MSF report highlights catastrophic toll of Sudan’s conflict on health and wellbeing

More than a year of full-blown conflict has had disastrous consequences on the 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 paucity of the international humanitarian response.

This is according to a new report from Doctor Without Borders, also known as Médecins Sans Frontières (MSF).

Titled “A War on People: The Human Cost of Conflict and Violence in Sudan”, the report includes research and interviews with MSF patients and staff detailing how the violence inflicted by the warring parties affected their lives, livelihoods and health.

Fighting in Sudan broke out in April 2023 between the Sudanese Armed Forces (SAF), under the leadership of General Abdel Fattah al-Burhan, and militia groups that fall under General Mohamed Hamdan Dagalo’s Rapid Support Forces (RSF).

The impact of urban warfare

The report details the consequences of widespread fighting in densely populated urban areas. MSF is supporting more than 12 health facilities in conflict-affected areas, including in Omdurman and Khartoum, the sites of high-intensity clashes since the beginning of the war.

“Between May 10 2024 and May 25 2024, MSF medical teams responding to the consequences of the current fighting in El Fasher received 930 casualties in MSF-supported South Hospital, leading to 123 deaths. This includes 160 casualties received on May 10 alone and 130 on May 12. Insecurity meant that most people remained unable to reach any of the few remaining functional medical facilities,” reads the report.

In the MSF-supported Al Nao Hospital in Omdurman, medical teams treated more than 6,776 patients for conflict-related trauma from mid-August 2023 to the end of April 2024, averaging more than 26 patients per day and including 3,607 cases of gunshot wounds (53%), 2,850 cases of shrapnel wounds (42%), and 319 of stabbing wounds (5%).

“At least 399 war-wounded patients have died from their injuries, including women and children. Hospital and staff capacities have been completely overstretched, with our teams reporting more than 100 responses to mass casualty events,” reads the report.

Read more: Sudan on brink of famine as Burhan and Hemedti’s deadly conflict hunger games persist 

In Sudan, there are more than 10.5 million internally displaced people and more than two million people have sought safety and protection in neighbouring countries. Most of the displaced population fled Khartoum, the epicentre of the conflict, followed by a second large wave of displacement from Wad Madani (Al Jazirah state) in December 2023, after the RSF took control of the city.

From Darfur, more than 550,000 people fled to Chad, and more than a million sought safety in other states. As of April 2024, 13% of the population in Sudan was internally displaced.

“In the camps and gathering sites where refugees and displaced populations seek safety, MSF patients recount horrific stories of inhuman treatment and violence perpetrated by armed groups on the civilian population.

“People’s accounts describe systematic cases of forced eviction, looting and arson, degrading interrogation, arbitrary arrest, abduction and torture — all against the backdrop of heightened suspicion around those attempting to flee and reach safer areas,”  read the report.

Health facilities affected

Destruction, looting and the presence of weapons in medical facilities have been a consistent feature of the conflict, making hospitals and healthcare centres unsafe and limiting access to care for patients in conflict zones.

“An estimated 70-80% of hospitals in conflict-affected areas are no longer functional and more than 65% of the population lacks access to healthcare,” reads the report.

MSF teams reported 60 incidents of SAF and RSF violence and attacks on MSF staff, assets and infrastructure — ranging from clashes and looting of medical supplies in hospitals and warehouses, to weapons being fired in the facilities MSF supports.

In early May, MSF teams in Wad Madani shut down operations in the only functioning secondary healthcare facility in the area as they could not operate safely. Also in May, a paediatric hospital in El Fasher, hosting 115 sick and malnourished children, collapsed because of an airstrike by the Sudanese Armed Forces.

Read more: The world turns its back while the noose tightens around Sudan

In June, the MSF-supported South Hospital in El Fasher was completely shut down after the RSF stormed, plundered and fired shots inside the facility.

“People in conflict zones are safe nowhere — neither in their homes nor in the few remaining health facilities and hospitals that have treated the thousands of war-wounded patients injured in bombardments, shelling and crossfire.

“Damage to infrastructure and medical facilities critically hinders access for the sick and wounded to lifesaving care. Violence and insecurity inside hospitals are putting a strain on healthcare and humanitarian workers’ ability to deliver care, with activities frequently reduced or suspended,” reads the report.

Disruptions in chronic treatment 

Pre-existing health issues have been further exacerbated by exposure to violence, displacement and lack of adequate support, food, and protection among the Sudanese population.

MSF also reports large numbers of deaths from renal failure due to a total absence of dialysis services. One dialysis centre in Darfur has indicated that all 200 of its clients are presumed dead due to the disruption of services.

Sexual and gender-based violence is pervasive but critically underreported due to stigma, silence for fear of retaliation, and the void in protection services and confidential spaces conducive to disclosure.

The report notes that due to stigma and security concerns around incidents of sexual and gender-based violence, survivors are often unable to seek care safely. Survivors of, and healthcare providers for, conflict-related sexual violence risk retaliation from armed groups and perpetrators and fear speaking out.

Shrinking protection services and safe spaces have drastically reduced the opportunities for survivors to break the silence. Confidential identification spaces, safe shelters, specialised case management and mental health follow-up remain limited, dysfunctional or non-existent in the areas where MSF operates.

“Data from MSF facilities supporting Sudanese refugees in Chad hint at the widespread use of sexual violence as a form of warfare, particularly targeting women and girls. Between July and December 2023, 135 survivors turned to our teams in Adre (Chad), disclosing cases of rape, abduction, and exploitation perpetrated in Sudan during the conflict. In 90% of cases, perpetrators were armed men,” reads the report.

The report also notes that in Western Darfur, violence has taken an ethnic dimension, targeted against the Masalit tribe, and has included forced displacement, unlawful killing, and other forms of inhuman treatment reportedly by the RSF and affiliated groups.

Deterioration of mental health conditions

The report notes that for many people in Sudan, the psychological wounds of violence and displacement remain untreated, with potential long-term implications on their ability to cope with hardship and heal from trauma.

“MSF teams mention psychological distress, difficulty sleeping, nightmares, flashbacks and other symptoms of post-traumatic stress. Anxiety and mood-related problems amounted to 64% of the main symptoms identified since April 2023 during mental health consultations,” reads the report. 

Another concern is that children have been particularly affected and vulnerable to chronic stress, anxiety and PTSD symptoms in response to certain triggering sounds they associated with the war.

In the report, the MSF called for warring parties to cease attacks on residential neighbourhoods, allow safe passage and routes for people seeking protection and protect vital infrastructure from further destruction and looting.

“Without an immediate end of violence and abuse and a humanitarian response commensurate with needs, people will continue to suffer the unbearable consequences of the conflict on their health, wellbeing and safety,” reads the report. DM

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