Sudan crisis: “A terrible escalation, an emotional decision”

Since the escalation of violence in many parts of Sudan on 15 April, Médecins Sans Frontières / Doctors Without Borders (MSF) teams have continued to provide medical and humanitarian aid in seven states across the country.

In the towns of Rokero and Umo, located in a mountainous region of Central Darfur state called Jebel Marra, the community has already suffered through decades of conflict, neglect and exclusion from essential services. 

Now, amid the ongoing fighting, our remaining medical teams here face very limited options to refer patients for higher levels of treatment – either because hospitals are no longer functional, or because roads are too insecure and getting staff and supplies in remains a concern.

Amid such danger, MSF project coordinator Nkemju Rosevelt, together with some of his Sudanese and international teammates, had to take the difficult decision to evacuate from the project – leaving behind an easier-to-protect skeleton staff.

They undertook a seven-hour drive through insecure terrain from Rokero to El Fasher, the capital of North Darfur, which had recently been much affected by fighting. From there they flew out to Chad and on to Nairobi, Kenya. 

On his way home to Cameroon, Nkemju now reflects on his experiences in the conflict-hit country.

I was in Rokero when the situation changed all over Sudan. We did not really expect this extreme escalation of violence. 

As a project coordinator, along with my team, we had put in place contingency plans to ensure the security of our staff and patients and to be able to assist in times of violence and insecurity. 

But what happened was far beyond what we had anticipated. 

While Rokero remains stable and calm, all the main cities in Darfur, like El Fasher, Nyala, El Geneina, Zalingei, Tawila and Kabila, as well as their surrounding areas, were caught up in heavy fighting, killing hundreds and injuring many more.

It was a tough decision to relocate and evacuate members of our team from the area. Before we arrived, most areas in Jebel Marra had been cut off from healthcare and other essential services for more than a decade, and in some in rebel-controlled areas for almost two decades. 

We left behind a skeleton team of dedicated and experienced Sudanese colleagues, some of whom are from Rokero and others who are from parts of Darfur. 

They continue to do an incredible job, working hard to maintain the hospital in Rokero, healthcare activities in Umo, and working in remote villages through MSF-trained community health workers.

Staying behind

In Rokero, we face the indirect effects of the terrible escalation. Although the area is calm, our team there is still dealing with multiple challenges as a result of the violence. 

Food, medication, as well as fuel to run generators or vehicles aren’t getting in easily. In addition, bringing staff in and out, as well as referring patients in need of surgery is extremely difficult as the road out of town remains dangerous. 

As a project coordinator, it is difficult to deal with such an uncertain and fast-changing situation. We don't know what’s going to happen next, or how best to plan ahead for our team or our patients and the communities we are there to assist. 

So, we had to evacuate our international colleagues, and the Sudanese colleagues who were from other parts of Sudan, while some Sudanese colleagues chose to stay and continue our work. 

In 2020, MSF upgraded the so-called ‘rural hospital’ in Rokero Town to a specialist healthcare facility serving a community of more than 250,000 people. We manage the inpatient department, emergency room, therapeutic feeding centre for malnutrition, as well as the maternity and delivery wards.

Since the violence escalated, our teams continue to assist around 10 deliveries every week and receive up to 15 new admissions per day, including referrals from our community programmes. We can also do emergency referrals to the only still-accessible hospital in Golo Town which has some surgical capacity.

However, the current situation is hard for patients and communities due to the fear of the unknown in an atmosphere of uncertainty. 

At the same time, increasing numbers of people are also arriving in Jebel Marra after fleeing from urban areas like El Fasher, Zalingei and Khartoum. They arrive on commercial trucks with nothing, having escaped extreme violence.

An emotional moment

It was a very difficult decision for us and an emotional moment for the communities, who expressed how they did not want to lose our services altogether. 

People there still remember the pain they went through, when sick and wounded people had to be carried on donkeys for days to Tawila and El Fasher. Many died of preventable conditions due to the long distances they had to travel in search of healthcare. 

Rokero itself has also experienced frequent flare-ups of fighting. In November 2022, when fighting broke out in the town, we treated more than 50 trauma patients.

Jebel Marra has always been fragmented by different rebel or armed groups, but they all committed to overcoming their differences, acknowledging that not having access to healthcare would be more fatal to the community than any violence itself. 

The number of deaths among pregnant women and new mothers is high in Darfur. Some women also lose their babies in the first trimester of their pregnancy because they have to ride donkeys or work extremely hard, tending to both the fields and their children. 

Most people here are farmers, growing sorghum and millet, but years of conflict and the recent violence have frequently disrupted farming activities, leaving families without their crops or with a poor harvest. Most people can barely afford two basic meals a day. 

I remember in July 2022, there was a huge malnutrition crisis. We travelled into the villages in the mountains with mobile clinics to treat children who were in deplorable conditions. We brought the most severely sick children to our therapeutic feeding centre and treated many in the villages.

It has been very emotional and difficult for those of us who left. We wanted to stay, but we could not ensure the safety of the whole team. 

I still speak daily with our Sudanese colleagues in Rokero to understand what is happening. I feel relieved to know that they are doing well and continue their amazing work supporting the communities there.