Sudan crisis response

In August alone, MSF teams in Sudan worked on

• 1,170 ER consultations and 682 surgeries at Bashair Teaching Hospital
• An average of 87 ER patients per day at the Turkish Hospital
• 926 external ER consultations at Shaheed Wadaatallah primary health care clinic
• 483 ER consultations at Al-Kamlin Hospital
• 658 ER consultations at the hospital in El Fasher, North Darfur

In addition, Al Nao Hospital in Omdurman received 6,393 ER cases in July and August, including 3,168 trauma cases, one-third related to the violence. At Alban Jadeed Hospital in northeast Khartoum, teams have treated 1,786 patients in the ER since August.

• 15 latrines built in Wad Madani, Al Jazeera state, including 12 at mobile clinic sites and three at a maternity hospital. Water tanks were also installed
• 1,000 people in River Nile state were provided with soap, plastic sheeting, jerry buckets, and mosquito nets after flooding in September 
• Five boreholes were installed near Camp Ecole in Chad to ensure refugees have access to clean water
• Two water distribution points were set up in Arkoum, Chad to serve refugees fleeing Sudan

In August alone, MSF teams in Sudan conducted

• 249 prenatal care consultations at Shaheed Wadaatallah primary health care clinic in Khartoum
• 622 maternity admissions at Al Saudi Maternity Hospital in Omdurman
• 249 prenatal and 41 postnatal care consultations at Althowra primary health care center
• 323 births assisted at the MSF hospital in Tanideba camp, along with 2,304 prenatal consultations
• 488 prenatal consultations and 41 births assisted at Um Rakuba camp
• An average of 28 babies delivered each week at the hospital in El Fasher, along with 33 Cesarean sections and treatment for other obstetric emergencies 
• 1,577 prenatal care consultations at the MSF clinic in ZamZam camp
• Four births assisted at the MSF clinic in Jebel Marra, South Darfur

At Umdawanban Hospital, just outside Khartoum, 415 births were assisted within just nine weeks of activity. And in Arkoum, Chad, MSF teams have assisted 130 births since July.

In August alone,

• 776 malnourished children were treated in the ambulatory program in White Nile state
• 154 children received care for malnutrition at the inpatient therapeutic feeding center at Al Kashafa hospital
• 15 children were treated for malnutrition at the inpatient therapeutic feeding center at El Geneina Teaching Hospital
• 275 children were treated for severe acute malnutrition at the MSF clinic in Jebel Marra
• 449 pediatric cases were received at the Turkish Hospital in Khartoum
• 13,474 children were vaccinated against measles in White Nile state
• 2,910 children were admitted to the pediatric ward of Adré hospital in Chad

Within nine weeks of activity at Umdawanban Hospital just outside Khartoum, there were 346 pediatric admissions.

In August, MSF teams conducted

• 178 malaria consultations at Shaheed Wadaatallah primary health care clinic
• 4,026 consultations for malaria and 925 for measles in White Nile state
• 64 rapid tests for malaria in El Geneina, of which 19 were positive

• 5.5 million people have been displaced by the current Sudan conflict as of September 2023, including 4.3 million internally displaced and 1.2 million who have fled across the border.
• 418,000 Sudanese refugees have reached Chad since mid-April, and 70 percent are in Ouddaï province
• 386 households were provided with non-food items and hygiene kits in two camps in River Nile state
• 48 individual mental health sessions were held at Um Rakuba camp in August
• 8,000+ consultations were conducted at the MSF clinic in ZamZam camp, North Darfur between June and August
• 22,594 consultations were held at the MSF clinic in Camp Ecole in Chad from early July to mid-September
• 16,000 medical consultations have been held and 130 births assisted in Arkoum since mid-July
• 1,370 patient consultations have been held since opening a 100-bed inflatable hospital in Ourang camp in Chad in late September
• 12,000 kits of non-food items and two water distribution points were provided in Arkoum, Chad

Bashair Teaching Hospital

Due to the blockage of necessary surgical supplies by military authorities, MSF suspended surgical activities at Bashair Teaching Hospital on October 18. We continue to support maternal, emergency, and outpatient care at the hospital, as well as medical activities in three other major hospitals in Khartoum and Omdurman.

Since mid-May, the hospital’s emergency room has received nearly 5,000 patients and MSF’s surgical team has performed more than 3,000 surgical procedures

Turkish Hospital

We also have surgical and medical teams working at the Turkish Hospital in Khartoum. This was originally a pediatric and maternity hospital, but since the start of the conflict it has been transformed into a facility with an ER and operating theater, and a team that can respond to mass casualty events and carry out lifesaving surgery. Its main focus, however, remains treating sick children and pregnant women.

In August, the Turkish Hospital saw an average 87 patients each day in its ER, of which 9 percent were war wounded as the fighting took place elsewhere in the city. In August the hospital treated 518 inpatient cases, 449 pediatric cases, and 551 trauma cases, of which 204 were war wounded. The team in the operating theater performed 98 surgeries (45 Cesarean sections and other obstetric emergencies, 34 orthopedic surgeries, and 19 general surgeries).

Since starting work in the Turkish Hospital in Khartoum in June, MSF teams have received more than 8,600 people in the emergency room (including almost 1,500 children and over 1,900 adult patients, including maternity cases), performed 122 general or orthopedic surgeries, and carried out 166 emergency obstetric surgeries such as Cesarean sections. Since August, MSF midwives at the Turkish Hospital have delivered almost 300 babies.

Shaheed Wadaatallah Primary Health Care Clinic

At Shaheed Wadaatallah primary health care clinic in Alkalakla (an area in southern Khartoum), MSF is providing medicines and medical supplies, a generator, and supplemental pay for Ministry of Health staff. The MSF team provides outpatient consultations including prenatal care, vaccinations, care for survivors of sexual violence, ER, observation room, and referrals to the Turkish Hospital. In recent weeks there has been an increase in outpatient consultations due to the arrival of displaced people in the area. There has also been an increase in dressing cases because of the continuous fighting between the warring sides. 

In August, we provided 4,355 external consultations at this facility, including 926 in the ER, 249 for prenatal care, and 178 for malaria. 

Al Nao Hospital

At Al Nao Hospital in Omdurman, northwest of the city of Khartoum, MSF staff are working alongside Ministry of Health staff and providing support to ensure they can sustain activities and improve patient outcomes. MSF regularly provides medicines and supplies, has been implementing several repairs such as fixing lighting and ventilation systems in the ER, and has improved the hospital’s water supply and general infection prevention control measures. The hospital now provides medical care to people 24/7.

MSF provides 128 Ministry of Health staff with transportation, meals, and supplemental pay to ensure continued operation of the only functioning emergency room in the Karari locality, where the fighting has been incredibly intense recently. 

In July and August, Al Nao’s ER received 6,393 cases, including 3,168 traumas, the majority (2,003) related to violence. In the same period, there were 3,225 medical cases. In the cold case clinic that MSF supports, in August alone, teams provided 402 consultations for noncommunicable diseases, of which 43 percent were for diabetes patients. Many people with diabetes are experiencing deteriorating health due to the inability to continue their treatment and the unavailability of medication in many places—as is the case for people with other chronic diseases.

On October 9, 2023, a shell hit the emergency department at Al Nao hospital, killing four people. MSF released a statement condemning the shelling.

Throughout Omdurman, MSF has been supporting Ministry of Health teams, who have received more than 10,000 emergency admissions.

Al Saudi Maternity Hospital

Al Saudi hospital was closed in July when one Ministry of Health staff member was shot inside the hospital and died. Al Nao hospital was able to accommodate Al Saudi hospital’s activities and staff, and MSF supported the move. MSF is providing supplemental pay for  Al Saudi staff in supported departments in addition to supplies, staff meals, and transport. In August, the hospital had  622 maternity admissions. Al Saudi hospital remains one of the few places that provide care for survivors of sexual and gender-based violence in the area. 

Alban Jadeed Hospital

MSF started supporting the Ministry of Health’s Alban Jadeed Hospital in northeast Khartoum in early August. The hospital receives large numbers of war wounded patients, and staff sometimes sleep in the hospital as it is too dangerous outside. The hospital had to reduce its activities due to lack of medicines and the security situation, and now focuses mostly on lifesaving activities. MSF is supporting staff from the Ministry of Health, as well as local volunteers such as medical students who are working hard to help their community. Our support includes ER support and general surgical services. We have also set up a pharmacy at this hospital.  

We are trying to improve the patient flow through better organization and logistical services within the hospital. Since August, 1,786 patients have been treated in the emergency room and outpatient department of this hospital. The main morbidity has been war-wound injuries, followed by malaria. In the first half of September, this hospital received 81 patients during four mass-casualty incidents as a result of explosions in markets and residential areas. 

Umdawanban Hospital

In June, an MSF team started supporting Umdawanban Hospital, just outside the city of Khartoum, in collaboration with the Ministry of Health. Our teams are working to enhance essential pediatric, nutrition, and maternity services. Additionally, we provide vital support in energy, water, sanitation, and hygiene. MSF bought a generator for the hospital and is working on the water supply lines. After nine weeks of activity, we have reported approximately 346 pediatric admissions, of which 27 percent were newborns, and 415 assisted births.

Donations

• In the Umbada locality in Khartoum state, we have donated drugs, medical supplies, wound treatment, and pediatric kits to Al Rahji hospital These donations were transferred from our Omdurman stock, which is located near the hospital. 
• In East Khartoum state in June, MSF teams delivered 11 tons of donations of medical supplies and equipment to Umdawanban and Alban Jadeed hospitals. 
• MSF also supports a diverse range of services provided by different groups and networks of medical volunteers in south Khartoum. These volunteer networks provide critical services such as trauma first aid, primary health care mobile clinics, and logistical support for the distribution of supplies.

Wad Madani Mobile Clinics

Across seven locations in Wad Madani, the capital of Al-Jazeera state, mobile clinic teams are providing health care to people who have fled the intense fighting in Khartoum as well as carrying out water and sanitation activities, such as constructing and cleaning latrines and providing clean drinking water. 

Al-Kamlin Hospital

A team is working at Al-Kamlin Hospital providing general support (fuel, medical supplies, and incentives), training hospital staff, and supporting the triage system. In addition, an MSF medical team is supporting the emergency room and outpatient department. In August, we provided 483 ER consultations at the hospital.

MSF also donated medical supplies to Al-Kamlin hospital.

Althowra Mobi Primary Health Care Center

At Althowra Mobi primary health care center, we have supported its rehabilitation, provided generators, and built latrines. In addition to providing Ministry of Health staff with supplemental pay and supplying medicines and medical supplies, we have activated a network of community health workers and trained them to detect measles cases. The team here visits nearby camps for displaced people. In this facility, we provided 2,660 outpatient consultations in August, including 249 for prenatal care. 

MSF distributed hygiene and non-food items and food staples to people in different camps and gathering sites for displaced people in Wad Madani, Rufaa and Elhasahisa. 

Women and Ob-Gyn Hospital

In August, MSF started to support the Women and ObGyn Hospital in Wad Madani, which is the main maternity referral hospital receiving pregnant women in critical condition. The patient numbers in the hospital have significantly increased, leading to overcrowding and overwhelming staff. MSF helps the hospital decongest its space, and works with hospital staff on patient flow, triage, and identification of critical cases.

MSF is also donating supplies and additional hospital furniture. MSF also supports infection prevention and control, provides the required cleaning materials and training, helps repair and build latrines, and works on the water provision.  

Orthopedic Trauma Center

The situation is similar at the Orthopedic Trauma Center in Wad Madani. MSF has focused on supporting the emergency room, providing technical support on patient flow and triage systems, sterilization, infection prevention and control, providing the required cleaning materials and training, and supporting water and sanitation within the hospital.  

MSF improved water and sanitation by building 12 latrines and installing water tanks at mobile clinic sites. We also constructed three additional latrines at the maternity hospital, which are now connected to a running water supply, and contributed two water tanks to the trauma hospital. 

In White Nile state, there are 10 camps hosting South Sudanese refugees and many others hosting internally displaced people from throughout Sudan. The refugee camps were established several years ago for South Sudanese refugees and are currently hosting double their capacity—hundreds of thousands of people. 

In Kwor Ajwal, Al Alagaya and Um Sangoor in White Nile, MSF supports three primary health care centers and two treatment centers for measles, and provides water, sanitation, and hygiene activities. MSF staff are working alongside Ministry of Health staff, who we support with incentives. 

MSF also supports the rehabilitation of health centers, aiming to increase their capacity so they can accommodate more patients, and we provide medicines and medical supplies according to the needs. We have also provided equipment such as generators. 

In  August, MSF provided 20,608 medical consultations, including 4,026 for malaria, 925 for measles, 776 for malnourished children in the ambulatory program, 1,663 for prenatal care, 41 for post-natal care, and 87 for mental health.

At the hospital in Al Kashafa, MSF is supporting the inpatient therapeutic feeding center, where 154 malnourished children received care in August. During the same period, our teams reactively vaccinated 13,474 children against measles in White Nile state. 

Ad-Damazine Teaching Hospital

The number of children admitted to the nutrition ward MSF runs at Ad-Damazine Teaching Hospital continues to rise, and is linked to the seasonal malnutrition peak. MSF has added additional wards under tents to increase capacity. We also support primary health care centers and run mobile clinics to bring health care services to people in remote villages. 

Existing health care services in the area are under significant pressure and currently only one other NGO has been able to develop plans for providing primary health care to people who have recently relocated to cities and villages within River Nile state. 

Shendi University Hospital

MSF has donated hygiene materials and additional beds to Shendi University Hospital and implemented training for infection prevention and control. Since May, we have provided medications to hospitals in Shendi and Atbara to cover specific gaps in their supplies. 

MSF also provided water and sanitation support to two camps, including desludging and cleaning latrines, and installing water points. Non-food items and hygiene kits were distributed to 386 households in two camps.

When flooding affected River Nile state in September, particularly Ad Damer, MSF provided mosquito nets, jerry buckets, plastic sheeting, and soap to 1,000 affected people, and donated essential medical supplies to one of the primary health care clinics in the most affected areas.

Tanideba camp

MSF has been running a hospital for refugees and host communities in Tanideba camp since 2021. The hospital offers outpatient and inpatient services for various medical conditions, including non-communicable diseases, Kala-azar, emergency care, comprehensive sexual reproductive health services, and mental health support. We also run an inpatient therapeutic feeding center. Our vaccination services, referrals, and handling of cases related to sexual and gender-based violence are operating at normal levels, without any significant increase in demand, although we see more of the host community coming to our facility and we are concerned about the nutrition status in the villages nearby. 

In addition, we are mapping the activities of other health care providers in the camp to help us streamline activities. Between May 1 and August 31 this year, we provided 18,291 outpatient consultations, and 1,379 admissions to inpatient, maternity, and the inpatient therapeutic feeding center. We also assisted 323 births and provided 2,403 prenatal consultations. 

Um Rakuba camp

In Um Rakuba refugee camp, where we are supporting refugees and host communities, the situation has remained quiet, without any conflicts or incidents that have disrupted our activities in the camp. However, there has been an influx of displaced people from Khartoum to Al-Gedaref state, as well as refugees returning to the camp. 

The onset of the rainy season has posed challenges in the camp. Since August, MSF teams have conducted about 2,656 outpatient consultations and 488 prenatal consultations. Additionally, there were 41 deliveries in our MSF facility. The main morbidities reported were acute diarrhea, skin and soft tissue conditions, and hypertension. A total of 48 individual mental health sessions were held.

El Geneina Teaching Hospital

MSF teams visited El Geneina Teaching Hospital in early August. This is the largest hospital in El Geneina, and it was almost deserted when the conflict intensified. Most of the equipment, documents, and medicines were destroyed. Nevertheless, the young doctors of the city managed to set up a committee of health volunteers with the approval of local authorities.  

MSF provided hygiene materials and products to support a major clean-up carried out in collaboration with the volunteer committee. Currently, MSF’s support to the hospital consists of pediatric services including inpatient and outpatient, ER, ICU, inpatient therapeutic feeding center, and aids the blood bank and laboratory.  

MSF provides pharmaceutical materials, biomedical equipment for the ICU, supplemental pay for 141 volunteer staff (medical, paramedical, and logistics), electrical energy supply (donation of fuels), and training to improve the quality of care to keep this hospital running.  

The hospital has now resumed health services for the population. As of mid-September, the hospital has performed 92 outpatient consultations and 64 malaria rapid tests, out of which 19 were positive. There were 32 inpatient admissions during this period, of which 17 have since been discharged, and one patient died. There are 15 children receiving treatment for malnutrition in the inpatient therapeutic feeding center. MSF has plans to continue supporting this hospital and expand the services where possible. 

Kreinik

The MSF-supported hospital in Kreinik has been running minimum services since our team left months ago, with only the pediatric and maternity wards functioning. There was some looting. Nearly half of the population has left Kreinik, but the town has come back to life. MSF teams visited the facility again and are trying to step up support by bringing fuel, medicines, and cleaning materials, and paying staff salaries to scale up activities.

El Fasher

The MSF-supported hospital in El Fasher, North Darfur was originally a maternity hospital with no surgical capacity. It was rapidly repurposed to provide urgent trauma care after receiving a huge influx of wounded patients during the first few weeks of the conflict, and is now the main referral hospital for the whole of North Darfur state, which has a population of more than 2.8 million people. In August, the hospital carried out 658 ER consultations, 33 Cesarean sections and other obstetric emergencies, and 190 orthopedic and general surgeries. The hospital helped deliver an average of 28 babies per week.  

We also support the pediatric hospital in El Fasher. At the beginning of the conflict, the original pediatric hospital was looted and forced to close as a result. The patients were relocated to a new building by the Ministry of Health and the community. MSF was then asked to rehabilitate the space and improve the quality of care. We have been supporting the hospital since August 1. 

ZamZam camp

We continue to run our clinic in ZamZam camp, where around 120,000 people displaced by previous conflicts live. The MSF clinic saw an increase in patients in August, providing 5,056 consultations compared to 3,000 in June and July. The team also provided 1,577 prenatal care consultations. 

Rokero

In Rokero, Jebel Marra, Central Darfur state, locally hired MSF staff and Ministry of Health staff continue to provide medical assistance. MSF runs a hospital that offers the only secondary health care for a population of more than 40,000 people, including inpatient, ER, inpatient therapeutic feeding center, and maternity and delivery wards. In recent weeks, there has been an increase in ER consultations because of the rupture of medical supply stocks in health structures supported by other organizations in North Jebel Marra, an area with limited access to health care. 

We currently have no options to refer patients for higher levels of treatment to El Fasher due to the ongoing fighting. There are no routine vaccinations for children. The only means of transport in more than 30 villages is by donkey or camel.

Our team also supports Umo primary health care center and is aiming to support another primary health care center in Sortony, a camp for displaced people where malnutrition levels are rising.

In Zalingei, the capital of Central Darfur state, we donated fuel and cleaning materials to the Zalingei Teaching Hospital to run generators and ambulances.

Since March 2021, MSF has been running a clinic in south Jebel Marra, providing free health care to people living across the mountains of South Darfur state. Patients come from more than 60 different villages, traveling as many as 10 hours by donkey to reach the clinic. The team was able to restart the clinic in Kalo Kitting at the end of July, in Torung Tonga in mid-September, and limited services in Dilli, We have been able to keep primary health care services running throughout the recent period of fighting in Kas and Nyala because the clinics are located further in the mountains and not directly affected. However, some of our staff is still in Nyala and has been unable to join the teams in the mountains.

In August the team provided 3,062 outpatient consultations, treated 275 severely children for acute malnutrition, and managed four deliveries.

We provided donations to the Emergency Pediatric hospital in Nyala, and to the hospital in Fora Bonga. Patient numbers have been consistently increasing over the past three weeks as patients come from outside of the catchment area, including Kas, Thur, and even as far away as Zalingei due to the lack of services. The number is expected to increase as information about the resumption of MSF activities spreads and other organizations suspend services. Malnutrition rates are very high, possibly because most of the children are presenting with diarrhea, which is the leading cause of weight loss. Monitoring will continue in the coming weeks.

The MSF teams in Dili have maintained the clinic's continuous operation since the conflict's onset and have undertaken remarkable efforts, including administering scheduled vaccinations twice a week. The teams are also operating three Integrated Community Case Management sites in Sulil, Hashaba, and Lugi. 

According to the United Nations, an estimated 418,000 Sudanese refugees have reached eastern Chad since mid-April, and 70 percent are in Ouaddaï province. Arrivals of refugees have decreased to 500 per day, from 2,000 per day in August, in a region already hosting some 400,000 Sudanese refugees who fled violence in previous years. 

MSF teams are scaling up medical care, nutritional support, water and sanitation activities, and disease prevention measures to address pressing challenges and prevent threats such as cholera outbreaks. The levels of malnutrition are alarmingly high while food assistance is scarce, and the overall aid response is overwhelmed by the scale of the needs. A massive increase in emergency aid, notably food assistance, is urgently needed for displaced people and those hosting them over the coming months to avoid a humanitarian catastrophe. 

Adré hospital

At Adré hospital, where MSF has been working since 2021, we treated over 900 injured patients within four days from June 16-19. Most recounted being shot at and witnessed numerous fatalities while fleeing the besieged El Geneina. Our teams provide maternal, pediatric, and nutritional care in 400-bed capacity wards at the hospital, where victims of sexual violence also receive medical assistance.

Since June, 1, 915 people have been admitted to the surgical trauma wards and 2, 910 to the pediatric wards. We’ve been providing vaccinations to curb a deadly measles outbreak and supporting 4 health centers, with over 22,000 medical consultations since May.   

Camp Ecole

MSF has expanded its operation to respond to the growing needs of refugees in temporary sites and newly built camps across Ouaddaï province. An estimated 200,000 people have settled in an informal settlement, Camp Ecole, in Adré since mid-June, straining the local population and resources—Adré initially had a population of about 50,000. MSF currently runs a clinic in Camp Ecole, where from early July to mid-September, the clinic has performed 22,594 consultations. 

We also installed five boreholes at various points so that people can access clean water. Latrines and showers have also been built to provide basic hygiene and sanitation. We started running a mobile clinic as well as water trucking to cover the needs of patients far away from these facilities. In September, a second mobile clinic was started to catch up with the constantly growing needs and to refer patients to Adré hospital if needed. Within the first week of its opening, this mobile clinic provided 1,389 consultations.  

Arkoum camp

We also provide medical care in Arkoum camp, which hosts 32 000 refugees. We have provided 16,000 medical consultations and assisted 130 deliveries since the start of our activities mid-July.

Ourang camp

Ourang camp currently hosts double its capacity, with 80,000 people. There, MSF is setting up a 100-bed inflatable hospital to provide necessary health care services. The hospital opened at the end of September, and there have already been 1,370 patient consultations. MSF has also provided 12,000 kits of non-food items and set up two water distribution points.

Metché camp

About 40,000 people live in Metché camp, where we have started running mobile clinics. Construction is underway to provide more comprehensive health care services as soon as possible.  

Since mid-April, more than 18,500 people have arrived in Central African Republic (CAR) after fleeing the conflict in Sudan, including a few thousand Central Africans who had previously sought refuge in Sudan, according to UNHCR.

Most of the arriving refugees are sheltering at the border town of Am Dafock, while over 1,800 have been relocated by the authorities to the town of Birao, where MSF launched an emergency response in May.

In early September, as the figure of relocated refugees was not so high, MSF handed over the management of a health post at the refugees’ site to a national organization after donating medicines and materials for one month. Today we continue to support the district hospital and refer patients in need of specialized care to Bangui.

More than 256,000 people have entered South Sudan to seek refuge as of first week of September. Of these, 91 percent are South Sudanese returnees who had fled South Sudan earlier due to violence, economic, or other reasons. 

The sudden and unplanned repatriation of returnees has resulted in a worrying humanitarian situation, particularly in areas close to the borders. People arriving from Sudan only have limited access to basic necessities such as food, water, sanitation, shelter, and health care, particularly in Upper Nile, Unity, and Northern Bahr El Ghazal states—the three busiest entry points. While people live in deplorable conditions at transit centers, they must wait for days and even weeks for their transfers to other parts of the country. 

MSF teams in South Sudan are running emergency activities in Renk, Bulukat, and Aweil to provide the refugees and returnees with health care services at mobile clinics and hospitals.

In Bentiu, we have expanded the capacity of the measles isolation ward and run a vaccination campaign to address the influx of patients. Our teams are recording an alarmingly high number of measles and malnutrition cases among returnees. MSF is calling for an improved humanitarian response to address the needs of those arriving from Sudan.