Intense fighting has been taking place between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) in Khartoum and other parts of Sudan since 15 April. Medecins Sans Frontieres (MSF) staff are treating the wounded at the MSF-supported South Hospital in El Fasher, North Darfur. Cyrus Paye, MSF Project Coordinator, speaks about the situation.
"There is currently heavy fighting in El Fasher. We are still hearing gunfire from our compound as I speak. It is very unsafe because of the shooting and the shelling - there have been large numbers of civilian casualties.
At the hospital we support, we have received 279 wounded patients since the fighting began on Saturday. Tragically, 44 have died. The situation is catastrophic. The majority of the wounded are civilians who were hit by stray bullets, and many of them are children. They have fractures caused by bullets, or they have gunshot wounds or shrapnel in their legs, their abdomen or their chest. Many need blood transfusions. There are so many patients that they are being treated on the floor in the corridors because there simply aren't enough beds to accommodate the vast number of wounded.
Until last weekend, South Hospital had no surgical capacity. It was a maternity hospital that we began to support last year to help reduce the high rates of maternal mortality in the region. However, since the fighting began, we have had to repurpose the hospital to make it possible to treat the wounded.
All other hospitals in the city have had to close due to their proximity to the fighting, or the inability of staff to reach them due to the intensity of the conflict. Surgeons from those hospitals have now come to South Hospital and have been able to carry out a number of operations. However, they are rapidly running out of supplies. We were able to reach the hospital to restock it on Tuesday, when there was a lull in the fighting, but if we cannot get more supplies to Darfur - and if we continue to receive such high numbers of wounded - there are only enough medical supplies to last another three weeks.
Currently, within Sudan, nothing can move. The airports across the country have all been closed since the fighting began and there is fighting in the streets, so we cannot get more supplies to North Darfur - or into the country. Chad has closed its border. So, if the situation doesn't change and humanitarian access is not granted, there will be even greater loss of life.
As things stand, the two operating theatres that have been established cannot cope with the non-stop influx of trauma and emergency obstetrics and gynaecology patients. In the maternity ward, there are currently two women in each bed. Previously, a neighbouring hospital was carrying out all emergency caesarean sections - usually around three to five per day - and with more than 30 normal deliveries in a 24 hour period. Now, all of these are taking place in South Hospital at the same time as the trauma surgeons are at work.
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We just heard that last night, the paediatric hospital where we used to refer newborn babies was completely looted, which means that we now have nowhere to refer newborns who have sepsis - or those who are born preterm. There are no incubators in South Hospital, which will make it difficult to keep those babies alive.
The current team are overwhelmed. They have been working round the clock. We are exploring options to bring supplies and experienced trauma surgeons into the country to provide support when the situation allows, but - as is the case with medical supplies - currently, this is not possible.
It is critical that we are able to gain access to all health facilities across the country. At this moment in time, this is what will save people's lives. Health facilities are running out of supplies and staff cannot get to work. Health worker, relief worker and rescue workers have all become immobilised by the fighting and people are dying as a result. Access is what will change this. That, and a guarantee from the warring parties that they will spare civilians' lives."
