Fighting in Sudan has brought health care to its knees, a doctor says

Deadly fighting between rival armies in Sudan that broke out more than a month ago has brought the health care system in the country to its knees amid failure by the two sides to adhere to an agreed ceasefire, a Sudanese doctor said Thursday on the sidelines of the World Health Assembly in Geneva. On April 15, clashes erupted between the Sudanese Armed Forces and the paramilitary group Rapid Support Forces, killing hundreds and forcing more than 1 million people from their homes, according to the International Organization for Migration, with hundreds of thousands fleeing the country, Africa’s third largest. The international community has warned that the conflict’s humanitarian consequences could spill over into neighboring states, exacerbating an already precarious situation in the region that includes a refugee crisis, persistent drought, and hunger. A ceasefire agreement struck over the weekend in Jeddah in talks supported by the American and Saudi governments is struggling to hold, Dr. Ahmed Abbas, a representative of the Sudan Doctors Unions, said. "The conflict is still going on," he said at the Devex Checkup @ WHA76 event. Abbas described a dire situation on the ground. About 70% of hospitals in the capital Khartoum and surrounding areas are "malfunctioning," he said, with 17 hospitals caught up in the fighting or have been raided and occupied by the fighting factions. These include some of the major teaching, academic, and historical hospitals in the country. They also include a major maternity hospital and a public institute lab that houses rare viruses and bacteria. “The medical personnel and the health care workers have been driven out,” Abbas said. “If the specimens within the institute have not been kept safely, there is a real danger of the area to be contaminated. There is a real danger of a spread of endemic diseases not only in Sudan but in the region.” The few hospitals that are open are barely functioning with meager resources amid repeated power and water supply cuts. "One of our friends, an obstetrician, she had to finish an emergency cesarean section under the lights of mobile phones," Abbas said. Hospitals are running short of oxygen, blood, and medication, he went on to say. The volunteers who are working around the clock are only able to provide emergency and basic trauma services under punishing conditions that are taking a toll. "They are exhausted, they are tired, they are depressed, they are overwhelmed. Unfortunately, they cannot be replaced," Abbas said. Ambulances carrying the injured have been ambushed and shot at. "The situation is very dire," he added. "We need to make sure that we give back hope because the fear is a loss of hope. When you lose hope, then your ability to withstand stresses weakens even further." --— Massimo Diana, deputy director, United Nations Population Fund Massimo Diana, a deputy director at the United Nations Population Fund, or UNFPA, who spoke on the same panel, echoed Abbas’ comments and said that 21 hospitals have been attacked over the last few weeks and four since the signing of the Jeddah agreement. The looting of warehouses has also made it challenging to know how much medical supplies are available in the country to meet the urgent demand. The blockade in Port Sudan, an entry point for a majority of aid into the country, has also meant that it has been hard to bring in new supplies. In addition to the injured, the collapsing health system is failing to treat the victims of rape, a growing crisis, Diana said. "If you are already talking about the difficulty of simply performing a caesarian section, imagine providing services … for a survivor of rape," Diana said. Asked what the international community can do to halt the deteriorating situation in Sudan, Abbas said more pressure needs to be applied to both parties to stop the fighting. He was pessimistic, though. "I personally think they are not going to respond, as we are witnessing.” He was also critical of the way donors are distributing the little aid that’s flowing into the country, saying that it was going to the government, which is controlled by the military. "Unfortunately, the aid, it is not reaching those who are needing it,” Abbas said, calling for the aid to go directly to nongovernmental organizations and local civil society outfits. If support fails to come through quickly, the current health situation will worsen, Abbas warned. "The health system at the moment is on its knees, but what we are anticipating is that it's going to be on its face very, very, very soon because the remaining functioning hospitals are running on very meager resources and personnel,” he said. Diana added that with the rainy season coming soon, the danger of floods will create even more havoc. He called out the international community who applauded the 2019 revolution that offered the promise of democratic governance — which has been dashed by the coup in 2021 and now the eruption in violence. "Many voices of support were coming from around the world. I don't recall many other countries that received the same amount of support and the least amount of help. Words of encouragement but followed by little deeds, he said. Almost 60% of the country is in need right now, Diana said, with the revised U.N. plan now at a whopping $2.6 billion. "We need to make sure that we give back hope because the fear is a loss of hope. When you lose hope, then your ability to withstand stresses weakens even further," Diana said.