Sudan: Voices from South Darfur

Before war erupted in Sudan in April 2023, the UN estimated that 1.6 million people in South Darfur needed humanitarian assistance, with more than 300,000 people suffering from malnutrition and the largest number of forcibly displaced people in Sudan. Ten UN agencies and 30 international and Sudanese NGOs were delivering humanitarian aid in South Darfur.

With the outbreak of the conflict between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) in April 2023, Darfur suffered fierce fighting between the warring parties and their allies and ethnically motivated massacres. Civilians were killed, injured, detained, and sexually assaulted, and people were forced to flee en masse. The RSF secured its grip on Darfur in 2023, with the exception of El Fasher, in North Darfur, where heavy fighting continues.

Humanitarian needs in South Darfur have escalated, but the humanitarian response has disintegrated. Humanitarian teams have evacuated and humanitarian warehouses have been looted. Organizations have struggled to resume vital aid in South Darfur ever since.

Warring parties are obstructing aid

Obstruction of aid has been wielded as a tactic of war. The Adré border crossing point from Chad into Darfur has been the most viable route into the region during the conflict. This crossing point is controlled by RSF but the UN has sought consent from SAF, the recognized authority for the UN in Sudan, before moving humanitarian supplies or personnel into Darfur through Adré.

Following months of negotiations escalating to the highest levels and countless public pleas, movements of UN cargo through Adré have gradually increased. Nevertheless, humanitarian supplies arrive sporadically and remain insufficient to meet the needs in the region. Only after lengthy delays and stymied attempts have time-limited visits to Darfur by a select group of UN personnel been permitted. 

More than two years into the current war, people in South Darfur are enduring harrowing, relentless violence, including sexual violence. They harbor fears of arbitrary detention in appalling conditions, face widespread theft and looting, and struggle to survive and to support one another as the economy deteriorates.

MSF teams face difficult choices

MSF's assessments of health care facilities in South Darfur reveal pervasive disruptions to vital medical supplies. In the health care facilities that remain standing and functioning, infection prevention and control is inadequate, and there is often a lack of water. Many of the most qualified, senior medical staff have fled. As a result, health care has become largely unavailable and unaffordable for the population.

MSF is faced with immensely difficult decisions in South Darfur. Stretched to capacity, we have been unable, thus far, to provide or support care for non-communicable, or chronic, diseases such as cardiovascular disease, cancer, chronic respiratory disease, and diabetes. These diseases were highly prevalent in Sudan before the war broke out. We know that possibilities for treatment are either absent or inaccessible, due to a lack of medical supplies, functioning health care facilities, and qualified medical staff, and because of the costs involved for patients to access services. This leads to quiet, painful deaths and suffering driven by the war, which are not reflected in our medical data, and are unseen and unrecorded.

In 2024, alarming numbers of women died while pregnant, during labor, or shortly after giving birth in Nyala Teaching Hospital in South Darfur. Prior to the outbreak of the current war, Sudan had one of the highest rates of maternal mortality globally. In 2024, we saw an aggravation of these rates amid violence and mass displacement and disintegrating access to health care. Between March and November 2024, 51 women and adolescents died in Nyala Teaching Hospital’s maternity department.

Progress is possible in maternal health

Maternal deaths have steadily reduced in Nyala Teaching Hospital since August 2024; MSF opened several women’s clinics to increase access to sexual and reproductive health care and better support timely referrals to the hospital. We are also providing technical support to midwives at Nyala Teaching Hospital, and our rehabilitation of the hospital and support to infection prevention and control is likely to have also contributed to the decrease in maternal mortality.

In addition to Nyala Teaching Hospital, we are supporting the running of Kas Rural Hospital in South Darfur. We are supporting a range of primary health care clinics, more basic health posts, and facilities that offer sexual and reproductive health care. We are doing so in urban and rural locations, including remote, mountainous towns and villages, as well as in camps for internally displaced people. We are focusing on general outpatient services and particularly on children under the age of 5, sexual and reproductive health care, care for survivors of sexual and gender-based violence, and outpatient treatment for children and pregnant and breastfeeding women with malnutrition.

MSF remains concerned about high maternal mortality in localities where sexual and reproductive health care is not being supported. In April 2024, in a short assessment conducted in a displacement camp close to Nyala, 68 maternal deaths were reported to MSF as having taken place since January 2024. In 2025, community members living in one settlement in southern Jebel Marra reported hearing of 17 maternal deaths in the first three months of 2025.

Providing direct support to families and community organizations

After witnessing persistently alarming malnutrition screening rates at our facilities, we decided to launch a new activity in November 2024. In December 2024, MSF starting providing targeted supplementary food support to the families of patients treated for acute malnutrition in our program. Using a voucher system, 6,000 families of acutely malnourished children under 5 and pregnant and breastfeeding women and girls received food packages. It is unusual for MSF to undertake food distributions. We hope that this proves that food distributions are eminently possible in South Darfur, and it is already clear that such assistance is sorely needed.

In early 2025, MSF has continued rehabilitating the Nyala Teaching Hospital, prioritizing the buildings which previously housed the blood bank, surgical wards, inpatient department wards, and the laboratory. In addition, we rehabilitated the main Nyala water station, and we are repairing 200 hand pumps which provide clean water across the city, and we provided group cash transfers to local humanitarian organizations and initiatives in recent months.

In these efforts, we are partnering with health care workers, the Ministry of Health, national and South Darfuri medical-humanitarian organizations, and grassroots initiatives and networks.

Constant threats of violence, including sexual violence

The war since 2023 represents the latest chapter in decades of violence in South Darfur. Many of the people MSF has spoken to were uprooted from their homes by hostilities in the early 2000s, and can still recall, with clarity, the horrors to which they were subjected. Moreover, they depict a now-pervasive climate of violence, in which murder, assaults, rape, detention, relentless thefts and looting, and airstrikes have become commonplace.

In South Darfur, the population is surviving in a state of alertness, struggling to maintain a sense of normalcy and provide for their families while armed men kill, beat, sexually assault, and rob civilians with impunity, and as families anxiously wait for the next airstrike.

Reports from the 659 survivors of sexual and gender-based violence who received care from MSF between January 2024 and March 2025 reveal the following:

• 56.2% of the survivors were assaulted by a non-civilian (by a member of the military, police, or other security forces or non-state armed groups). A further 7% of survivors were abused by a member of a criminal group. Those in South Darfur are also being assaulted by known and unknown civilians (12.3% and 11.7% respectively), and by their intimate partners (5.3%) and members of their family or household (5.8%).
• 34% faced sexual violence while working in the fields, or on the way to the fields.
• Survivors have faced abuse while on the road in South Darfur (4.5%), while collecting wood and water, and while looking for food (16.3%).
• 71.3% of survivors to whom MSF provided care accessed a facility within 72 hours of the assault, highlighting how conflict-related sexual violence is continuing in South Darfur.

“Every day, when people go to the market, there are four or five cases of rape," a displaced woman in southern Jebel Marra told MSF in November 2024. "When we go to the farm, this happens. Men, they will cover their heads, and they will rape women."

A call to increase support for people at risk

It is possible for humanitarian actors to operate in South Darfur. MSF urges humanitarian actors to explore all means possible to intensify the support reaching communities in South Darfur and the broader Darfur region.

A crucial part of this must entail channeling far more substantial resources to Sudanese frontline responders and providers of health care. Humanitarians must also pour energy into negotiating access, securing proximity to those at risk.