Sudan’s “war on people” must end now

Over the past two months, MSF-supported health facilities have been repeatedly attacked and targeted. We were forced to suspend operations in Wad Madani, in southeastern Sudan, and recently in the Turkish Hospital in Khartoum, the capital. Since May, MSF-supported hospitals or premises have been hit by shelling or airstrikes at least five times in Omdurman, Khartoum, and El Fasher, leading to the deaths of health workers and patients, including children. Hospitals in which we work in El Fasher and in Khartoum were also stormed and attacked. 

In conflict areas in Khartoum and across Darfur region, we support some of the few remaining hospitals and emergency wards functioning in Sudan. Our teams treat thousands of war-wounded patients in locations surrounded by violence, large-scale bombing, and shelling. In these areas, homes, health facilities and essential infrastructure have been hit, destroyed, and made inoperable. 

Between August 15, 2023, and April 30, 2024, the Al Nao Hospital in Omdurman—one of the eight facilities MSF is or has supported in Khartoum state—admitted a total of 6,776 war-wounded patients. This is an average of 26 war-wounded patients admitted per day. Just over half of these patients had gunshot wounds, 42 percent had shrapnel wounds, and 5 percent had been stabbed. At least 399 people died from their injuries. 

One MSF patient from Nyala, Darfur, told us in March 2024, “The men were armed with guns and dressed in RSF camouflage/military uniform. When I turned to walk back into my house, one of the armed men stabbed me in the back and another soldier hit me on the back of the head very hard……and I fell to the ground. The soldiers broke into my house and took some clothes and personal belongings.”

Women and children have not been spared. In March this year, women and children comprised almost 30 percent of the 624 war-wounded [patients] treated at Al Nao Hospital in that month. In the 11 months between May 2023 and April 2024, MSF teams in Bashair Teaching Hospital in Khartoum treated 4,393 patients who had trauma-related injuries. This corresponds to just over 4 in 10 emergency department consultations our teams provided during this period. 

Despite the health system struggling to adequately meet people’s needs, humanitarian and medical organizations have frequently been blocked from providing support. Although authorities have begun issuing visas for humanitarian staff more readily, attempts to provide essential medical care are still regularly impeded through bureaucratic blockages. These include refusals to issue travel permits to allow the passage of people and essential supplies. The violence of the warring parties is compounded by obstructions: by blocking or interfering services when people need them most, the withholding of stamps and signatures can be just as deadly as firing bullets and bombs.

Across Sudan, people’s access to lifesaving care has been drastically affected. Not only are humanitarian and medical workers blocked from providing lifesaving services, but hospitals have been routinely looted and attacked throughout the war. In April, the UN Office for the Coordination of Humanitarian Affairs estimated that 70 to 80 percent of hospitals in conflict-affected areas were no longer functional. 
 

Some of the attacks that we have documented include the MSF-supported Al Nao Hospital in Omdurman having been shelled on [three] separate occasions, most recently about a month ago, on June 19.

In July 2023, a health care worker of the MSF-supported Al-Saudi Maternity Hospital was fatally shot inside the maternity ward, leading the facility to close and relocate to another MSF-supported facility. 

In May this year, an airstrike killed two children after the intensive care unit roof collapsed at the MSF-supported Baker Nahar Pediatric Hospital in El Fasher. The hospital was forced to close.

The list of attacks on health facilities goes on and on. We have documented at least 60 incidents of violence and attacks by the Sudanese Armed Forces and the Rapid Support Forces on MSF staff, properties, and infrastructure.

Attacks on our colleagues, fellow humanitarian workers, and health facilities are completely unacceptable. But we know the violence that we have suffered pales in comparison to the violence endured by the people as a whole. 

The conflict has forced millions to flee home. In the camps and gathering sites where refugees from the region and displaced people seek safety, patients recount horrific stories of inhumane treatment and violence perpetrated by armed groups on them. People’s accounts describe forced eviction, looting and arson, degrading interrogation, arbitrary arrest, abduction, and torture on a systematic level. 

Sexual and gender-based violence is pervasive but critically underreported due to stigma, silence for fear of retaliation, and the void of protection services and confidential spaces to disclose violence. Data from MSF facilities supporting Sudanese refugees in Chad hint at the widespread use of sexual violence as a feature of the conflict, particularly targeting women and girls. Between July and December 2023, 135 survivors in Adre, on the Chadian side of the border with Sudan,  disclosed to our teams instances of rape, abduction, and exploitation in Sudan during the conflict. In 90 percent of cases, perpetrators were armed men.

The report also details targeted ethnic violence against people in Darfur. A retrospective mortality survey conducted by MSF between August and September 2023, in three Sudanese refugee camps in Chad, showed a significant increase in mortality in Sudan since the start of the conflict. Responses from refugees housed in Ourang camp, who come mainly from El Geneina in Sudan, indicated that their families have lost the greatest number of family members. Reports from people surveyed in Ourang suggest as much as a 20-fold increase in mortality rates in Sudan from April 2023, with a peak in June of that year, compared to pre-war rates.

This data corresponds with testimonies people shared with MSF in Nyala, South Darfur, describing events in mid-2023. People told us Rapid Support Forces and aligned militia went house to house, looting, beating, and killing people, targeting Masalit and other people of non-Arab ethnicities. 
 

Ethnic violence and sexual and gender-based violence must never happen. MSF calls on warring parties to stop all targeted forms of violence and abuse against the people of Sudan. 

The existing conflict is having a disastrous effect on the lives, health and wellbeing of people in Sudan. The physical and mental wounds of violence have been exacerbated by the collapse of the health system and the scant international humanitarian response. MSF teams continue to treat people dying from preventable causes because patients were unable to reach facilities earlier or afford medicine, if available. Our mental health teams are seeing the tremendous toll of conflict and violence on people’s mental health and psychological wellbeing. Trauma-related symptoms are widespread, and some patients are moved to self-harm. 

MSF continues to respond to urgent medical needs and the consequences of ongoing violence, further exacerbated by the lack of humanitarian access and the warring parties’ blatant disregard for human life and international humanitarian law. Today, we reemphasize our calls on all warring parties to ensure the protection of civilians and humanitarian workers, and to allow the wounded and sick access to health care. We call on the warring parties in Sudan to abide by their obligations regarding the protection of civilians, and we also call on international aid organizations and donor governments to ensure that aid is delivered to all those in need and to urgently increase the humanitarian response where needed.

This war on people highlighted in our report provides a glimpse on the humanitarian situation across eight states in Sudan where we work, and where our teams witness these crises. People in Sudan continue to be the victims of both the direct and indirect consequences of this deadly and destructive conflict. After 14 months of war, the different warring parties are hampering the response, leaving people unable to access lifesaving assistance and protection, severely compromising access to quality, affordable health care, and blocking vitally needed aid. 

This must end now.”