The Neglected War: Operational challenges during one year of conflict in Sudan

More than a year since the outbreak of war in Sudan, the country is facing one of the worst humanitarian tragedies ever recorded.

With more than 20 years of experience delivering aid in Sudan, EMERGENCY has published a new paper on the possibilities and constraints of humanitarian interventions during the current conflict, entitled:

Sudan, the Neglected War:
Operational challenges during one year of conflict, from the perspective of an NGO

Read EMERGENCY’s latest paper on our humanitarian interventions in Sudan throughout one year of war, challenges we’ve faced, and our recommendations to address the current crisis.

The Humanitarian Context

Reports of more than 15,000 dead and 27,700 injured are likely to severely underestimate the conflict’s true toll. Over 8.2 million people have been displaced, on top of the more than 3 million already displaced by previous conflicts in the region. It is the largest child displacement crisis in the world: close to 4 million children have been forced to flee their homes.

Nearly 25 million people are in need of humanitarian assistance, including 11 million in need of urgent healthcare. Yet, Sudan’s healthcare system is collapsing: between 70 and 80% of healthcare facilities are not functioning due to the ongoing conflict and the detection system for infectious disease outbreaks has been disrupted, meanwhile, there are around 11,000 suspected cases of cholera alone.

EMERGENCY in Sudan

EMERGENCY has been present in Sudan since 2004, first providing support to hospitals in North Darfur and soon constructing our own hospitals and Paediatric Centres throughout the country. During more than 20 years of activities, we have provided over 776,000 services, including more than 10,000 surgical interventions at the Salam Centre for Cardiac Surgery.

Opened in Khartoum in 2007, the Salam Centre sits at the heart of our Regional Programme, a system for screenings, referrals and follow-ups with cardiac patients across Africa; it has treated patients from more than 30 countries. The Salam Centre was also the first hospital within the African Network of Medical Excellence, an initiative between EMERGENCY and authorities from African countries to develop an integrated network of high-quality, collaborative and free medical centres across the continent.

When war broke out in April 2023, we immediately reshaped our activities in the country. We opened Cardiology Outpatient Clinics in Atbara and Wad Madani to support cardiac patients from the Salam Centre, where activities continue at a reduced capacity (activities in Wad Madani are currently suspended due to security conditions). Within the Salam complex, we ran a trauma surgery centre while operational constraints allowed, from August to November 2023, and in March 2024, we opened a Paediatric Outpatient Clinic to support children and families in the area.

The Paediatric Centre in Port Sudan has seen a major increase in patients as internal movement towards the city remains high. The city is also now the entry point for supplies and personnel. Paediatric activities in Mayo, located on the outskirts of Khartoum, have been suspended due to security conditions since the war began, while in Nyala (South Darfur) they continued until fighting intensified in October, when the Paediatric Centre was looted and some of our Sudanese staff were temporarily arrested by the RSF. Today, paediatric activities remain suspended, but monitoring and support for our cardiac patients have resumed.

OUR ACTIVITIES SINCE APRIL 2023

Challenges to Humanitarian Aid Delivery

EMERGENCY has faced serious challenges during efforts over the past year to reshape our activities in Sudan and to ensure continuity of care for our patients, while also addressing emerging needs.

Physical access to humanitarian space is restricted. Obtaining visas for international staff has become a complicated and lengthy process incompatible with our interventions, which require predictable staff turnover even more so now that many of our Sudanese colleagues have been displaced and are no longer working. The essential movement of staff, medical personnel and supplies throughout Sudan is impeded by internal divisions and permitting requirements; complex and shifting bureaucratic procedures completely obstructed our ability to transport supplies dedicated to our trauma centre in Khartoum, ultimately leading to the centre’s closure. Only the acknowledgment by all actors that the Salam Centre is a vital and neutral facility guarantees movement of goods and personnel.

Lack of respect for healthcare infrastructure threatens the collapse of the entire system. Direct attacks on medical facilities and workers – including our Paediatric Centre in Nyala – in addition to the displacement and exodus of many healthcare workers, have disrupted essential and emergency services relied on by vulnerable people across Sudan.

Widespread shortages of goods and medicines as well as unreliable power lines have coincided with an exponential increase in the price of fuel. Support provided to Sudanese colleagues, such as transportation or accommodation, is also directly impacted by the rising cost of living. Rapidly increasing costs across nearly all sectors threaten the viability of our interventions in Sudan. 

Electricity and mobile network blackouts are also negatively affecting day-to-day communication with patients, between projects in Sudan, and with headquarters in Milan. This impacts our patient support, operations management, and ability to guarantee security conditions in our projects.

Recommendations

EMERGENCY firmly believes that the path to resolving the current crisis must begin with the construction of a concrete and shared peace process. Only with an immediate cessation of the hostilities will it be possible to begin the hard work of reconstruction, giving the Sudanese people their future back, and avoiding further exacerbation of the situation in an already fragile region.

We urge all parties involved to immediately cease all hostilities, and grant full, rapid, safe and unhindered access into and throughout Sudan to enable humanitarian assistance.

Addressing the humanitarian cost of the conflict is not possible without the international community, who are crucial for adequately funding the Humanitarian Response Plan to alleviate suffering in Sudan, while also meeting the needs of host communities impacted by the mass displacement.