Sudan: Escalating humanitarian needs for more than half a million newly internally displaced people fleeing violence in Wad Madani
On December 15, the Rapid Support Forces (RSF) launched an attack on Wad Madani, Sudan, and took control of several other cities and areas in Al Jazirah state within days. Since then, more than half a million people have fled the fighting and ensuing insecurity, including about 234,0001 internally displaced people who had previously sought refuge in Wad Madani as violence in Khartoum intensified.
The chaos following the evolving conflict dynamics and the severe insecurity and widespread violence created an environment in which Médecins Sans Frontières/Doctors Without Borders (MSF) could no longer operate in Wad Madani. MSF had to suspend all activities and evacuate its staff from Wad Madani on December 19, leaving behind a population with even less access to basic medical services. We also had to evacuate staff from Damazine, Um Rakuba in Gedaref state, and Doka. In Damazine, we reduced activities.
MSF had been present in Wad Madani since May 2023. Conditions were already dire for the half a million internally displaced people living there, which made up 8 per cent of all internally displaced people in Sudan—already the world’s largest internal displacement crisis, with more than 6 million forced from their homes within the country in addition to more than 1.42 million who have fled across borders. Between May and November, MSF teams performed 18,390 medical consultations (40 per cent of them for children under 15 years old) in several of the hundreds of locations hosting displaced people across the state, some in schools or old public buildings.
“Through its mobile clinics, MSF diagnosed and referred 66 children suffering from severe acute malnutrition with serious complications in the past six months—cases that could be fatal if not treated in a hospital urgently,” says Slaymen Ammar, MSF medical coordinator for Sudan. “But health facilities were overwhelmed. As the population of the city had increased by 30 per cent, there were more and more patients, but considerable supply and staffing challenges. And as prices soared for all goods, access to lifesaving services was an obstacle for both displaced people and regular residents. Nowadays, with the departure of most international organisations—and despite efforts of local volunteer health workers—we can only assume it has worsened.”
During the last month, MSF teams in Gedaref and Kassala states—where MSF has been operational since 2021 in response to the Ethiopian Tigray crisis—witnessed the arrival of thousands of people from Wad Madani3, and are currently assessing and responding to the escalating health and humanitarian needs. In Tanideba (Gedaref), MSF has started a short-term emergency intervention for newly displaced Ethiopian refugees and newly displaced Sudanese citizens covering basic health care, water and sanitation, and food rations. This included one-off distributions and donations. However, it is important to note that activities in Tanideba were temporarily reduced for a short while due to the escalation of conflict in Wad Madani.
The conflict in Sudan has caused immeasurable suffering, displaced millions, killed thousands, and injured countless others. For many displaced people, Gedaref and Kassala are just the latest stops in a long journey to seek safety, during which they have suffered violence and have endured a lack of essential needs such as food, clean water, sanitation, and access to medical care.
“We are originally from Darfur, but because of the violent clashes and the crisis over there, we went to Khartoum. But the war followed us to Khartoum, so we went to Wad Madani. And then, the story continues,” says Salem4 a displaced man who arrived with his family in a gathering site in the Al Mufaza locality, Gedaref, two weeks ago from Wad Madani. Salem’s family fled Khartoum eight months ago, after a shelling hit their house and severely injured one of their children.
“We were six people in the house, and at that time my wife was pregnant. Our house was destroyed. I was hit on my arm, but my child got a much worse injury on his head. We managed to take him to the hospital, because he needed urgent lifesaving surgery. But as soon as he was discharged, we had to flee the city because of insecurity. We arrived in the internally displaced camp in Wad Madani, and she delivered there,” he continues.
In mid-December, he and her family fled once again to Gedaref: “Clashes started, and we started hearing sounds of fires and those armed men fighting again. Immediately, we decided to leave. I started thinking where we should go now. Nowhere was safe at that time.”
In a region where healthcare and essential medicine were already extremely limited, displaced populations are now suffering from growing health demands, stemming from direct and indirect effects of violence. Basic needs are now further escalating and need an urgent response.
"At the gathering sites in Kassala city, displaced people told our teams they haven’t received any assistance since their arrival in mid to late December,” explains Pauline Lenglart, MSF emergency project coordinator in Sudan. “Families are sleeping on the ground, access to healthcare is still severely restricted, there are few working medical facilities, and medicines aren't provided for free. Many people have told us that they are unable to afford items like food and medicine, forcing them to choose between these necessities. The MSF team is constantly evaluating the needs at new sites that are opening to house recently displaced people.4 In all these places, we see that the amount of humanitarian assistance provided is still woefully inadequate to meet people's basic needs and ensure them dignified living conditions."
MSF has worked in Sudan since 1979. We currently work in 9 states in Sudan, including Khartoum city and state, and White Nile, Blue Nile, River Nile, Al Gedaref, West Darfur, North Darfur, Central Darfur, and South Darfur states.
On January 13, as a result of discussions MSF had with the GoS and RSF to assure staff access and the impartiality of our medical mission. An MSF team has returned to Wad Madani to assess the needs and evaluate the feasibility of carrying out activities in the city.
MSF teams in Sudan are treating people injured in the fighting, including blast injuries and gunshot wounds, as well as treating communicable and non-communicable diseases, providing maternal and pediatric care, running mobile clinics in IDP gathering locations and hospitals in refugee camps, providing water and sanitation support, and supporting healthcare facilities through donations. MSF is also continuing the majority of its activities that were in place before the start of the conflict.
MSF Sudan´s emergency response operates with a budget of 76 million euros for 2023 and a team of 1,145 Sudanese staff and 57 international staff in Sudan. MSF is also paying incentives to 1,358 Ministry of Health staff, as well as providing training and logistical support.
1 International Organizaton for Migration (IOM) Displacement Tracking Matrix (DTM) Focused Flash Alert. Jan 8, 2024
2 According to the International Organization for Migration Displacement Tracking Matrix (IOM DTM), and UN refugee agency (UNHCR). Jan 15, 2024
3 64,000 IDPs arrived in Gedaref and 30,000 in Kassala since December 15th, according to the UN.
4 Alias name to protect patients’ identity
Hannah Hoexter