NAIROBI, January 16, 2024—On December 15, the Rapid Support Forces (RSF)—one of the warring parties in Sudan—launched an attack on the city of Wad Madani and took control of several other parts of Al Jazirah state within days.
Since then, more than half a million people have fled the fighting and ensuing insecurity, including about 234,000 internally displaced people who had previously sought refuge in Wad Madani as violence in Khartoum intensified.
Widespread violence caused Doctors Without Borders/Médecins Sans Frontières (MSF) to suspend all activities and evacuate staff from Wad Madani on December 19, leaving behind a population with even less access to basic medical services. We also had to evacuate staff from Damazine, Um Rakuba in Al Gedaref state, and Doka. In Damazine, we reduced activities.
Dire conditions in Wad Madani
Prior to the evacuation in December, MSF had been present in Wad Madani since May 2023. Conditions were already dire for the half a million internally displaced people living there, who made up 8 percent of all internally displaced people in Sudan—already the world’s largest internal displacement crisis, with more than 6 million forced from their homes within the country in addition to more than 1.4 million who have fled across borders.
Between May and November, MSF teams performed 18,390 medical consultations (40 percent of them for children under 15 years old) in several of the hundreds of locations hosting displaced people across the state, some in schools or old public buildings.
“Through our mobile clinics, MSF diagnosed and referred 66 children suffering from severe acute malnutrition with serious complications in the past six months—cases that could be fatal if not treated in a hospital urgently,” said Slaymen Ammar, MSF medical coordinator for Sudan. “But health facilities were overwhelmed. As the population of the city had increased by 30 percent, there were more and more patients, but considerable supply and staffing challenges."
From Mayo, south Khartoum
Souad
"The journey [took] three days riding caro [a wooden cart pulled by a donkey] along with my six children.
When we arrived here, we were suffering. There were no bathrooms and no water and food. The organizations then arrived and intervened, providing us with water, soap, and buckets, and our conditions improved slightly.
"As prices soared for all goods," added Slaymen, "access to lifesaving services was an obstacle for both displaced people and regular residents. Nowadays, with the departure of most international organizations—and despite efforts of local volunteer health workers—we can only assume it has worsened.”
On January 13, as a result of discussions with the Government of Sudan and RSF to assure staff access and the impartiality of our medical mission, an MSF team returned to Wad Madani to assess the needs and evaluate the feasibility of carrying out activities in the city.
At the same time, MSF teams in Al Gedaref and Kassala states—where MSF has been operational since 2021 in response to the Ethiopian Tigray crisis—are currently assessing and responding to the escalating health and humanitarian needs following the arrival of thousands of people from Wad Madani. In Tanideba, MSF started a short-term emergency intervention for newly displaced Ethiopian refugees and newly displaced Sudanese citizens covering basic health care, water and sanitation, and food rations. This includes one-off distributions and donations. However, activities in Tanideba were temporarily reduced due to the escalation of conflict in Wad Madani.
“Woefully inadequate" humanitarian response
In a region where health care and essential medicine were already extremely limited, displaced people are now suffering from growing health demands, stemming from the direct and indirect effects of violence. Basic needs are now further escalating and need an urgent response.
"At gathering sites in the city of Kassala, displaced people told our teams they haven’t received any assistance since their arrival in mid to late December,” explained Pauline Lenglart, MSF emergency project coordinator in Sudan. “Families are sleeping on the ground, access to health care is still severely restricted, there are few working medical facilities, and medicines aren't provided for free. Many people have told us that they are unable to afford items like food and medicine, forcing them to choose between these necessities."
"The MSF team is constantly evaluating the needs at the new sites that are opening to house recently displaced people," Pauline added. "In all these places, we see that the amount of humanitarian assistance provided is still woefully inadequate to meet people's basic needs and ensure they have dignified living conditions."
From Al Engaz, south Khartoum
Al Bakri
The war brought nothing but destruction and the separation of families. We lost our home, and we lost our city, Khartoum. I survived death twice. I got injured the first time by a bullet and the second time by shrapnel due to bombing by planes.
I lost my nephew. He died on the first day of the Ramadan Eid by a shell. He was divided into three parts. He was performing ablution to go to the mosque when he died in front of the door of his house, and three neighbors died in front of the mosque.
A long journey to seek safety
For many displaced people, Al Gedaref and Kassala are just the latest stops in a long journey to seek safety, during which they have suffered violence and have endured a lack of essential needs such as food, clean water, sanitation, and access to medical care.
“We are originally from Darfur, but because of the violent clashes and the crisis over there, we went to Khartoum," said Salem*, a displaced man who arrived with his family in a gathering site in the Al Mufaza locality, Al Gedaref, two weeks ago from Wad Madani. "But the war followed us to Khartoum, so we went to Wad Madani. And then, the story continues."
Salem’s family fled Khartoum eight months ago after a shell hit their house and severely injured one of their children.
“We were six people in the house, and at that time my wife was pregnant,” said Salem. "Our house was destroyed. I was hit on my arm, but my child got a much worse injury on his head. We managed to take him to the hospital, because he needed urgent lifesaving surgery. But as soon as he was discharged, we had to flee the city because of insecurity. We arrived in the internally displaced camp in Wad Madani, and [my wife] delivered there."
In mid-December, Salem and his family fled once again to Al Gedaref. “Clashes started, and we started hearing sounds of fires and those armed men fighting again. Immediately, we decided to leave. I started thinking where we should go now. Nowhere was safe at that time.”
From Al Samarab, Bahri
Marry
“This is my first time here in Wad Madani. I lived my entire life in Khartoum from my birth until I got married, and I gave birth to my children there.
The situation here is very chaotic. My baby is a month old, and he doesn't look like one month old because I don't have any milk. There is no education or healthy food here, there is no controlled environment to take care of the children, and there is also no healthy environment with the crowding and mixing of people.
About MSF in Sudan
MSF has worked in Sudan since 1979. We currently work in nine states in Sudan, including Khartoum city and state, and White Nile, Blue Nile, River Nile, Al Gedaref, West Darfur, North Darfur, Central Darfur, and South Darfur states.
MSF teams in Sudan are treating people injured in the fighting, including blast injuries and gunshot wounds, as well as treating communicable and non-communicable diseases, providing maternal and pediatric care, running mobile clinics at displacement sites and hospitals in refugee camps, providing water and sanitation support, and supporting health care facilities through donations. MSF is also continuing the majority of its activities that were in place before the start of the conflict.
MSF Sudan's emergency response operates with a budget of $82 million for 2023, with a team of 1,145 Sudanese staff and 57 international staff based in Sudan. MSF is also paying incentives to 1,358 Ministry of Health staff, as well as providing training and logistical support.
*Name changed for privacy
