people can barely afford two basic meals a day.  

I remember in July 2022, there was a huge malnutrition crisis. We traveled into the villages in the mountains with mobile clinics to treat children who were in deplorable conditions. We brought the most severely sick children to our therapeutic feeding center and treated many in the villages. 

An emotional goodbye

It has been very emotional and difficult for those of us who left. We wanted to stay, but we could not ensure the safety of the whole team. I speak daily with our Sudanese colleagues in Rokero to understand what is happening. I feel relieved to know that they are doing well and continue their amazing work supporting the communities there. 

Supplies form El-Fasher unloaded in Rokero supported hospital in Rokero
On May 12, MSF delivered supplies from El-Fasher, North Darfur, to Rokero hospital.
Sudan 2023 © MSF

About MSF in Sudan

In 2020, MSF upgraded a hospital in Rokero town, turning it into a specialist health care facility serving more than 250,000 people across two localities. We manage its inpatient department, emergency room, therapeutic feeding center, maternity wards, and observation room. Our teams continue to assist around 10 deliveries every week and typically admit between five and 15 new patients per day, including those referred from a community program we support. MSF staff also conduct emergency referrals to the only accessible hospital with surgical capacity, in the town of Golo in Jebel Marra, and in 2021 we ran an emergency mobile nutrition program across 20 villages, treating more than 500 malnourished children.   

MSF began working in Sudan in 1978, providing life-saving medical care to people who need it most. MSF-supported facilities continue to provide life-saving medical care in El Fasher and Zamzam camp, North Darfur, in Kreinik, West Darfur, in Rokero and Umo, Central Darfur, in Khartoum, in Al-Jazeera, in Um Rakuba and Tinedba, El-Gedaref, and in Ad-Damazin, Blue Nile states. 

Learn more about how MSF is responding to the crisis in Sudan >