Khartoum state
MSF supports a diverse range of services provided by different groups and networks of medical volunteers in southern 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.
MSF continues to run surgical and emergency medical activities at Bashair Teaching Hospital in southern Khartoum, working with local volunteers and medics. From May 9 to July 1, MSF teams treated 1,831 emergency room patients, three-quarters of whom needed care for violent trauma including gunshot wounds, blast injuries, and stabbings. Of 674 surgical procedures performed, one in 10 patients was under 15 years old. In July, the emergency room received 1,073 patients and more than 60 percent had experienced violent trauma; during the same time period, MSF’s team performed 587 surgical procedures.
Elsewhere in southern Khartoum, MSF surgical and medical teams are also working in the Turkish Hospital. Originally a pediatric and maternity facility, this hospital has been transformed since the start of the conflict to offer an emergency room and operating theater, with a team that can respond to mass casualty events and carry out lifesaving surgery.
In total, MSF treated 3,855 patients at the Turkish hospital from mid-June to the end of July, and carried out 1,772 emergency room consultations, of which around one-fifth were for war trauma. The majority of injuries have been fractures, lacerations, internal abdominal injuries caused by blunt trauma, and injuries to the head, jaw, and face.
The hospital also continues to care for children: In July, we treated 201 pediatric patients—mainly neonatal cases suffering from sepsis, jaundice, and malnutrition, among other conditions. The hospital also treats patients with chronic diseases, many of whom were transferred there at the beginning of the conflict following the closure of a hospital located close to the frontlines.
In northern Khartoum, MSF provides support to Al Nao hospital to ensure that medical staff can sustain activities and improve patient outcomes. We have provided medicines and supplies, repaired lighting and ventilation systems in the emergency room, and improved the hospital’s water supply and general infection prevention and control measures. The hospital now provides medical care to people 24/7, and MSF provides staff with transportation, meals, and incentives to ensure continuity of services. In June and July, MSF teams at Al Nao hospital provided 1,600 emergency room consultations, of which 830 were trauma cases.
The area has seen intense fighting recently. In the first three weeks of August, the emergency room received 2,509 patients, including 1,249 trauma patients, 749 of whom had been injured in the violence. During the same time period, the hospital also received 1,260 medical cases (non-trauma patients).
In collaboration with the Ministry of Health, MSF began supporting Umdawanban hospital in Khartoum state in June. Our teams are working to enhance essential pediatric, nutrition, and maternity services. Additionally, we provide vital support in energy, water, sanitation, and hygiene services. MSF also purchased a generator for the hospital and is working on its water supply lines, and delivered 11 tons of medical supplies to Umdawanban and Alban Jadeed hospitals in June.
In the first two weeks of our response, there were approximately 80+ pediatrics admissions, of whom 20 percent were newborns; 250 maternity unit admissions; and 107 deliveries. After five weeks of activity, we have recorded approximately 191 pediatric admissions, of which 31 percent were newborns, and 200 normal deliveries.
MSF worked with the Ministry of Health to reopen the primary health care center at Shaheed Wadaatallah, which had been closed due to shortages of drugs and other supplies and a lack of electricity and water. MSF has provided drugs, a generator, and payment for Ministry of Health staff, and continues to provide outpatient consultations including prenatal care, vaccinations, and care for survivors of sexual violence.
We have increased capacity at Umbada hospital by sending MSF teams to work in collaboration with Ministry of Health staff. We currently support the hospital by providing medical supplies and fuel to run its generator, procuring oxygen and food for patients, and paying Ministry of Health staff. In the Umbada locality, we have made donations of drugs and medical supplies, as well as wound treatment and pediatric kits to Al Rahji hospital, which were transferred from our Omdurman stock about 15 kilometers [9.3 miles] away.
Al Saudi hospital closed at the beginning of July when a Ministry of Health staff member was shot and killed on the premises. With MSF's support, Al Nao hospital was able to accommodate its patients and staff. MSF is also providing supplies as well as meals and transport for staff.
In early August, MSF started providing support to the Ministry of Health’s Alban Al Jadeed Hospital in northeastern Khartoum. The hospital is receiving large numbers of war-wounded patients, and staff sometimes sleep at the hospital due to the dangers outside. The hospital had to reduce its activities due to the security situation and lack of medicines, instead focusing on lifesaving care. MSF is supporting staff from the Ministry of Health, many of whom have not been paid for months, as well as local volunteers including medical students working to help their community.
MSF support includes emergency room and general surgical services. We have also set up a pharmacy at the hospital, which was donated to the hospital’s management. We are trying to accommodate patient flows through improving organization and logistical services within the hospital. We also plan to provide support for its pediatric and maternity services.
Al-Jazeera state
In Wad Madani, the capital of Al-Jazeera state, two MSF mobile clinic teams provide health care in five locations for people who have fled the fighting in Khartoum. They also carry out water and sanitation activities, such as constructing and cleaning latrines and providing clean drinking water.
A team is working in Al-Kamlin hospital, training hospital staff, supporting its triage system, and providing fuel, medical supplies, and incentives. An MSF medical team also supports its emergency room, which received 190 patients in June, and its outpatient department. Some of the main issues we see are respiratory tract infections, non-communicable diseases, sanitation needs, and a lack of necessary medical items. Around 40 percent of the area is also experiencing a water shortage, and the team has launched an urgent response to fix toilets.
In August, MSF started to support the Women and Ob-Gyn Hospital in Wad Madani, which is the main maternity referral hospital receiving pregnant women in critical condition. Patient numbers have significantly increased, leading to overcrowding and overstretched staff. MSF is helping the hospital decongest its space and working with its staff to manage patient flow, triage, and identification of critical cases. MSF also supports infection prevention and control services, provides required cleaning materials and training, and helps repair and build latrines and water provision, in addition to donating supplies and furniture to the hospital.
At the Orthopedic Trauma Center in Wad Madani, MSF aids the emergency room and provides technical support to manage the patient flow and triage systems, as well as sterilization, infection prevention and control, water and sanitation, and training.
We have distributed food staples as well as hygiene and non-food items in displacement camps and other gathering sites in Wad Madani, Rufaa, and Elhasahisa.
White Nile state
There are 10 camps hosting South Sudanese refugees and internally displaced people in White Nile state, which were established several years ago. Each day, there are new arrivals, mostly from Khartoum, and many refugees are fleeing to South Sudan as returnees. According to local authorities, about 428,000 people currently live in refugee camps in White Nile state, including 130,000 who have arrived in recent weeks. Another 12,000 are taking shelter in a displacement camp where MSF works.
In Kwor Ajwal, Al Alagaya, and Um Sangoor, MSF supports three primary health care centers and two treatment centers for measles. Over 2,500 people have been treated for measles, and many patients are presenting with malnutrition symptoms. In July, the outpatient team conducted 16,662 consultations for malaria, diarrhea, and lower respiratory tract infections. Additionally, MSF has provided prenatal care to 838 expecting mothers as well as water and sanitation support.
In July, MSF started supporting the inpatient therapeutic feeding center at the hospital in Al Kashafa refugee camp, where 50 malnourished children have been admitted. The center also provides malnutrition care to children referred from other refugee camps. We are seeing high numbers of children with severe acute malnutrition in both Um Sangour and Alagaya, often with suspected measles co-infection.
Blue Nile state
MSF teams have run two mobile clinics that provide prenatal and measles care, in two villages and two days per week. The mobile clinic teams conduct between 150 and 200 consultations per day, including an average of 20 prenatal care consultations and 20 suspected measles cases daily.
The nutrition ward MSF runs in Ad-Damazine teaching hospital continues to admit rising numbers of malnourished children, linked with the seasonal malnutrition peak. MSF has added additional wards under tents to increase its capacity from 40 to 75 beds. Between April 15 and July 1, 80 malnourished children were admitted to the outreach-based therapeutic feeding program and 420 were admitted for treatment at the hospital.
We also provided 1,141 consultations at primary health care centers, including 695 consultations for children under five years old.
River Nile state
Existing health care services in the area are under significant pressure. Currently, only one other nongovernmental organization 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.
MSF has donated hygiene materials and additional beds to Shendi University Hospital and has implemented training for infection prevention and control. Since May, MSF has provided medication 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 also distributed to people in the camps.
Red Sea state
Mobile clinic teams in Red Sea state conducted 733 outpatient consultations in July alone. In Port Sudan, the capital of Red Sea state, MSF started implementing water, sanitation, and hygiene (WASH) activities in camps for displaced people and other gathering sites. Our activities include cleaning latrines, trucking water, distributing hygiene items, and training local health care workers on mass casualty protocol and emergency triage.
Al-Gedaref state
In Tanideba camp, MSF runs a hospital for refugees and host communities. The facility offers outpatient services for various medical conditions, including noncommunicable diseases, Kala-azar, emergency care, maternity services, and mental health support. 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. We are also mapping the activities of other health care actors in the camp to help us streamline activities.
From May to the end of July, MSF teams at Tanideba camp admitted 12,000+ outpatients, 450+ inpatients, and 380 maternity patients. We also performed 2,250+ emergency room consultations and delivered 240 babies during the same period. In July, there were 5,400 outpatient consultations, 122 maternity admissions, 86 inpatient admissions, and 64 admissions to the inpatient therapeutic feeding center (ITFC). In the first three weeks of August, there were 4,337 outpatient consultations, 117 maternity admissions, 105 inpatient admissions, and 52 admissions to the ITFC.
In Um Rakuba camp, MSF is responding to support the refugees and host communities. The camp has remained quiet, with no conflicts or incidents that have disrupted activities. However, there has been an influx of displaced people from Khartoum to Al-Gedaref state, as well as refugees returning to the camp. Over the past month, approximately 850 new refugees from Khartoum have arrived at Um Rakuba. The top reported morbidities were acute diarrhea, skin and soft tissue conditions, and hypertension. The onset of the rainy season has posed challenges in the camp. Strong winds in June damaged refugee shelters and destroyed some service centers.
From April to July, MSF teams conducted about 6,700 outpatient consultations. Additionally, there were around 64 deliveries in our facility. The top 10 reported morbidities were acute diarrhea, skin and soft tissue conditions, and hypertension. A total of 209 individual mental health sessions were provided.
In June, MSF made two donations of medical supplies to the Ministry of Health in Al-Gedaref state to support the provision of medical care to people in need.
West Darfur state
The MSF-supported El Geneina Teaching Hospital in West Darfur was looted during the violence on April 26. MSF has supported the Ministry of Health in the pediatric department, providing emergency and inpatient care. The hospital has been closed due to the violence, making it impossible for our teams to continue working on pediatrics or in the neonatology and maternity departments.
Activities at the hospital supported by MSF in Kreinik and mobile clinics were suspended. MSF is trying to step up support to re-open the health facility in Kreinik and re-activate the mobile clinics to offer medical assistance to nomadic communities in West Darfur. The biggest challenge is that supplies usually come from El Geneina, where intense fighting and violence continue.
North Darfur state
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. Now it is the main referral hospital for the whole of North Darfur state, which has a population of more than 2.8 million people.
Over the past three months, the hospital has treated more than 1,000 war-wounded patients with injuries including second- and third-degree burns, brain injuries, spinal cord injuries, paralysis, post-traumatic stress disorder (PTSD), limb loss, nerve damage, and fractures. MSF also carries out emergency obstetric surgery in this hospital, as well as normal deliveries. There were 235 prenatal patients from April 15 to July 1.
MSF is also now supporting 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. MSF was then requested to rehabilitate the space and improve the quality of care. We have been supporting the hospital since August 1.
We continue to run a clinic in ZamZam camp, where around 120,000 people displaced by previous conflicts are sheltering. The MSF clinic sees around 200 patients each day.
Central Darfur state
In Rokero hospital, MSF built new wards and recently moved the inpatient department, ER, ITFC, observation room, and pediatric, maternity and delivery wards. In addition, our team also supports Umo primary health care center. In July, the MSF team saw a steep increase in the number of malnourished children, admitting 112 children in July—51 percent more than in June.
Typically, August to October is when we see high rates of malnutrition in this part of Sudan, but this year the increase is happening earlier. There is a lack of food due to the security situation, and many other organizations in the area are out of stock of medical supplies. There hasn’t been a food distribution in the area since April, again due to a lack of stock. Also in July, the hospital’s ER saw 685 patients, 103 pregnant women were admitted to the maternity department, 36 children were admitted to the pediatric department, 56 adults were admitted to inpatient care, and three patients received treatment for sexual and gender-based violence.
Tens of thousands of people who fled fighting in Zalingei continue to arrive in remote North Jebel Marra, a locality with extremely limited access to health care. We donated fuel and cleaning materials, and built the ER; pediatric, maternity, and delivery wards; observation room; and the inpatient therapeutic feeding center.
At Umo primary health center in Central Darfur, we screened over 2,000 children for malnutrition in July, finding 13.4 percent were moderately acutely malnourished and 8.3 percent were severely acutely malnourished. Although screenings took place in the primary health care center and thus were only conducted for children who were already sick, these levels are alarming and demonstrate the need for organizations focused on food distribution to increase their efforts.
From April 15 to July 1, MSF teams in Central Darfur received 1,800 emergency room cases and conducted 2,258 outpatient consultations, treated 150 patients with severe malnutrition and admitted 76 malnourished children to MSF's nutrition program.
In Zalingei, the capital of Central Darfur state, MSF donated fuel and cleaning materials to the Zalingei Teaching Hospital to run generators and ambulances. MSF also donated medical supplies to Ed Daein Teaching Hospital in East Darfur in July.
South Darfur state
Since March 2021, MSF has run 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 for as long as 10 hours by donkey to reach the clinic. The team was able to reopen a clinic in Kalokitting at the end of July and has been able to maintain primary health care services throughout the recent period of fighting in Kas and Nyala, because the clinics are located farther away in the mountains and are not directly affected. However, some of our staff are still in Nyala and have been unable to join the teams in the mountains.
In the first three weeks of August the team carried out 2,041 outpatient consultations, treated 161 severely acute malnourished children, and managed two deliveries. Donations have been provided to the Emergency Pediatric hospital in Nyala, and to the hospital in Fora Bonga.
Patient numbers have consistently increased over the past three weeks, as patients are coming from other areas including Kas, Dilli, and Torung Tonga due to a lack of services. Numbers are expected to increase as information about resumption of MSF activities spreads and other organizations suspend services. Malnutrition rates are high, possibly due to high rates of children presenting with diarrhea, which is the leading cause of weight loss. Monitoring will continue in the coming weeks.
Previously, an MSF compound and warehouse were looted in Nyala. Equipment, vehicles, and medical supplies were taken. The MSF team in South Darfur was unable to continue providing health care services without supplies and was evacuated to South Sudan.
2022
In 2022, humanitarian needs reached their highest levels in a decade amid conflict, erratic rainfall, flooding, food insecurity, funding cuts, and an ongoing political and economic crisis.
There was a surge in fighting between fragmented armed groups in Darfur, Kordofan and Blue Nile states, causing further displacement.
We worked in four states in Darfur, mostly in hard-to-reach communities otherwise cut off from assistance, including in the Jebel Marra region, providing care through hospitals, mobile and fixed clinics. Services include general, specialist, emergency, and reproductive health care, nutrition support for children, health promotion, and vaccination campaigns.
In Blue Nile state, we run a therapeutic feeding program for malnourished children and support rural health clinics offering basic health care. We conduct mobile clinics and water and sanitation activities at sites where displaced families reside following waves of violent clashes.
Our teams in Khartoum and Omdurman continued to provide general health care and emergency services for refugees, displaced people, and host communities.
In early 2022, during protests, we supported seven Ministry of Health ambulances, donated supplies, and trained eight hospitals in mass casualty management. In January, nine MSF staff were detained briefly in Khartoum, and health facility raids were common. In December, we concluded our support to Mygoma orphanage in Khartoum and handed activities over to the Ministry of Social Development and the Ministry of Health.
In Al-Gedaref and Kassala states, we assisted Ethiopian refugees and local communities by offering basic health and reproductive care, nutrition support for children, and treatment for neglected tropical diseases.
From June to September, heavy rains caused widespread flooding. Partnering with local communities, MSF responded across four states, providing drinking water and essential items, along with sanitation and hygiene services.
