Sudan is facing a colossal man-made catastrophe; MSF calls for an urgent, rapid scale-up of the humanitarian response

Port Sudan/Darfur, 12 April 2024 – In one of the world's worst crises for decades, Sudan is facing a colossal, man-made catastrophe one year after the start of the war between the Government-led Sudanese Armed Forces (SAF) and the paramilitary Rapid Support Forces (RSF). It is a matter of life or death for millions of people to urgently enable safe humanitarian access. As governments and officials, aid organisations and donors meet on 15 April in Paris1 to discuss ways to improve the delivery of humanitarian aid, Médecins Sans Frontières (MSF) is making an urgent call for them to immediately scale up the humanitarian response.

Millions of people are at risk, yet the world is turning a blind eye as the warring parties intentionally block humanitarian access and the delivery of aid. The United Nations (UN) and member states must redouble their efforts towards negotiating safe and unhindered access and to scale up the humanitarian response to prevent this already desperate situation from deteriorating any further.

“People in Sudan are suffering immensely as heavy fighting persists —including bombardments, shelling and ground operations in residential urban areas and in villages—, and the health system and basic services have largely collapsed or been damaged by the warring parties. Only 20 to 30 per cent of health facilities remain functional in Sudan, meaning that there is extremely limited availability of health care for people across the country,” says Jean Stowell, MSF head of mission in Sudan.

In areas close to hostilities, MSF teams have treated women, men and children directly injured in the fighting, including shrapnel wounds, blast injuries and gunshot injuries, and from stray bullets. Since April 2023, MSF supported facilities have received more than 22,800 cases of traumatic injuries and performed more than 4,600 surgical interventions, many of them related to the violence which occurred in Khartoum and Darfur. In Wad Madani, a town surrounded by three active frontlines, we see currently 200 patients per month with violence related injuries.

According to the UN, more than eight million people have already been forced to flee their homes and been displaced multiple times, and 25 million – half of the country’s population – are estimated to be in need of humanitarian assistance. “Every day we see patients dying because of violence-related injuries, children perishing due to malnutrition and the lack of vaccines, women with complications after unsafe deliveries, patients who have experienced sexual violence, and people with chronic diseases who cannot access their medicines,” Stowell continues. “Despite all this, there is an extremely disturbing humanitarian void.”

Although MSF works in good cooperation with the Ministry of Health (MoH), the Government of Sudan (GoS) has persistently and deliberately obstructed access to humanitarian aid, especially to areas outside of their control: it has systematically denied travel permits for humanitarian staff and supplies to cross the front lines, restricted the use of border crossings, and established a highly restrictive process for obtaining humanitarian visas.

“Today, our biggest challenge is the scarcity of medical supplies. We've run out of surgical equipment, and we are on the brink of stopping all work unless supplies arrive,” says *Ibrahim , an MSF doctor working in Khartoum, a city that has been under a blockade for the past six months. A similar situation has been impacting the city of Wad Madani since January.

In RSF-controlled areas, where many different militias and armed groups also operate, health facilities and warehouses were frequently looted in the first months of the conflict. Incidents such as carjackings continue on a regular basis and medical workers, particularly from the Ministry of Health, have been harassed and arrested.

In hard-to-reach areas like Darfur, Khartoum or Al Jazirah, MSF often finds itself the sole or one of the few international humanitarian organisations present, while needs far exceed our capacity to respond. Even in more accessible areas such as White Nile, Blue Nile, Kassala and Gedaref states, the overall response is negligible: a drop in the ocean.

One example is the catastrophic malnutrition crisis in Zamzam camp in North Darfur, where there have been no food distributions from WFP since May 2023. Almost a quarter (23 per cent) of children we screened there in a rapid assessment in January were found to be suffering from acute malnutrition – seven percent were severe cases. 40 per cent of pregnant and breastfeeding women were suffering from malnutrition, and there was a devastating mortality rate across the camp of 2.5 deaths per 10,000 people per day.

“The situation in Sudan was already very fragile before the war and it has now become catastrophic. In many of the areas where MSF has started emergency activities, we have not seen the return of the international humanitarian organisations that initially evacuated in April,” says Ozan Agbas, MSF Emergency Operations Manager for Sudan.

Khadija Mohammad Abakkar, who had to flee her home in Zalingei, Central Darfur, in search of safety, recounts how difficult it was to survive without humanitarian assistance: “During the fighting, there was no access to health care or food in the camp. I sold my belongings to earn some money for food.”

While these are difficult conditions in which to operate, the response should have increased, not diminished, especially in the areas where access is possible. Increased efforts are urgently needed by all humanitarian actors and organisations to find solutions to these problems and scale up activities across the country.

“The United Nations and their partners have persisted in self-imposed restrictions on accessing these regions and, as a result, they have not even pre-positioned themselves to intervene or establish teams on the ground when opportunities arise,” Agbas continues.

MSF calls on warring parties to adhere to International Humanitarian Law and the humanitarian resolutions of the Jeddah declaration by putting in place mechanisms to protect civilians and to ensure safe humanitarian access to all areas of Sudan without exception – including stopping blockages. MSF also calls on the UN to show more boldness in the face of this enormous crisis and to focus on clear results related to increasing access so that they actively contribute towards enabling a rapid and massive scale-up of humanitarian assistance. MSF also urges donors to increase funding for the humanitarian response in Sudan.

*Name changed to protect identity

Factbox –MSF medical figures at glance

MSF currently works in and supports more than 30 health facilities in 10 states in Sudan: Khartoum, Al Jazirah, White and Blue Nile, Al Gedaref, West Darfur, North, South and Central Darfur, and Red Sea. Our teams have also recently intervened in Kassala. We run activities in both SAF- and RSF-controlled areas. We provide trauma care, maternal care and treat malnutrition alongside other healthcare services. The needs across the country are massive and largely unmet. Below are just a few medical indicators that illustrate what MSF sees in some of the areas we are able to access and respond in. But we know that this is just the tip of the iceberg:

• Since April 2023, more than half a million people have sought medical consultations at our supported hospitals, health facilities and mobile clinics.
• In hotspots of violence, atrocities have been committed, civilians have been ethnically targeted and killed:
• o An example is that in June, over 1,500 war-wounded Sudanese were received in the MSF-supported hospital in Adré (Chad) in one week.
• o A retrospective mortality survey carried out among refugees confirmed reports of mass killings in West Darfur. o We treated survivors of sexual violence. Between July and December 2023, 135 of the patients who presented to an MSF medical facility in eastern Chad disclosed that they were survivors of rape. All are women or girls, between 14 and 40 years old, and most were attacked before their arrival in Chad. The attackers were armed in 90 percent of cases, and 40% of the survivors were raped by multiple attackers.3
• o · The indirect health consequences of the war have been equally devastating. Between 70 and 80% of hospitals in conflict-affected areas are no longer functioning.
• o Many people have to travel long distances, often amid extreme insecurity, to seek medical care. Patients often arrive late to the health facilities.
• Poor living conditions, lack of access to clean water, lack of vaccinations and lack of access to healthcare combine to create conditions for outbreaks, as happened over the last year, and exacerbate the prevalence of diseases significantly.
• o MSF teams have seen over 100,000 malaria cases, treated more than 2,000 people for cholera and seen many thousands of measles cases. · Pregnant women are particularly affected by the lack of access to healthcare.
• o Over the past year, MSF has assisted more than 8,400 deliveries and performed 1,600 caesarean sections. · Another growing issue is malnutrition. MSF has supported treatment for over 30,000 children with acute malnutrition in a year. · MSF is also responding in Chad and South Sudan where over a million people have taken refuge since the start of the war in Sudan.
• o The needs of the refugees and returnees there are also immense and not sufficiently addressed. In Chad, for instance, there is currently a hepatitis E outbreak.