Sudan's forgotten camp: where humanitarian organisations all but disappear
Across Sudan, the word “severe” has become the norm. Healthcare, nutrition, clean water, and the basics of survival are in short supply in many areas. And as needs become more extreme, local crises must reach near-catastrophic levels just to attract attention and unlock emergency funding.
Um Rakuba refugee camp in eastern Sudan has not yet reached catastrophic threshold. But many of the warning signs are already there.
Walk through the hospital in the camp and the common sound you hear most is the crying of newborn babies being delivered or treated for malaria, malnutrition, and other medical emergencies. It is a sound that cuts through everything else.
Um Rakuba has hosted Ethiopian refugees since 2020, when conflict erupted in Ethiopia’s Tigray region. The camp hosts about 17,000 refugees, most of them women and children.
MSF has been present since the beginning of the response, supporting the camp hospital and providing emergency medical care. When Sudan’s own war erupted in 2023, the hospital became far more than a refugee health facility. Today, about 80 per cent of consultations are for people in Sudanese host communities, drawn from a surrounding population of around 100,000 people.
“I came here because three or four hospitals in our area have closed,” says Manasak, a Sudanese woman seeking care for both her aunt and her child in the camp hospital. “Where else should we go? We need more support, and not only for Sudanese communities, but also for refugees.”
One by one, the NGOs left
At the height of the Ethiopian refugee response in 2021, around 35 national and international organisations were operating in and around Um Rakuba camp. Today, fewer than 10 remain.
Many relied heavily on UNHCR funding. As donor budgets to the humanitarian sector shrank, services followed suit.
The consequences are visible across every sector. Community leaders regularly tell MSF teams about deteriorating access to primary healthcare, protection services, water and sanitation, food assistance, and education.
“Our health promotion teams consistently hear concerns about the decline in essential services,” says Zelie Antier, MSF project coordinator of the camp hospital. “Communities continue to place strong trust in MSF, but they are asking for greater advocacy to address growing gaps. Local organisations supporting women and children often lack the resources to meet increasing needs.”
The impact extends far beyond healthcare. Protection referral pathways for the refugees have weakened, particularly for women and children, including unaccompanied minors. Water and sanitation shortfalls affect both the community and our hospital. Refugees report reductions in food assistance, while treatment interruptions at primary healthcare facilities are leading to more severe medical complications by the time patients reach MSF.
The absence of humanitarian organisations is leaving communities with fewer options at a time when needs continue to grow.
A war over resources
El-Gedaref state is not a frontline in the traditional sense. Yet the state has borne a heavy burden since Sudan’s war began.
In 2024, more than one million Sudanese people were displaced from areas that witnessed harsh fighting, such as Khartoum, Sennar, and Al Jazirah , placing enormous pressure on already limited services. At the same time, cholera outbreaks stretched local health systems to their limits.
For many people, the crisis has become a war over resources.
Dr Tanya Hajj Hassan, an MSF paediatrician who visited El-Gedaref nearly a year ago, recalls driving through fertile green fields on her way to the hospital.
“Sudan was once called the food basket of the area,” she says. “Yet every day we were treating children with severe acute malnutrition. I have never seen this level of despair in my career.”
What struck her most was the loss of hope among many mothers.
“The first time I observed it was when a mother brought her child to the emergency department in a very critical condition,” she recalls. “While we were resuscitating the child, she asked if she could leave. We explained that the child might die, and she simply accepted it. I think that reflects how tragically normalized child deaths have become in Sudan.”
We cannot stand alone
Almost a year after Dr Tanya’s visit, many of the same challenges remain in the camp.
Food assistance remains insufficient. Refugees currently receive about 4 kg of wheat per person per month, dropping to around 2.5 kg in some months — compared to around 14 kg in early 2023, before the war in Sudan broke out in April.
Additionally, there are not enough latrines, and shelter remains inadequate. Protection concerns continue to grow. The funding cut continues to affect water and sanitation services, shelter, protection activities, and primary healthcare.
MSF remains the only provider of secondary healthcare and comprehensive services for sexual and gender-based violence in the camp. Access to HIV, TB, and neglected tropical disease care remains severely constrained, while recurrent outbreaks of cholera, measles, malaria, and meningitis continue to threaten vulnerable communities.
“Across sectors from healthcare and protection to water, sanitation, food, and education, people are telling us they feel increasingly abandoned,” says Mohamed Ahmed, MSF head of mission. “Without increased funding and a stronger humanitarian presence, people will continue to face preventable suffering. MSF alone cannot meet these needs.”
MSF had already raised the alarm in El-Gedaref, warning humanitarian organisations and UN agencies about the deterioration of living conditions and essential services in and around Um Rakuba camp. Yet, despite the warning signs and growing needs, no clear plan to scale up assistance has materialized.
Sudanese local organisations continue to provide vital support, often with extremely limited resources. Their contribution is essential, but they cannot replace a fully funded humanitarian response.
“Our appeal to donors and humanitarian organisations is to match words with action,” Ahmed says. “Communities cannot survive on promises. We need stronger protection services, restored primary healthcare, and greater investment in essential services. Refugees must not be forgotten within the broader Sudan crisis.”
The people of Um Rakuba are not asking for sympathy. They are asking for the minimum every human being deserves: healthcare, protection, and the chance to live with dignity.
The cries of newborns still fill Um Rakuba's hospital wards. Mothers who are refugees and members of the host community continue to arrive seeking care.
The question is not whether the needs exist. The question is whether anyone is still willing to respond.