Conflict in Sudan

In Bashair Teaching Hospital in south Khartoum, MSF has been working, alongside volunteers and MoH staff since May 2023. The hospital has an emergency department, maternal care including c-sections, and surgical care.

Since June 2023, MSF has been supporting Umdawanban Teaching Hospital in Sharg-en-Nile, focusing on the high paediatric needs and the maternity department. Similarly, Albanjadeed Tertiary Hospital in Khartoum East has been receiving support from MSF since July 2023, primarily for the emergency room department, to provide free and quality emergency health care. 

Al Nao Hospital, the largest functioning public hospital remaining in Omdurman, receives a high number of war-wounded and medical emergency cases daily. MSF supports this hospital with donations of essential drugs and medical supplies, incentives for staff, technical support for logistic, water and sanitation as well as food for patients. The support is focused on the emergency room, the 24/7 observation ward, and the operation theatre.

Since May 2023, MSF has been supporting Al Saudi Hospital, the last functioning maternity hospital in Omdurman, with essential drugs and supplies, technical support and logistics, and water and sanitation support. MSF also provides incentives to MOH staff. MSF’s main focus in the hospital is on improving access for survivors of sexual and gender-based violence.

MSF has also been supporting Al Buluk Paediatric Hospital, with ad-hoc donations of essential drugs and medical supplies, technical support for logistic, water and sanitation, and food for patients. The focus of MSF support is inpatient management of patients with malnutrition complications. Since August 2024 the hospital has seen a huge surge in cases of severe malnutrition and in response, MSF has increased their support by providing more technical support to medical staff; providing protection rations to discharged patients; and covering the costs of admission files.

In September/October 2024, MSF partnered with the Khartoum state Ministry of Health and the Sudanese Red Crescent Society to carry out a multi-antigen vaccination catch-up campaign in 3 neighbourhoods of Omdurman city; targeted ue to the high rates of malnutrition and low vaccination coverage in these areas. It is hoped that this activity can be replicated in more neighbourhoods across Khartoum using a similar partnership model. 

MSF has supported the MoH in responding to cholera outbreaks since the start of the conflict including the ongoing outbreak. Currently MSF supports an MoH CTU and Rapid Response Teams for active case finding and community-level preventative WASH activities. 

Activities Suspended 
Until further notice, MSF has suspended activities in Al Shaheed Widatalla PHCC, in Jebel Aulia locality, since end of September. MSF continues to support with incentives for MoH staff. Until July 2024, MSF worked in southern Khartoum’s Turkish hospital, supported the emergency room and operating theatre, provided ante-natal care, post-natal care and family planning, ran the paediatric intensive care unit, the inpatient therapeutic feeding centre for children with severe acute malnutrition, and the neonatal unit—the only neonatal unit in the whole of Khartoum. However, because of repeated security incidents both inside and outside the hospital—including threats made against the lives of MSF staff—MSF took the decision to evacuate its team from the hospital, meaning that our hands-on support to these activities is currently suspended. However, we continue to support the Ministry of Health in terms of staff incentives and supplies. 

MSF has also donated medical supplies to the MoH in Khartoum on several occasions.

In the early months of the war, White Nile received the arrival of tens of thousands of people fleeing other areas of Sudan, mostly from Khartoum. Many of them were South Sudanese and took shelter across existing refugee camps, others were in transit towards South Sudan. To support them, as well as internally displaced people, MSF launched a response in June 2023. 

MSF teams are supporting both Al Kashafa and Tendelti hospitals with donations of medical and non-medical supplies. In Al Kashafa hospital, MSF runs an inpatient therapeutic feeding centre, maternity, paediatrics, and the emergency room. Precariousness and the increased overcrowding in the camps led to a spike of diseases across the camps in 2023, including a measles outbreak, since many children were not vaccinated. This outbreak was combined with high malnutrition rates. MSF supported the MoH in mass vaccination (Aug-Nov) and afterwards medical indicators improved, and we were able to control the outbreak. MSF teams are also providing cholera trainings and supporting cholera treatment centres in Kosti, Ad Douim and Tendelti hospital. 

In early October MSF handed over the Umsangor and Alagaya primary healthcare clinics to Ministry of Health supported by UNHCR partner MTI, where our teams were providing OPD consultations, ambulatory therapeutic feeding centre, mental health support and SRH services.

MSF runs a nutrition ward in Ad-Damazine Teaching Hospital with a bed capacity of 160. The ward provides care for severely malnourished children, particularly complicated cases where children cannot be treated at home. MSF also runs mobile clinics providing patient consultations, including maternity care, and malnutrition and malaria screening and treatment.

In Tanedba, MSF has been a vital healthcare provider since 2021, offering secondary and emergency healthcare to both the refugee, IDPs and host communities. The MSF hospital provides a range of services including primary health care, mental health, antenatal/postnatal care, family planning, nutrition, emergency stabilisation and referrals. It operates a 24/7 emergency room, an inpatient department, and a Kala Azar diagnosis and case management unit. The maternity department offers deliveries and Basic Emergency Obstetric and Neonatal Care, including care for survivors of sexual violence and referral of complicated cases and life-threatening emergencies. The project also includes community engagement, health promotion, surveillance and outbreak monitoring and response. 

MSF has been responding also to ongoing cholera outbreak, establishing a cholera treatment unit (CTU) in its Tanedba hospital. In Al Fao we support an MOH CTU with WASH and case management. Also in Gedaref city MSF provided water and sanitation services in the community. In EL Gederaf city, MSF established a 50-bed Cholera Treatment Unit (CTU) on August 22 which has admitted 376 patients till mid of September, as well establishing another CTU of 10-bed capacity in Um Rakuba camp. Our team has been running mobile clinics for 2 major IDPs sites in El Gederaf city. 

Similarly, in Um Rakuba camp, MSF ensures access to preventive and curative healthcare for Tigrayan refugees, the host community, and surrounding communities. The MSF health facility provides a wide range of services including outpatient consultations, inpatient department admissions, emergency room admissions, maternity admissions, antenatal consultations, and deliveries. The inpatient therapeutic feeding centre caters to malnourished patients. In addition to these, MSF also engages in health promotion activities at the hospital, camp, and community level, and provides mental health consultations. 

Since August 2024, MSF has been providing additional support to the internally displaced population in the state through free primary health care via mobile clinics in 2 sites in Gedaref city. This includes referrals for life-saving services, maternal care, and patients with severe acute malnutrition. As of 13 September 2024 we have screened 942 children under five for malnutrition. Our health promotion team has reached at least 8,371 individuals, including 1,430 children under 15. MSF also deliver 13,000 litres of water daily, have distributed 9,600 bars of soap and are constructing over 120 emergency latrines and handwashing points for internally displaced people at 3 sites in Gedaref city. 

Till mid of September, the health promotion teams have provided around 5, 595 sessions about cholera, sanitation and personal hygiene to 6,354 people. A home-based care approach has also been adapted with 20 community volunteers and 14 community health care workers trained.

MSF has been responding to a significant cholera outbreak in Kassala state since August, providing medical care to over 3,500 patients so far. MSF teams have been running a cholera treatment centre, a smaller cholera treatment unit, and oral rehydration points in the community, as well as building latrines and carrying out community-based awareness activities. Cholera cases are now decreasing, so activities will be reviewed and if necessary reoriented to address other medical needs.

MSF has been responding to the cholera outbreak in collaboration with River Nile State health authorities. In the Atbara Teaching Hospital, MSF is supporting a 100 beds cholera treatment centre where has attended 2,819 patients so far. We have been doing some outreach activities, providing technical support and donations to other CTUs and ORPs in the State as well as runninghealth promotion activities. MSF will also construct 50 latrines in some IDPs sites that have been more affected by the outbreak.

MSF supports El Geneina Teaching Hospital in the provision of primary and secondary healthcare services. This support is particularly focused on paediatric services, including the paediatric outpatient department, and inpatient therapeutic feeding centre. MSF also supports the blood bank, laboratory, sterilization, water, sanitation, and energy for the hospital. The teams supported by MSF are able to conduct a significant number of outpatient department paediatric consultations, inpatient therapeutic feeding centre admissions, inpatient department admissions, group sessions on mental health, and group health promotion sessions.MSF is also supporting Ministry of Health staff at the hospital by paying incentives and providing essential supplies to enable them to maintain a range of medical services that are essential for emergency care. Our team also manages electricity, water and waste management for the entire hospital. 

In response to the increase in malnutrition, MSF started door-to-door community screening for malnutrition in villages far from El Geneina, where abandoned health facilities underline the urgency of the situation. This lack of medical services prompted the MSF team to carry out exploratory assessments aiming to extending medical support. 

From May 2024, MSF's outreach team visited places such as Jabal Moon, Sirba, Beida, Habila, and Fora Baranga, where they conducted nutritional screenings, treated severe malnutrition, assessed rural health facilities, and distributed medical and nutritional supplies. Following theses assessments, MSF has opened ATFC and ITFC in Beida, Habila and Foro Baranga, where we are also treating Malaria patients. This period saw an increase in consultations, admissions and overall workload, likely due to the ean season and an increase in malnutrition cases. 

MSF also supports Murnei Hospital, including providing general outpatient consultations, sexual and reproductive health, maternal health, and malnutrition screenings and treatments. The team also runs mobile clinics in nearby Ramalia. MSF teams also support water and sanitation activities.

One of the sole secondary healthcare facilities for Central Darfur, the Zalingei Teaching Hospital was looted and attacked multiple times during the war over the past year. Since early April 2024, MSF has re-opened and rehabilitated the maternity, the emergency room, the inpatient therapeutic feeding centre, and the paediatric department. The rehabilitation of the surgical department is on- going. MSF opened an operation theatre for surgical interventions. 

In Rokero, North Jebel Marra, MSF in collaboration with the Ministry of Health, continues supports a comprehensive range of services at a secondary healthcare facility and facilitates referrals to Golo hospital. Due to the conflict, we have been unable to resupply medical and non-medical items for months and reinforce the team with international staff. All the community from the rural villages access this hospital on donkeys, camels and on foot due to lack of good roads and public transportation. The hospital serves over 200,000 residents of the area in addition to 41,000 new arrivals fleeing conflict. This includes over 7,200 who have arrived from El Fasher after recent escalation of hostilities there. 

In North Jebel Marra, MSF also supports the Umo healthcare centre, serving rural communities. Additionally, in response to the influx of internally displaced persons in the surrounding areas of Sortony IDPs camp and Kaguru (in North Darfur), MSF began supporting the Sortony healthcare centre in October 2023, thereby improving access to healthcare for around 51,000 displaced people living 45km north from Rokero town. MSF also supports five decentralized model of care sites in very remote areas of North Jebel Marra (Funga, Kome, Kormi, Sallah and Della).

In North Darfur state, hospitals have closed one by one as the fighting has intensified since May 2024. Working in health facilities increasingly under attack and unsafe for staff and patients in El Fasher, MSF teams reoriented medical services, including maternity wards, to the field hospital they opened in nearby Zamzam camp. MSF keeps donating supplies when available to health facilities still functional inside El Fasher, such as South Hospital. 

In Zamzam camp, MSF currently runs a 80-bed field hospital focused on child and maternal healthcare (emergency room, paediatric ward, intensive care unit, nutritional centre, maternity and neonatology wards). Hosting approximately 450,000 people, the camp was declared as undergoing famine conditions in August by the famine review committee (IPC). As delivery of food, medicines and supplies to El Fasher and its surroundings have been blocked for months, we had no choice but to scale down our medical activities in Zamzam. First, we capped the number of children treated for malnutrition, we stopped general paediatric consultations for children under 15 years old and adults, and at the end of September we suspended for a month our outpatient nutritional program (leaving behind 5,000 children in need of lifesaving treatment) due to lack of supplies. 

Thousands of people fled the violence from El Fasher in search of safety in other parts of Darfur and in Chad. In North Darfur, MSF will support the only hospital with a 100-bed paediatric and maternity in addition to a 40 bed ITFC in Tawila.

Access to secondary health is almost non-existent in South Darfur. MSF is supporting the rehabilitation and provision of maternity, paediatric and emergency care in Nyala Teaching Hospital, attending over 500 births in September alone. MSF supports maternity, paediatric, and emergency departments of Kass rural hospital. 

Since 2021, MSF has been operating two clinics in the Jebel Marra mountains, namely Kalokitting and Torun Tonga. These clinics provide primary healthcare services, including deliveries, nutrition, essential programme on immunization, and referrals to Kass hospital when feasible. These clinics are the only healthcare services available in the area. The program also includes community engagement, health promotion, surveillance, outbreak monitoring and response, as well as water and sanitation activities. 

As the Kalokitting primary healthcare centre started seeing increasingly complex cases, MSF expanded its services and began supporting Kass Hospital in October 2023. This support is focused on the emergency and maternity and paediatric wards, ensuring cost-free deliveries and paediatric healthcare to the population in Kass city and the surrounding area. ICCM sites with focus on under 5 and nutrition care throughout isolated rural communities in Jebel Marra and Kass areas. 

Two Periodic Intensification of Routine Immunization Campaigns took place, successfully vaccinating a large number of children under two years old in three localities supported by MSF. The campaign also included a MUAC screening and Vitamin A distribution. 

In partnership with SUDO, MSF started supporting primary healthcare centres in Beliel town, serving host, displaced, and refugee communities with free healthcare. MSF also supports secondary healthcare in Nyala Teaching Hospital, which includes the rehabilitation and reconstruction of the maternity and paediatric units, repairs of the neonatal unit, and rehabilitation of the ER department. 

With SFPA, MSF supported 3 women's clinics in IDP camps in Nyala area with sexual and reproductive health care, antenatal care, and birth services. In collaboration with the MOH, the malaria department and local community health groups MSF established ICCM sites which focused on providing healthcare for children under 5 and nutritional care in places where displaced people have congregated and urban communities around Nyala. 

MSF supports nutrition, sexual and reproductive health, and care for survivors of sexual and gender-based violence in Al Wahda Hospital. A ‘Confidential Corner’ was created for family planning and sexual and gender-based violence care in Wahda and Nyala Teaching Hospital.

Despite the lack of supplies across the region, MSF continues to make donations to other organisations, as well as transporting supplies for the UN and UN supported agencies, ensuring that some healthcare services can continue to operate.

Since the beginning of the war in Sudan in April 2023, more than 820,000 people have crossed into South Sudan to seek refuge. While daily arrivals have recently declined to an average of 600 to 700, the influx overwhelmed the already dire humanitarian situation in the country.

The influx of displaced people further stretched an already overwhelmed system. Many people arrive injured and acutely malnourished, facing an equally desperate situation with little food, water, or shelter; People going through transit centres for refugees and returnees from Sudan are grappling with worsening conditions, including overcrowding and limited access to services.

MSF is concerned by lack of funding for water, sanitation and hygiene programs across South Sudan, particularly as acute watery diarrhoea (AWD) is a top comorbidity among acutely malnourished children under five admitted to MSF health facilities. On 28 October 2024, the South Sudan Ministry of Health declared a cholera outbreak in Renk County, one of the main transit centres, caused largely by poor sanitation and overcrowded conditions. 

Currently, MSF runs a stabilisation centre in Joda, Renk county at the border with Sudan, and provides healthcare services in facilities in Renk and Bulukat in the Upper Nile state, providing primary care including mental health, vaccinations, treatment for malnutrition, and maternal and child health services among others. In Abyei Special Administrative Area, the arrival of returnees through Amiet Market entry point has continued to strain the limited resources, especially water and sanitation facilities.

Prior to the current war, the country was already hosting several hundreds of thousands of Sudanese refugees. Since mid-April 2023, 899 000 displaced refugees and returnees have crossed the border to eastern Chad (according to UN data), and hundreds more keep arriving every day. MSF teams work in three border regions which have been hosting most of the new arrivals—Ouaddaï, Wadi Fira and Sila—supporting refugees, returnees and host communities. 

MSF provides a wide range of medical services: primary healthcare, malnutrition screening and treatment, vaccination, sexual and reproductive healthcare; through a wide range of modalities: supporting existing local health structures, setting-up hospitals, clinics and Integrated Community Case Management (ICCM) and referral systems, in addition of mobile clinics allowing to reach the most vulnerable communities. We are also playing a key-part in large-scale public health initiatives such as responses vaccination campaign, or SCP (seasonal chemoprophylaxis) on the benefits refugee communities. 

As populations often struggle to acquire water in enough quantity and quality, MSF is constantly working at improving the access to water and sanitation. Over the past year, our organisation has been digging boreholes, building and connecting waterpoints in the camps, brought its technical support to other actors, set-up hundreds of latrines, rehabilitated water-pump in host-communities, distributed hundreds of thousands of soap bars. An intervention, that among other, contribute to decrease the number of cases of hepatitis E, which is currently an epidemic in the east of the country. 

Finally, where other competent organisations don’t have the capacity to do so, MSF keeps providing refugee communities with non-food items, such as plastic sheeting, mosquito nets or soap bars which, during the rainy season, are crucial to prevent additional heath troubles and to regain a minimum of dignity. 

Despite our relentless efforts, the humanitarian response in eastern Chad has been hampered by insufficient funding for humanitarian organisations on the ground, leaving critical gaps in the provision of food, shelter, water and sanitation.