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Sudan was my most challenging assignment with MSF

MSF nurse Jessica Comi shares her story about treating patients in a war zone.

MSF nurse and surgeon operate on a patient at Bashair Teaching Hospital in Khartoum, Sudan, during the conflict.

Sudan 2023 © Ala Kheir/MSF

Jessica Comi is an operating theater nurse who has worked with Doctors Without Borders/Médecins Sans Frontières (MSF) in various countries. Recently, she spent two months in Khartoum, Sudan, with MSF’s surgical team at Bashair Teaching Hospital.
By Jessica Comi, MSF nurse

We arrived in Khartoum, Sudan on May 8 and started operating at noon the following day. I was excited because I knew it was, in that moment, the right place to be, and that professionally, I could be useful. But there was also fear about what we were hearing about the situation. We had two days on the road to get to know each other as a team before we arrived at Bashair Teaching Hospital.  

When the conflict started, a lot of hospital staff left, so volunteers had stepped in to restart activities. We received a beautiful welcome because everybody was super happy to have us there, but it would not be easy. There were also challenges with supplies. Plus, we were in the middle of a conflict. There were a lot of different feelings. 

At the same time, we knew the needs. It’s as if something clicks in your head and you say to yourself, “Okay, we have water. Sometimes we will have electricity. Let’s make it work.” 

Teaming up with volunteers from the community 

The first week was incredibly challenging. There were no more than 10 patients in the hospital before we arrived. By the end of June, we had over 58 patients on some days. It seemed like an impossible place to work and, together with the volunteers, we made it possible. That is an amazing feeling. So many people were coming and saying, “I don’t need money, I just want to be working alongside MSF because I know it’s what my community needs.” It was incredible.

After a while, the volunteers really started to trust us and saw how we could grow together. They started to help us manage logistics, for example. We had somebody that was always responsible for the oxygen.  

Sudan crisis response

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There can be a lot of challenges in working with wounded patients. It's really difficult when you aren’t used to doing war surgery. When you are used to doing war surgery, you know the potential risks for a patient if they are not treated immediately—risks like infections or losing a limb or hemorrhage. You need to act quite quickly and it is complex. Experience and expertise make a big difference.  

As the conflict continued and more people heard that Bashair Hospital was open, we started to see more children and women who were able to reach us.   

We tried to never to close the door to any emergency, but we had limitations. And every patient we operated on meant we also needed the capacity to provide post-surgery care. We extended the intensive care unit, but it was challenging to find enough staff to run it properly.  

Preparing for mass casualties  

Every time we heard explosions, we got ready for a mass casualty incident. You never know if it will be 20 or 40 or 100 patients arriving at the same time. The pressure got worse as some of the other hospitals in the city began to close. One day, 127 patients arrived in a short time after a series of explosions. The volunteers sent messages to their networks saying that Bashair Teaching Hospital needed help, and people immediately started arriving to assist.  

We were running two operating theaters, trying to manage the most complex cases in one and those that were a bit less complicated in the second. That day, we were in the operating room until four or five in the morning. In a case like this, all scheduled operations for the day have to be postponed. That has a domino effect. It can take a week before you can get back to your normal activity. 

Living and working on the front lines of a brutal conflict in Khartoum

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Depending on the kind of wound, some patients need multiple surgeries and many days to recover. Some may need longer treatment—weeks or sometimes months. Sometimes we managed to provide them with crutches or other walking aids and tried to teach them how to walk with them, so they could get home and come back for treatments.  

In an ideal world, we would be able to link patients with mental health support, physiotherapy, and other resources to support their rehabilitation. While I was in Khartoum, it was not yet possible. This is what I wish most for this project.  

The most challenging assignment 

I have worked a lot in war zones. My assignment in Sudan has been unique, even compared to my time working in Mosul, Iraq in 2017. The contexts were similar, but in Iraq we didn’t face the same challenges and there were a lot more staff.  

This has probably been my most challenging assignment. But it was also special how the team worked through it all together. You could feel that we were all working for one reason and that was to save lives.  

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

Sudan crisis response