MSF: Three Years of War Have Shattered Sudan’s Lifelines

The confrontation between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF), along with the allied groups of both parties, has evolved into a systemic dismantling of the essential services people rely on— including healthcare, protection, food security, and basic safety.

In 2025, MSF teams alone treated more than 7,700 patients due to physical violence, including gunshots, provided more than 250,000 emergency consultations and carried out over 4,200 consultations for sexual violence, very often used as a weapon of war, with women bearing the heaviest burden.

Over the same period, more than 15,000 children under five were admitted to our inpatient feeding programs due to suffering acute malnutrition, which is on the rise, compounding the risk of death from otherwise treatable illnesses.

Together, these figures show that beyond the direct casualties of the conflict, the relentless violence is inflicting profound and far‑reaching harm, driving severe health consequences.

A Healthcare System Weakened and Targeted

Throughout the conflict, vaccination programs have been disrupted, and disease-surveillance systems have collapsed, accelerating the spread of diseases and delaying the detection of epidemics. The international humanitarian response — including that of UN agencies, particularly in Darfur — remains far from sufficient to prevent avoidable loss of life. Funding cuts are making an already dire situation even worse, with people once again paying the price: they are dying from preventable causes because Sudanese authorities and the world are failing to come to their aid.

MSF has witnessed recurrent outbreaks of deadly, yet preventable, diseases across Sudan — from measles in Darfur to Hepatitis E in Jazeera state, and cholera in Khartoum or White Nile. In 2025, we treated more than 12,000 patients for measles and nearly 42,200 for cholera. These surges are claiming the lives of the most vulnerable, especially children and pregnant women.

“My baby-girl was born prematurely because the war forced us to flee from Omdurman while I was pregnant,” says Ferdos Salih, mother of a 11-month-old baby suffering from measles and severe acute malnutrition in El Geneina Teaching hospital, in West Darfur. “She has suffered a lot with repeated hospitalisation. Also, because of the war, she couldn't get vaccinated.”

In addition to that, hospitals have been looted, bombed, and occupied. Medical staff have been threatened, detained, or forced to flee. Ambulances have been blocked from reaching the wounded.

Since April 2023, more than 2,000 people have been killed, and 720 injured in 213 attacks to health facilities across the country — in 2025, Sudan accounting for 82% of all global deaths from attacks on healthcare, according to WHO. During that same period, MSF has documented 100 violent incidents targeting its staff, supported facilities, and medical supplies.

As recently as 2 April, an attack on Al Jabalain Hospital, reportedly carried out by the RSF, resulted in 10 fatalities, including seven medical staff, some of whom had previously worked with MSF. Only two weeks before, on March 20, an attack reportedly carried out by the Sudanese Armed Forces on El Daein hospital, East Darfur, resulted in the deaths of 70 people, including 15 children.

Yet, despite constant threats, repeated attacks from both warring parties, and ongoing international indifference, Sudanese volunteers and medical staff continue to show extraordinary dedication, striving to provide care where it is most needed.

“Sudanese authorities continue to make it sometimes impossible for MSF and other humanitarian actors to deliver or scale up lifesaving care — whether by blocking our entry into certain areas or by preventing us from carrying out activities even after we have arrived,” says Amande Bazerolle, MSF Head of Mission in Sudan. “Being prevented from intervening forces MSF into an unacceptable position: unable to respond to avoidable suffering and death despite being ready and willing to do so.”

Today, the vast region of Kordofan - south-central part of the country - is the most volatile and active conflict zone and is feared to be the next site of atrocities as they have happened in the past in other regions, including Darfur, Khartoum or Gezira. It is also one of the least accessible areas for humanitarian organisations, leaving communities even more exposed as violence intensifies.

A Pattern of Unrelenting Violence Against Civilians

In recent months, MSF has observed a disturbing shift in the conduct of the war, including an extensive use of drones by both RSF and SAF. These strikes are increasingly occurring far beyond frontlines, targeting logistical infrastructure and populated civilian areas.

Since February, MSF has treated around 400 people for drone injuries after strikes hit civilian areas in eastern Chad as well as in various areas of Darfur. According to the United Nations, these attacks have killed over 500 civilians from 1 January to 15 March.

“The teams are receiving patients with horrific injuries: patients with transfixing wounds, amputated limbs, devastating burns—many of whom are already dead by the time they reach the hospital, says Muriel Boursier, MSF Emergency Coordinator in Darfur. “The scale of violence and atrocity we witness is unbearable.”

These strikes, carried out in blatant disregard for international humanitarian law, are not consistently directed at military targets. This marks yet another severe deterioration in a conflict where people’s suffering continues to deepen.

A Collective Political Failure

The crisis in Sudan is not only a humanitarian catastrophe — it is also a collective political failure. After three years of what has become the world’s largest humanitarian crisis, the response from governments and international organisations has failed to meet even the most basic expectations.

Repeated warnings of atrocities, including those committed against non-Arab communities in El Fasher by RSF, have led to no meaningful action.

Meanwhile, children, mothers, and others in communities continue to die every day — whether from indiscriminate violence against civilians, including mass killings, starvation, torture, and rape, or from a lack of basic services that the international humanitarian system is supposed to deliver.

Since April 2023, nearly 14 million people have been forced from their homes, and many had to flee multiple times, losing everything. The two warring parties, who previously formed Sudan’s government, are dismantling the country’s capacity to protect, heal, and sustain its own population.

“Now more than ever, protection of civilians, respect for healthcare facilities, accountability for atrocities, and sustained humanitarian access are urgent and non-negotiable”, says Amande Bazerolle. “Three years of war have already cost Sudan immeasurably. Allowing this trajectory to continue risks condemning an entire generation.”

Warring parties and their allies must take immediate, concrete steps to protect civilians. They must be held accountable for the ongoing violations that are inflicting immense suffering on the population.

Influential international actors must urgently exert meaningful diplomatic pressure on those financing, arming, or politically supporting the parties to the conflict. Even though they have so far tragically failed to use their leverage to stop mass atrocities, a window still exists to influence the situation and prevent further crimes.

Silence and inaction are prolonging the suffering of millions.