27 August marks 500 days since Sudan began enduring its worst humanitarian crisis yet. This is a shameful moment for international humanitarian organisations and donors, who, for over 16 months, have failed to provide an adequate response to the country's escalating medical needs, from catastrophic child malnutrition to widespread disease outbreaks. Heavy restrictions from both warring parties have drastically limited capacities, including ours, to deliver aid, says Médecins Sans Frontières (MSF).
Fighting between the Rapid Support Forces (RSF) and the Sudanese Armed Forces (SAF), starting from the capital, Khartoum, on 15 April 2023, has been raging across multiple parts of the country, triggering a massive humanitarian crisis in Sudan. The conflict has left tens of thousands of people killed and injured. Between April 2023 and June 2024, MSF treated 11,985 war-wounded at supported hospitals. The violence has created the world's largest displacement crisis: over 10 million people, or one in five people in Sudan, have been forced to flee their homes, many of them facing repeated displacement, according to the UN.
As political solutions for the crisis stagger, malnutrition rises amid increasing food prices and a lack of humanitarian supplies. Beyond the catastrophic situation in North Darfur's Zamzam camp, MSF's inpatient therapeutic feeding centres in other areas of Darfur like El Geneina, Nyala and Rokero are full of patients, and the same applies to refugee camps where we operate in eastern Chad. Since the onset of the war until June 2024, we treated 34,751 acutely malnourished children in Sudan.
"Today children are dying of malnutrition across Sudan. The help they most urgently need is barely coming and, when it does, it is often blocked," says Tuna Turkmen, MSF Emergency Coordinator in Darfur. "In July, for instance, trucks with MSF supplies in two different locations in Darfur were blocked from reaching their destination. Two trucks were held by RSF, and one was seized by unknown armed men."
The situation is also challenging in east and central Sudan. "In south Khartoum, MSF has been blocked from bringing medical supplies and international staff to hospitals for many months. It is becoming increasingly difficult to provide the medical care our patients need, including maternity and emergency care," said Claire San Filippo, MSF Emergency Coordinator for Sudan.
On top of man-made impediments imposed or tolerated by the warring parties, including lawlessness, insecurity, bureaucratic obstacles, and delayed or denied permissions to reach affected populations that have significantly slowed down the humanitarian response, now natural impediments are also hampering movements of humanitarian personnel and supplies.
The rainy season, an annual occurrence that exacerbates needs and complicates movements, is at its peak. Heavy rains have flooded crossing points and washed off critical roads and bridges. With the collapse of Mornei bridge in West Darfur, the only lifeline route connecting Central and South Darfur with Chad, from where supplies arrive, millions of people will not be able to receive assistance coming by road.
We already see an uptick in malaria cases and water-borne diseases with cholera outbreaks now declared in at least three states. The threat of vaccine preventable diseases among children, such as measles, is looming with the war putting immunization campaigns on hold.
Meanwhile, the conflict has put nearly 80 per cent of the health facilities out of service, according to World Health Organization, crippling an already struggling health system. In El Fasher alone, MSF-supported facilities were attacked 12 times and only one public hospital remains partially functional with the ability to perform surgery since fighting escalated in the city in May.
Most recently, on 22 August at around 4:40 am, shelling struck the house accommodating part of the MSF team working in El Fasher and Zamzam. Fortunately, the damage was only material and no one in the house was injured. This constitutes the 84th violent incident against MSF staff, vehicles and premises in Sudan since the start of this conflict, which has been characterised by a glaring disregard for the protection of civilians, as well as health personnel and facilities.
The situation is not much better in neighbouring countries, where about two million people have sought refuge, often separating from their loved ones.
"My husband has been missing for over a year and I don't know where he is," says Um Adel, a woman in Metche, a camp in eastern Chad. "[My son] Khalid was fine, until the food started to diminish. After a day or two of not eating well, he developed a high fever. I don't feel comfortable here and the situation is not good, I want to go back to Sudan."
Warring parties, and member states with influence over them, must ensure the protection of civilians, health personnel and medical facilities. Responsible authorities on both sides of the conflict must simplify the processes granting permissions for humanitarian movements and personnel through all available routes across borders, states, and frontlines, and provide prompt responses. And the United Nations, relevant agencies and anyone who has the power to help must employ all measures to ensure that available access routes are used to their fullest extent.
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"MSF tries to fill some of the gaps. In many places we work, we are the only international organisation operating, but we cannot tackle this huge crisis alone," says Esperanza Santos, MSF Emergency Coordinator in Port Sudan. "We are also struggling to get supplies and staff to our projects."
"In tandem with access, securing sustained funding to UN agencies, as well as to local organisations and responders, who are carrying the brunt of this response, is also essential," continues Santos. "A meaningful response with aid reaching people who need it most must start now. There is no more time to waste."
MSF is one of the few international organisations working on both sides of the conflict in Sudan. We currently run and support medical projects, including over 20 healthcare clinics and hospitals across 8 of Sudan's 18 states. We employ 926 Sudanese staff and 118 international staff, and provide incentives to 1,092 Ministry of Health staff.
