Sudan: 500 days of war, and a failing humanitarian response
Today marks 500 days since Sudan began enduring its worst humanitarian crisis yet.
This is a shameful moment for international humanitarian organisations who, for over 16 months, have failed to provide an adequate response to the country’s escalating medical needs – from catastrophic child malnutrition to widespread disease outbreaks.
At the same time, heavy restrictions from both warring parties have drastically limited the ability to deliver humanitarian aid says Médecins Sans Frontières / Doctors Without Borders (MSF)
Fighting between the Rapid Support Forces (RSF) and the Sudanese Armed Forces (SAF) started from the capital, Khartoum, on 15 April 2023. It has since raged across multiple parts of the country, triggering an unprecedented humanitarian crisis in Sudan.
The conflict has left tens of thousands of people killed and injured. Between April 2023 and June 2024, MSF treated 11,985 war-wounded at supported hospitals.
At the same time, the violence has created the world’s largest displacement crisis. According to the UN, over 10 million people (or one in five people in Sudan) have been forced to flee their homes, many of them facing repeated displacement.
A malnutrition emergency
As political solutions for the crisis stagger, malnutrition is rising, food prices are increasing, and humanitarian supplies remain limited.
Beyond the catastrophic situation in North Darfur’s Zamzam camp, MSF’s medical feeding centres in other areas of Darfur like El Geneina, Nyala and Rokero are full of patients. It’s the same situation where we operate in the refugee camps of eastern Chad.
Since the onset of the war until June 2024, we have treated 34,751 acutely malnourished children in Sudan.
“Today children are dying of malnutrition across Sudan,” says Tuna Turkmen, MSF Emergency Coordinator in Darfur.
“The help they most urgently need is barely coming and, when it does, it is often blocked.
“In July, for instance, trucks with MSF supplies in two different locations in Darfur were blocked from reaching their destination. Two trucks were held by RSF, and one was seized by unknown armed men.”
“MSF tries to fill some of the gaps. In many places, we work we are the only international organisation operating, but we cannot tackle this huge crisis alone."
The situation is also challenging in east and central Sudan.
“In south Khartoum, MSF has been blocked from bringing medical supplies and international staff to hospitals for many months,” says Claire San Filippo, MSF Emergency Coordinator for Sudan.
“It is becoming increasingly difficult to provide the medical care our patients need, including maternity and emergency care.”
Man-made and natural obstacles
There are many man-made obstacles imposed or tolerated by the warring parties. This includes lawlessness, insecurity, bureaucratic obstacles, and delayed or denied permissions to reach people in need that have significantly slowed down the humanitarian response.
However, now natural impediments are also hampering humanitarian personnel and supplies: the annual rainy season, which exacerbates needs and complicates movements, is at its peak.
Heavy rains have flooded crossing points and washed off critical roads and bridges. With the collapse of the Mornei bridge in West Darfur – the only lifeline route connecting Central and South Darfur with supplies in Chad – millions of people will not be able to receive assistance coming by road.
Added to this, we already see a rise in malaria and water-borne diseases with cholera outbreaks now declared in at least three states.
The threat of vaccine-preventable diseases among children, such as measles, is looming with the war putting immunisation campaigns on hold.
![out-patient department in Batil refugee camp At MSF's out-patient department in Batil refugee camp Gandhi Pant, a nurse, escorts a patient with a possible appendicitis to a waiting ambulance.
Batil is one of three camps in South Sudan’s Upper Nile State sheltering at least 113,000 refugees who have crossed the border from Blue Nile state to escape fighting between the Sudanese Armed Forces and the SPLM-North armed group. Refugees arrive at the camp with harrowing stories of being bombed out of their homes, or having their villages burned. The camps into which they have poured are on a vast floodplain, leaving many tents flooded and refugees vulnerable to disease. Mortality rates in Batil camp are at emergency levels, malnutrition rates are more than five times above emergency thresholds, and diarrhea and malarial cases are rising.](https://media.msf.org/AssetLink/vbx10vidc5x73e38ur4xax3frhu7u425.jpg)
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Attacks against healthcare
Meanwhile, the conflict has put nearly 80 percent of the health facilities in Sudan out of service, according to the World Health Organization. This has crippled an already struggling healthcare system.
In El Fasher alone, MSF-supported facilities have been attacked 12 times since the fighting escalated in the city in May, while only one public hospital remains partially functional with the ability to perform surgery.
Most recently, on 22 August at around 4:40 am, shelling struck the house accommodating part of the MSF team working in El Fasher and Zamzam.
Fortunately, the damage was only material and no one in the house was injured. However, this constitutes the 84th violent incident against MSF staff, vehicles and premises in Sudan since the start of this conflict – a war which has been characterised by a glaring disregard for the protection of civilians, as well as health personnel and facilities.
The situation is not much better in neighbouring countries, where about two million people have sought refuge, often separating from their loved ones along the way.
“My husband has been missing for over a year and I don't know where he is,” says Um Adel, a woman in Metche, a camp in eastern Chad.
“[My son] Khalid was fine until the food started to diminish. After a day or two of not eating well, he developed a high fever. I don't feel comfortable here and the situation is not good, I want to go back to Sudan.”
A call for action
MSF is one of the few international organizations working on both sides of the conflict in Sudan.
We currently run and support medical projects, including healthcare clinics and hospitals across eight of Sudan’s 18 states.
Warring parties, and states with influence over them, must ensure the protection of civilians, healthcare personnel and medical facilities.
Responsible authorities on both sides of the conflict must simplify the processes granting permissions for humanitarian aid through all available routes, across borders, states, and frontlines.
And, the United Nations, relevant agencies and anyone who has the power to help must employ all measures to ensure that available access routes are utilised to their fullest extent.
Sudan: The biggest humanitarian crisis on Earth
“MSF tries to fill some of the gaps,” says Esperanza Santos, MSF Emergency Coordinator in Port Sudan.
“In many places, we work we are the only international organisation operating, but we cannot tackle this huge crisis alone.
“We are also struggling to get supplies and staff to our projects. In tandem with access, securing sustained funding for UN agencies, as well as local organisations and responders, who are carrying the brunt of this response, is also essential.
“A meaningful response with aid reaching people who need it most must start now. There is no more time to waste.”
MSF and the crisis in Sudan
On Saturday 15 April 2023, intense fighting broke out across Sudan with a wave of gunfire, shelling and airstrikes.
The violence between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) has trapped millions of people in the middle of an unexpected conflict. Many have been forced to flee their homes while access to essential services such as healthcare has become increasingly difficult.
Médecins Sans Frontières / Doctors Without Borders (MSF) teams already working in Sudan have been responding to the crisis since its first moments.