Sudan crisis response

For more than a year, large parts of Sudan have been experiencing ongoing violence, including intense urban warfare, gunfire, shelling, and airstrikes. The health system, already fragile before the conflict started, is struggling to cope with existing and emerging medical needs while facing overwhelming pressure from the destruction and looting of health facilities, acute shortages of utilities and medical supplies, and under-resourced, unpaid, and overworked personnel. As a result, people face significant challenges accessing medical care throughout the country.

Ethnic violence

The violence has taken on an ethnic dimension in Sudan’s Darfur region, which was devastated by another war in the early 2000s. Refugees who have fled from West Darfur to Chad describe an unbearable spiral of violence, with looting, homes burned, beatings, sexual violence, and massacres, particularly targeting the Masalit ethnic minority.

Displacement

Sudan is experiencing the world’s largest and fastest-growing internal displacement crisis. More than 10 million people—1 in 5 people in the country--are currently internally displaced and over 2 million have crossed the borders to neighboring countries. MSF is providing assistance for Sudanese refugees and returnees in South Sudan and Chad. Half of the internally displaced people are from Darfur, a key hotspot of violence, and a third come from Khartoum, a city that has lost about half its original population of 8 million. Before the start of the current war, Sudan already had over 2 million internally displaced people.

Many displaced people are sheltering in crowded camps established in the aftermath of the 2003 Darfur crisis, with no roof over their head to protect them from rain and the scorching summer heat.

Insufficient humanitarian response

MSF is currently one of the few international organizations working in parts of Sudan that are more heavily impacted by the violence. The UN and other humanitarian organizations are barely visible on the ground beyond the main entry points in the east (Port Sudan) and west (El Geneina). This is partly due to the mounting violence, lawlessness, and access challenges imposed by both parties to the conflict.

Food insecurity and malnutrition

Food insecurity and malnutrition have reached catastrophic levels in parts of Sudan. In March and April 2024, MSF conducted a mass screening of more than 63,000 children under 5 years old, as well as pregnant and breastfeeding women and found a catastrophic and deadly malnutrition crisis in Zamzam camp, North Darfur. Of more than 46,000 children screened, 30 percent were found to have acute malnutrition, including 8 percent with severe acute malnutrition. Similar figures were found among more than 16,000 pregnant and breastfeeding women who were screened: a third were acutely malnourished, including 10 percent with severe acute malnutrition.

Malnutrition will increase even further over the coming months amid the ongoing lean season, and as the rainy season begins, transporting vital supplies will be more challenging.

The UN and other organizations have warned that Sudan could turn into the world’s largest food crisis, and project that a famine could take place in the coming months if there is no immediate scale-up in food delivery and unimpeded access to people in need of aid.

Access to health care

Sudan’s health system was already fragile before this conflict.. Today, artillery attacks, the occupation of hospitals by armed forces, power outages, and shortages of medical supplies and personnel have brought Sudan’s health system to the brink of collapse. In hard-to-reach areas and areas heavily affected by the war, like Khartoum and Darfur, only 20 to 30 percent of health facilities remain functional, and even so, at a minimal level, according to WHO. Active fighting and lack of transportation hinder patients’ ability to reach the health facilities that are functioning. By the time many arrive at a hospital, they are in critical condition; pregnant women often have to give birth at home.

Despite our best efforts, MSF has been forced to close projects that provided critical care in three states due to insecurity and attacks on health care workers and facilities.

Disease outbreaks

Before the current war, Sudan had a high prevalence of non-communicable diseases and faced both seasonal and non-seasonal outbreaks of diseases like measles and cholera. Now, as the ongoing conflict has disrupted essential services such as water supply and the availability of medicine, the health situation has become even more dire.

As people flee to overcrowded camps, the risks of disease outbreaks has risen, especially among children. People with chronic diseases such as diabetes, asthma, and heart disease are facing serious complications due to lack of medicines and lack of access to functional health facilities.

Access to vaccination

Lack of availability and access to vaccinations has left many children unvaccinated, creating a high risk of outbreaks of vaccine-preventable diseases such as measles.

Surgery and emergency care

The war has put intense pressure on hospitals with surgery and emergency departments. MSF teams are seeing war-wounded patients with catastrophic injuries caused by explosions, bullets, and stabbings, and are responding to mass casualty incidents. People injured in road traffic accidents and women in need of emergency cesarean sections also face difficulty accessing care.

Maternal and pediatric care

Pregnant women and children residing in camps, particularly in the western, southern, and eastern regions of the country, are especially vulnerable to health risks due to harsh living conditions and the insufficient humanitarian response. Women often give birth in unsanitary tents or at home, increasing the risk of complications and infections, while access to prenatal care remains insufficient.

At the same time, the need for postnatal and pediatric care is immense. Children under 5 years old, especially newborns and toddlers, have an increased likelihood of contracting diseases and are more vulnerable to complications from malnutrition, malaria, measles, or acute watery diarrhea.

Obstruction of humanitarian access

Throughout the war, but particularly in the last six months, there has been a systematic obstruction of aid, humanitarian access, and supplies. It has been difficult to get visas for humanitarian staff to enter the country and travel permits to move around Sudan. Permits to cross front lines, for example from Port Sudan to RSF-controlled areas, have been repeatedly denied. Attempts have also been made to prevent aid from entering the country across the border, including from Chad and South Sudan.

Mental health

The war and violence continue to have serious mental health implications for people fleeing or stuck in the midst of the fighting. People continue to experience extreme trauma as they lose family members and loved ones; witness and experience violence, including sexual violence; and the deterioration of their own health or the health of loved ones. Many continue to fear for their lives with the continuous heavy fighting, especially in Khartoum, Darfur, and Al Jazirah states.

MSF works in 11 out of 18 states in Sudan with a team of more than 1,400 Sudanese staff and over 230 international staff. Our teams work in or support 21 hospitals; 12 primary health care facilities/clinics and mobile clinic sites; and 15 integrated community case management sites. We also pay incentives to 3,356 Ministry of Health staff.

MSF’s main medical activities in Sudan include:

• Emergency care and surgery, including trauma care for war wounds and non-war related injuries, and cesarean sections
• Maternal and pediatric health care
• Malnutrition screening and in-hospital and at-home treatment for acutely malnourished children and pregnant mothers
• Outpatient care and mobile clinics, including in sites hosting displaced people and refugees
• Routine- and catch-up vaccination campaigns
• Responses to outbreaks of diseases such as cholera and measles
• Donations of medicines and medical supplies to health care facilities
• Incentives, training, and logistical support to Ministry of Health staff
• Water and sanitation activities, including setting up, restoring, and cleaning latrines and water points. 

Chad

Before the current war in Sudan, Chad was already hosting several hundreds of thousands of Sudanese refugees. Since mid-April 2023, nearly 900,000 displaced refugees and returnees have crossed the border to eastern Chad, according to UN data, and hundreds more continue to arrive each day. MSF teams have been supporting refugees, returnees, and host communities in three border regions that have been hosting most new arrivals: Ouaddaï, Wadi Fira, and Sila. 

MSF provides a wide range of medical services in Chad, including primary health care, malnutrition screening and treatment, vaccination, and sexual and reproductive health care. We support existing local health structures, set  up hospitals, clinics, and integrated community case management and referral systems, and run mobile clinics to reach the most vulnerable communities. We also play a key role in large-scale public health initiatives such as vaccination campaigns.

MSF works on improving access to water and sanitation, as communities often struggle to acquire enough clean water, which increases the risk of waterborne disease outbreaks and spread. Over the past year, MSF teams have been digging boreholes, building and connecting water points in camps, providing technical support to other actors, setting up hundreds of latrines, rehabilitating water pumps in host communities, and distributing hundreds of thousands of bars of soap. This intervention, among others, helps decrease the spread of hepatitis E, which is currently an epidemic in the east of the country.

MSF also provides refugee communities with non-food items, such as plastic sheeting, mosquito nets, and soap bars. These items are crucial to prevent additional heath issues, particularly during the rainy season.

Despite our efforts, the humanitarian response in eastern Chad has been hampered by insufficient funding for humanitarian organizations on the ground, leaving critical gaps in the provision of food, shelter, water, and sanitation. 

South Sudan

More than 820,000 people have crossed into South Sudan from Sudan since the conflict erupted in April 2023. While daily arrivals have recently declined to an average of 600 to 700, the influx of refugees and returnees has overwhelmed the already dire humanitarian situation in the country. Many people arrive injured and acutely malnourished, facing an equally desperate situation there, with little food, water, or shelter.

People at transit centers for refugees and returnees are grappling with worsening conditions, including overcrowding and limited access to services. MSF is particularly concerned about the lack of proper water, sanitation, and hygiene facilities in transit centers, which are crucial as cases of acute watery diarrhea are increasingly common. On October 28, the Ministry of Health declared a cholera outbreak in Renk county, one of the main transit centers, caused largely by poor sanitation and overcrowded conditions.

Currently, MSF runs a stabilization center in Joda, Renk county, at the border with Sudan, and provides health care services in facilities in Renk and Bulukat in Upper Nile state. We provide primary care including mental health, vaccinations, treatment for malnutrition, and maternal and child health services, among others. In Abyei Special Administrative Area, the arrival of returnees through Amiet Market entry point has continued to strain the limited resources, especially water and sanitation facilities. 

MSF has been present in Sudan since 1979, witnessing historic changes and escalating needs in response to the rapid shifts in the country’s political and social dynamics, which in turn impact health needs. 

Our intervention began shortly before the Second Sudanese Civil War (1983-2005), which was fought primarily between the north and south of Sudan and was one of Africa's longest civil wars. MSF was actively involved in providing medical care to war-affected communities dealing with massive displacement, famine, and the outbreak of diseases. With the independence of South Sudan in 2011, MSF continued operations in both countries, adapting to the shifting dynamics of conflict and the division of resources. 

When the war broke out in April 2023, many activities were either stopped or shifted to respond to the emerging needs and emergencies across the country. Some activities continued—in Darfur, for example—thanks to the efforts of our locally hired MSF staff, who continued to work despite the extremely difficult personal and environmental circumstances. 

MSF provides medical care to anyone who needs it, regardless of race, religion, or political affiliation. We are calling on all parties to the conflict to ensure the safety of civilians, medical facilities, and personnel. Hospitals must remain a sanctuary for people seeking care.  

To facilitate our humanitarian and medical work, we speak to all parties to the conflict to request safe, rapid, and unimpeded access to civilians who require medical care and to ensure the safety and security of our staff. This is why our independence and impartiality are essential to our work in all the places we operate across the globe. 

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