Sudan: Dire conditions for vulnerable fleeing violence

“They came with their machineguns,” says Mariam*, 40, who reached Tawila three days after the offensive. “They attacked and killed people—including children. They burnt our house, with everything we had inside. They raped the women. They looted.” Even before the attack, she adds, people had died of thirst and of starvation because of the siege imposed on Zamzam for the past year. “Everything was so expensive in the end.”

Mariam arrived with her mother, her sisters and their own children. They now spend their days squeezed against each other under a few branches and a piece of fabric, sharing the little shade it provides. Food is also in short supply. “A few people in Tawila shared a bit of millet flour with us, which we used to make porridge,” says Mariam. “This is how we have survived so far: begging. We get water from a tank, but they only let us fill one jerrycan per family, and we are 20 in ours. We only have one blanket for all of us.”

Since people like Miriam first began reaching Tawila, makeshift shelters have transformed previously uninhabited fields surrounding the city.

Ibrahim*, 42, and 11 members of his family are staying under a tree “with nothing: no walls, no roof. It is so crowded, we’re lacking water . . . [and] everyone is hungry.” They sometimes get rice from the community kitchens, “but if we don’t, we must wait until the next day to eat. For water, we go to a borehole, but there are so many people we wait hours to drink.”

This is the fourth time in 10 years Ibrahim has been displaced. He fled Zamzam on foot, carrying one child on his shoulders and another on his back. He describes how soldiers entered people’s homes, brought them outside and opened fire. Three of his brothers were killed. A victim of looting on his way to Tawila, Ibrahim witnessed people being beaten so harshly they could no longer move.

A handful of organisations are operating in Tawila, but the number of people who need assistance far exceeds the capacity to respond. Two health posts set up by MSF teams on the main arrival sites provide water and medical and nutritional support and refer critical patients to the local hospital, which MSF has supported since October 2024.

An influx of critical patients on 12 April overwhelmed the emergency room, says MSF’s head nurse, Tiphaine Salmon. “Over the first few days, the number of patients almost doubled. At one point, we had four in a bed. A lot had gunshot wounds and blast injuries.” The teams have treated 779 patients, including 138 children, over the past three weeks. The youngest, “a seven-month-old baby with a bullet wound that went under his chin and into his shoulder,” says Salmon. “We also received patients as young as one day old suffering from dehydration. Many children arrived without their parents, and many parents were searching desperately for their children.”

The teams also witnessed an influx of admissions in the intensive therapeutical feeding centre, which treats children under five years of age suffering from severe acute malnutrition. In the following week, admissions increased almost tenfold, to more than 60 per week. Most were children from Zamzam.

Adding to the pressure on the hospital, a suspected measles outbreak in Tawila. MSF has treated more than 900 suspected cases since early February, with more than 300 in such a severe condition the patient required hospitalisation. So, the teams launched a large-scale vaccination campaign in the first week of April, reaching 18,000 children under five years of age.

Malnutrition and measles, in sites with a high density of people in low hygiene conditions, can be a deadly combination, particularly for children.

MSF is scaling up its intervention in Tawila. It has donated dry food to community kitchens, enabling them to prepare and distribute more than 16,000 meals each day, and provided 100,000 litres of clean water each day. And it has plans to build 300 latrines.

Although other organisations have also mobilised, and a first mass food distribution has taken place, the humanitarian needs remain immense and far outstrip MSF’s capacity to respond.

* We have changed the names of displaced people in this story.