Since Saturday 15 April, intense fighting has been taking place between the Sudanese Armed Forces (SAF - the military forces of the Republic of the Sudan) and the Rapid Support Forces (RSF – a powerful paramilitary group) in the capital Khartoum and other parts of Sudan
Many people, including healthcare workers, are currently trapped and unable to move or reach health facilities due to the intensity of the conflict.
Since Saturday 15 April 2023, intense fighting has been taking place between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) in Khartoum and other parts of Sudan. Many people, including healthcare workers, are currently trapped.
As of 4 May, Médecins Sans Frontières / Doctors Without Borders (MSF), received 4427 wounded people at South Hospital – the hospital we support in El Fasher. There have been 89 deaths.
Hospitals are overstretched, and running out of supplies, water, electricity and fuel for generators.
Staff are exhausted and working non-stop, while off duty medical staff are unable to reach medical facilities due to intense fighting and insecurity.
Some people remain trapped, and others are fleeing to safer areas of the country or across borders. Pressure on hospitals is intense and many face shortages. Some staff are unable to get to the facilities because the fighting is too intense and/or they have been damaged in the fighting. Many people are cut off from medical care at a time when they need it most.
Due to the ongoing violence and fear that they will be risking their safety, many cannot reach any of the small number of health facilities that are still functional and open. However, MSF has been able to donate medical supplies to five health facilities in Khartoum since Sunday 23 April, and we are in contact with hospitals and Sudanese medical associations trying to supply additional hospitals and facilities within the capital – but the fighting is continuing to make this extremely dangerous.
As things stand, the hospital is rapidly running out of medical supplies to treat survivors. It is running out of blood for transfusions. Fuel supplies for the hospital generator are also running low. It’s important to mention that, without those vital supplies, there will be further loss of lives.
MSF supported facilities continue to provide medical care in Kreinik, West Darfur, in Rokero, Central Darfur, in Um Rakuba and Tinedba, Al-Gedaref state and in Damazin in Blue Nile State.
We continue to assess where and how we can scale-up our response to this crisis, while also continuing to provide medical care in several locations and starting new responses where needs are clear and we are able to use capacity and supplies already in the country, and as additional supplies and staff arrive. We remain committed to providing much needed healthcare to people in Sudan, especially during these challenging moments.
In El Fasher, North Darfur, where MSF was supporting the maternity ward in South Hospital, large numbers of wounded people arrived at the hospital seeking treatment. The hospital has had to be repurposed to respond to mass casualty events, and our teams are working round the clock to treat the injured – 427 people have so far made it to the hospital for treatment, which is now the only hospital that is operational in the city.
We continue to provide limited support in some hospitals. In the hospitals supported by MSF in Kreinik, West Darfur, and Rokero, Central Darfur, locally hired MSF staff and MoH staff continue to provide medical assistance. The supplies they have are likely to last for another two to three months.
We have suspended all mobile clinics and outreach activities in West Darfur and Central Darfur. We currently do not have the option to refer patients for higher levels of treatment due to the ongoing fighting, either because hospitals are no longer functional, or roads are too insecure.
The violence that escalated on 20 April in El Geneina, has forced MSF to stop almost all of its activities in West Darfur, including mobile clinic activities in the nomadic communities Galala, Mogshasha, Wadi Rati and Gelchek. We have been able to continue providing services only in Kreinik hospital to date, where we have seen a reduction in the number of patients coming from outside the town.
In Nyala, South Darfur, we experienced the intrusion and looting of supplies in our compound and warehouse, which meant we suspended all our activities.
The majority of MSF coordination and project staff that were based in Khartoum have been relocated to Wad Madani. some staff have left the country and handed over to experienced emergency teams.
Since 23 April, MSF teams have been able to make donations to five health facilities in Khartoum to help them continue functioning and providing medical care. This includes 10 tons of life-saving medical supplies to Jabra Hospital to treat the wounded in Khartoum. An MSF surgical team has arrived in Port Sudan. The team is ready to move immediately to areas of the country where their skills are needed to provide urgent medical care, such as Khartoum.
A team started running mobile clinic activities in Wad Madani on Tuesday 2 May 2023. We distributed hygiene and non-food items to displaced people in Wad Madani, prioritising the most vulnerable who are currently sheltering in public buildings. We are also starting support to Kamlin hospital, which has been designated as referral hospital for patients from Khartoum affected by the violence. These will continue while assessments for additional activities to respond to the health and humanitarian needs of displaced people in this area continue.
In other areas of the country where the situation is calmer, such as Damazin in Blue Nile State, MSF projects have continued. Likewise, in Umm Rakuba and Tinedba, Al-Gedaref state, in the camps for refugees from Ethiopia and for the host communities in East Sudan.
Our regular projects in Jebel Aulia and Omdurman, Khartoum state and in Kassala state have been suspended.
MSF worked in 12 states of the country and ran many different activities before the escalation of violence on 15 April 2023, including primary and secondary healthcare, support to hospitals and other health facilities, mobile clinics, outpatient and inpatient nutrition activities, reproductive and mental health care, vaccination campaigns, health promotion and WASH activities.
MSF supported the Teaching Hospital’s paediatric and nutrition inpatient departments in El Geneina, the capital of West Darfur, as well as enhancing the infection prevention control measures, and water and sanitation services.
In October 2022, MSF teams saw a significant increase in the number of paediatric patients due to malaria and respiratory tract infections. Even though we increased our capacity from 100 beds to 150 to care for the high number of patients, the hospital was overwhelmed.
MSF provided humanitarian assistance and primary and secondary healthcare services, which include mental health services and health promotion activities, to both the internally displaced population and local communities with fixed (until July 2022) and mobile clinics inside and outside of El Geneina city.
In January 2023 we launched a new project in Kreinik town. We rehabilitated the ER, maternity and paediatric ward in the hospital, and we continue to run mobile clinics in nomadic settlements Galala, Mogshasha, Gelchek and Wadi Rati, that otherwise do not have access to healthcare in Kreinik locality and in two communities south of El Geneina city.
In 2020, our team started providing medical services in the mountainous region of Jebel Marra. In Rokero, which is a government-controlled locality, we provided medical services at a state-run health centre (called a ‘rural hospital’). We manage the inpatient department (IPD), the emergency room (ER), the maternity and delivery wards and the observation room. In June, we started an emergency nutrition intervention, running mobile clinics in remote villages to screen, treat, and refer malnourished children to Rokero hospital.
An MSF team was also based in Umo, a locality controlled by a non-state armed group. Until we opened our healthcare facility, the area was cut off from outside assistance for more than ten years. The only means of transport in and out of Umo and many villages is by donkey or camel. There are no roads, and no access for cars or buses. It is a four-hour ride from Rokero to Umo.
MSF teams established and run three primary healthcare centres in the mountainous villages of Kalo Kitting, Dilli and Torong Tonga in South Jebel Marra, treating patients from the conflict-affected communities who have been facing extreme challenges in accessing healthcare or other basic services, some of them for over a decade. Due to the geographical and political isolation of the area, the clinic in Dili and Torong Tonga can only be reached by donkeys and camels as it is the only means of transportation.
In all three clinics, MSF provides general outpatient services, vaccination and nutrition programmes, and child and reproductive health (ANC and PNC), in addition to facilitating referrals of severely ill patients. MSF started also Community Based Health Care programme in two other remote and difficult to access locations (Sulil and Hashaba) and mobile clinic activity in Sulil.
Zamzam camp is one of the largest camps for internally displaced people in Sudan, hosting approximately 120,000 people. Between January and March 2022, the camp’s population rose by 83,000 people, with new arrivals coming from recently affected communities, including from West Darfur.
MSF started its activities in Zamzam camp in August 2022, providing comprehensive primary healthcare services for internally displaced families. These include sexual and reproductive health services, community outreach and health promotion, as well as ambulance referrals.
MSF also supports South Hospital in El Fasher, the capital of North Darfur, where we ran the maternity ward and will soon establish surgical capacity for obstetric emergencies. MSF water and sanitation engineers also worked to improve people’s access to clean water, both in Zamzam camp and the areas surrounding South Hospital.
MSF ran a nutrition programme at Ed Damazine Teaching Hospital for moderate to severe malnourished children under five, including health promotion and infection prevention and control activities. The team also provides capacity building and training to staff of the Ministry of Health in the hospital.
Between July 2022 and early 2023, violent clashes erupted between communities around the towns of Damazin and El Roseires. This led to displacement, and new and more deadly clashes later that year. MSF gave ad hoc support to the MoH to deal with the influx of wounded and provided basic services to groups of IDPs through mobile clinics. Mobile clinics continued to be an important part of the activity of the project, bringing healthcare to people outside of the Ed Damazin.
In Gedaref State, MSF assited Ethiopian refugees in Tinedba camp and local communities near refugee camps by providing basic healthcare and hospital care/specialist medical care, comprehensive support to local healthcare centres, psychological support and reproductive healthcare, treatment for diarrheal diseases, malaria as well as water, sanitation and hygiene support.
Our activities in refugee camps also included nutritional support for children, maternal healthcare and treatment for neglected tropical diseases such as kala azar. An MSF team worked in Tinedba in Um Rakuba refugee camps.
The Um Rakuba refugee camp provided primary, secondary, and emergency medical care, including services for sexual and reproductive health and mental health care. The camp also provided referrals to secondary and tertiary health care facilities in Gedaref, as well as health promotion, advocacy, and emergency preparedness. Additionally, our work in the camp is involved in building water supply and latrines for the refugees and the host community.
MSF team worked along with MoH in Primary Health Care Clinic in Hamdayat, Wedi Sherifay and Amara PHCC assisting Ethiopian, Eritrean refugees and host population. In Hamdayat, MSF provided extended basic health care package to people of the locality, including small number of refugees who stayed in the area after majority of them were resettled to the permanent camps.
MSF provided primary healthcare services in open areas to refugees and host communities in Umbadda locality near Omdurman city. We provided basic health services including sexual and reproductive health (SRH), health promotion and other areas where no assistance has been provided by other actors.
In July 2022, MSF began supporting Al Rasheed primary healthcare centre in the Jebel Aulia area, 40km south of Khartoum. It is an area that is prone to recurrent outbreaks and flooding, and where an estimated 1.6 million residents and South Sudanese refugees struggle to access basic healthcare. MSF teams support comprehensive primary health care services in this facility, including sexual and reproductive health and mental healthcare - as well as ambulance referrals. We also have an emergency preparedness team that works in close collaboration with the Ministry of Health's emergency department to respond to a range of emergencies and disease outbreaks. Additionally, we are working to improve access to clean water in the area, to mitigate against future outbreaks of waterborne diseases.
