Sudan: "The situation remains extremely difficult"

12 Mar 2024

The city of Khartoum has been the epicentre of the war in Sudan for many months. While part of the city is now experiencing some respite, the situation remains extremely difficult and precarious for the civilian population who continue to live there. 

We take a look at the situation with Jean-Guy Vataux, who recently returned from Sudan, where he was Head of Mission for Médecins Sans Frontières (MSF) in Khartoum.   

Patients at an MSF clinic in Zamzam camp, currently hosting more than 300,000 internally displaced people.

Patients at an MSF clinic in Zamzam camp, currently hosting more than 300,000 internally displaced people. A rapid nutrition and mortality assessment carried out by MSF in Zamzam camp in January 2024 reveals a deadly situation that has unfolded over the past nine months. © Mohamed Zakaria

After several months under the control of the Rapid Support Forces (RSF), what is the state of the Sudanese capital?  

Khartoum is partly a ghost town. Around 20 to 30 per cent of its population remains. The inhabitants fled en masse. However, some returned after the RSF took control of neighbouring Al Jazirah state in December. As a result, in some areas you can see ordinary scenes of life, such as children playing outside and parents going to the market. But the atmosphere remains very tense and extremely anxiety-provoking, even post-apocalyptic. Many buildings have been gutted and looted. There are large numbers of RSF fighters roaming the streets and regularly forming checkpoints.  

So Khartoum remains a city at war. The RSF attacks the government enclaves with artillery on a regular basis, while the Sudanese Armed Forces respond with aerial bombardments. There is still an atmosphere of active war and a very strong fear of both parties to the conflict among the population. For example, some of the staff working at the Turkish Hospital supported by MSF never go outside, not even to run an errand in front of the hospital.  

What are the living conditions like for the civilians who have remained in Khartoum? 

Since the RSF took control of neighbouring Al Jazirah state, the markets in Khartoum have become better supplied with food, particularly fruit and vegetables. But the situation remains extremely difficult for the inhabitants and will likely continue to deteriorate. There is a major economic crisis in Sudan. And not just since the start of the war. For the last five years, the economy has been shrinking and today it's very hard to earn a living in Khartoum. It's an economy that is heavily affected by looting, and eventually there will be nothing left to loot.   

The overall indicators calculated by the United Nations teams for Khartoum state are extremely worrying. Even though we have not been able to verify these through our work, they show that 3.9 million people face high levels of food insecurity in Khartoum state. 

There is also the risk of an epidemic, which could lead to high mortality rates among a population that is particularly vulnerable in terms of nutrition. For the time being, Khartoum has been relatively spared, probably because of the low population density due to the mass departure of inhabitants. The cholera epidemic, which developed mainly in the towns of eastern Sudan, has affected the capital, but at very low rates. Similarly, there have been a few cases of measles, but here too the outbreak has remained extremely limited. Khartoum has not seen any outbreaks of dengue fever either, although there have been major outbreaks in other Sudanese cities. But there is no guarantee that Khartoum will remain unaffected by future epidemic outbreaks. 

3.9 million people face high levels of food insecurity in Khartoum state.

Jean-Guy Vataux
MSF Head of Mission in Khartoum

How does the population access healthcare?  

There are a few hospitals financed and run by the RSF, which do a bit of medical work in the city, but these are mainly for their fighters. A highly specialised cardiac surgery programme, set up by an international NGO, also continues to operate, but it does not meet the needs of a population in a city at war. This leaves only the four hospitals and a primary health care centre supported by MSF.

Even if Khartoum has achieved a degree of stability in terms of security, going to a hospital still represents a major risk. So people delay coming for as long as possible and think twice before crossing the city. The only people who continue to come quickly are those who have suffered trauma, whether from acts of war or accidents.  

At the Turkish Hospital, we saw people taking great risks to come and get the treatment they needed, like crossing the Nile by boat when there were bombings and snipers everywhere.  

How does the Turkish Hospital, where you were based in Khartoum, continue to function? 

The Turkish Hospital is one of the few hospitals where the staff stayed after the war broke out. Today, the teams from the Ministry of Health tell us that if MSF hadn't come to support the hospital, whether by supplying medicines or paying salaries, they would have left the city—and therefore their posts—very quickly. 

The hospital was in a government zone when MSF began its collaboration. It then came under the control of the RSF when they took over the whole of the south of the town, including the hospital area. Despite this, the hospital was relatively spared from the fighting and bombing.   

Since then, activity in the emergency room has been fairly constant, with around a hundred visits a day, mainly for non-war related surgeries, obstetrics and road accidents. From time to time, war surgery is also necessary. During offensives or bombardments, we can treat up to 60 war casualties a day. For the rest of the facility, it is standard hospital activity, with a paediatric ward, a maternity unit, an internal medicine ward and a small outpatient department.  

...some of the staff working at the Turkish Hospital supported by MSF never go outside, not even to run an errand in front of the hospital. 

Jean-Guy Vataux
MSF Head of Mission in Khartoum

What is the impact of the war on health staff? 

The staff who work in the Turkish Hospital are under immense pressure. On the one hand, they are under pressure from the RSF, who are carrying out arbitrary arrests and brutal detentions of the civilian population, including Ministry of Health employees. As Ministry of Health staff are civil servants, the Rapid Support Forces consider that they may be spies in the pay of the Sudanese Armed Forces.  

On the government side, they also face growing suspicion. As the war goes on and civil servants carry out their work in RSF-controlled areas, the government's view of them is that they are now part of the RSF. There have been reports of incidents where civil servants have been arrested and ill-treated at Sudanese Armed Forces checkpoints on their way back to government zones, for example. So they're really between a rock and a hard place. But obviously, the fear is that the pressure will become too great and they will decide to flee abroad or to elsewhere in Sudan. 

How is the hospital supplied with equipment and medicines?  

As with the other health structures supported by MSF, we have had problems at the Turkish Hospital since October when the government decided to blockade the city of Khartoum. At that point, it was no longer possible to transport medical equipment and medicines to RSF-controlled areas from Port Sudan, where the cargo ships arrive.   

So there was a serious shortage for a few weeks, until the RSF took control of Al Jazirah state and in particular the town of Wad Madani where our supplies were stored. From the moment it was taken over by the RSF, we were able to go there and bring most of the medical stocks to Khartoum.  

That said, in two months' time, the shortage problem will arise again.  We probably still won't be able to get the stocks and staff reinforcements through from Port Sudan, which remains under government control. We don't foresee that the government will change its policy. We are therefore in the process of trying to build a supply corridor from Chad.