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    Sudan is facing a colossal man-made catastrophe

    Khadija Mohammad Abakkar, 25, in Zalingei hospital, Central Darfur, Sudan, 03 April 2024 © MSF

    Khadija Mohammad Abakkar, 25, in Zalingei hospital, Central Darfur, Sudan, 03 April 2024 © MSF 

    Port Sudan/Darfur, 12 April 2024 – In one of the world's worst crises for decades, Sudan is facing a colossal, man-made catastrophe one year after the start of the war between the Government-led Sudanese Armed Forces (SAF) and the paramilitary Rapid Support Forces (RSF). It is a matter of life or death for millions of people to urgently enable safe humanitarian access. As governments and officials, aid organisations and donors meet on 15 April in Paris to discuss ways to improve the delivery of humanitarian aid, Doctors Without Borders / Médecins Sans Frontières (MSF) is making an urgent call for them to immediately scale up the humanitarian response. 

    Chira Casah, Sudan,15 March 2024 © MSF

    Chira Casah is a 24-year-old refugee from Sudan. "Fleeing with my mother, brother, and sister, we lost contact with my father and two other brothers in the chaos of war. I hope they are still alive." Sudan,15 March 2024 © MSF

    Millions of people are at risk, yet the world is turning a blind eye as the warring parties intentionally block humanitarian access and the delivery of aid. The United Nations (UN) and member states must redouble their efforts towards negotiating safe and unhindered access and to scale up the humanitarian response to prevent this already desperate situation from deteriorating any further. 

    “People in Sudan are suffering immensely as heavy fighting persists —including bombardments, shelling and ground operations in residential urban areas and in villages—, and the health system and basic services have largely collapsed or been damaged by the warring parties. Only 20 to 30 per cent of health facilities remain functional in Sudan, meaning that there is extremely limited availability of health care for people across the country,” says Jean Stowell, Doctors Without Borders head of mission in Sudan.

    In areas close to hostilities, Doctors Without Borders teams have treated women, men and children directly injured in the fighting, including shrapnel wounds, blast injuries and gunshot injuries, and from stray bullets. Since April 2023, Doctors Without Borders supported facilities have received more than 22,800 cases of traumatic injuries and performed more than 4,600 surgical interventions, many of them related to the violence which occurred in Khartoum and Darfur. In Wad Madani, a town surrounded by three active frontlines, we see currently 200 patients per month with violence related injuries.

    According to the UN, more than eight million people have already been forced to flee their homes and been displaced multiple times, and 25 million – half of the country’s population – are estimated to be in need of humanitarian assistance. 

    “Every day we see patients dying because of violence-related injuries, children perishing due to malnutrition and the lack of vaccines, women with complications after unsafe deliveries, patients who have experienced sexual violence, and people with chronic diseases who cannot access their medicines,” Stowell continues. “Despite all this, there is an extremely disturbing humanitarian void.”

    Although Doctors Without Borders works in good cooperation with the Ministry of Health (MoH), the Government of Sudan (GoS) has persistently and deliberately obstructed access to humanitarian aid, especially to areas outside of their control: it has systematically denied travel permits for humanitarian staff and supplies to cross the front lines, restricted the use of border crossings, and established a highly restrictive process for obtaining humanitarian visas.

    "Today, our biggest challenge is the scarcity of medical supplies. We've run out of surgical equipment, and we are on the brink of stopping all work unless supplies arrive,” says Ibrahim (name changed to protect identity), a Doctors Without Borders doctor working in Khartoum, a city that has been under a blockade for the past six months. A similar situation has been impacting the city of Wad Madani since January.

    UNHCR Transit Centre for Sudanese Refugees - Abyei, Sudan, 07 August 2023 © MSF

    "Numerous families trapped in perilous areas are desperate to reach this safe haven. However, the journey here is fraught with challenges: it's costly and perilous, coupled by frequent attacks and rampant looting. The attackers leave nothing behind. We urgently need both transportation and protection. The current circumstances are horrific beyond words."

    "I was in Darfur and had to flee in 2003. My journey took me to Myala, and now, escaping from there, I've arrived here," Ahmed Mohammed. UNHCR Transit Centre for Sudanese Refugees - Abyei. Sudan, 07 August 2023 © MSF

    In RSF-controlled areas, where many different militias and armed groups also operate, health facilities and warehouses were frequently looted in the first months of the conflict. Incidents such as carjackings continue on a regular basis and medical workers, particularly from the Ministry of Health, have been harassed and arrested.

    In hard-to-reach areas like Darfur, Khartoum or Al Jazirah, Doctors Without Borders often finds itself the sole or one of the few international humanitarian organisations present, while needs far exceed our capacity to respond. Even in more accessible areas such as White Nile, Blue Nile, Kassala and Gedaref states, the overall response is negligible: a drop in the ocean.

    Sudan, 29 March 2024 © MSF

    Four months ago, Khartouma found refuge in Adré, Eastern Chad, after fleeing extreme violence and clashes in her village of Ardamata, in West Darfur, Sudan. With her six children, aged from 9 months to 15 years, she is still struggling to live in the transit refugees’ site of Adré. 29 March 2024 © MSF

    “Life is very hard here. But what worries me the most is the children."

    Four months ago, Khartouma found refuge in Adré, Eastern Chad, after fleeing extreme violence and clashes in her village of Ardamata, in West Darfur, Sudan. With her six children, aged from 9 months to 15 years, she is still struggling to live in the transit refugees’ site of Adré, with very limited access to basic essential services. Since the outbreak of the conflict, 550, 000 Sudanese refugees fled to Eastern Chad and continue to live in dire conditions, desperately lacking food, water, and decent sanitation.

    “When armed clashes and bombings came close to my village, I had no other choice than to leave. We fled with a group of people but some of them did not make it to the border. With my neighbors, we fled by car and took as much luggage as possible. But along way, there have been attacks, people have been killed. We were looted by armed men but us, we were lucky, they took only our belongings and not our lives. 

    "We arrived late at night and empty-handed at the border. The next day, we went to the Adré transit refugee site where I met my aunt. She shared with us what little she had: a tarpaulin, few pieces of wood and three kilos of flour so at least we could build a shady spot, sleep, and eat. In the past four months, I beneficiated from two distributions only, with different bags of cereals, flour, oil and more. But it is not enough to cover our needs. 

    "Back home I made my living making pottery so to survive here, I find ways to make pottery, which I then sell in the community and buy a little food with it. 

    "Life is very hard here. But what worries me the most is the children. I can’t provide for them, even to find shoes. There is no school, so they do nothing all day and go round in circles. They don’t want to stay in the camp, they want to go back to Sudan. 

    "My husband fled before us as he has another wife in El Geneina. He has been relocated to an official camp in Farshana. I am desperately trying to join him with the children, but I don’t know when it will happen. One day, they told us we will be moving so we packed everything but, in the end, it did not happen. So, we are waiting."

    One example is the catastrophic malnutrition crisis in Zamzam camp in North Darfur, where there have been no food distributions from WFP since May 2023. Almost a quarter (23 per cent) of children we screened there in a rapid assessment in January were found to be suffering from acute malnutrition – seven percent were severe cases. 40 per cent of pregnant and breastfeeding women were suffering from malnutrition, and there was a devastating mortality rate across the camp of 2.5 deaths per 10,000 people per day.

    “The situation in Sudan was already very fragile before the war and it has now become catastrophic. In many of the areas where Doctors Without Borders has started emergency activities, we have not seen the return of the international humanitarian organisations that initially evacuated in April,” says Ozan Agbas, Doctors Without Borders Emergency Operations Manager for Sudan.

    Khadija Mohammad Abakkar, who had to flee her home in Zalingei, Central Darfur, in search of safety, recounts how difficult it was to survive without humanitarian assistance: “During the fighting, there was no access to health care or food in the camp. I sold my belongings to earn some money for food.”

    While these are difficult conditions in which to operate, the response should have increased, not diminished, especially in the areas where access is possible. Increased efforts are urgently needed by all humanitarian actors and organisations to find solutions to these problems and scale up activities across the country. 

    “The United Nations and their partners have persisted in self-imposed restrictions on accessing these regions and, as a result, they have not even pre-positioned themselves to intervene or establish teams on the ground when opportunities arise,” Agbas continues. 

    “For three days, we couldn't sleep.”

    I’m Khadija Mohammad, 25, and this is my daughter Malaka, I have been displaced by the war in Sudan. Five months ago, I was forced to flee my home in the displaced camp of Hasahissa, in Zalingei, Central Darfur, Sudan. I sought refuge in the displaced camp of Tululu, approximately one hour away from her home. 

    When the problems started between SAF and RSF, I lived at the edge of the [Hasahissa] camp which is close to a military base. The militia would come into our homes and loot our belongings. 

    During the fighting, there was no access to health care or food in the camp. I sold my belongings to earn some money for food. Eventually, the security situation became too difficult, and I was forced to move to Tululu camp, one hour away. 

    We suffered a lot. For three days, we couldn't sleep [in Hasahissa camp]. Now, where we are is also bad, because we don´t have enough food.

    In Tululu camp, we don´t have access to health care me and my family. I traveled over an hour to Zalingei teaching hospital to receive treatment for my child Malaki, who tested positive for malaria at the hospital. 

    In Hasahissa camp [previous home], we would receive medication for free. Here in Zalingei, it´s not the same. But today [for the first time], we received medication for free. 

    Doctors Without Borders teams are supporting the Zalingei teaching hospital. On the 2nd of April, the hospital opened the newly refurbished emergency department, where Doctors Without Borders teams support the Ministry of Health staff with incentives, training and rehabilitation of the facility. 

    Doctors Without Borders calls on warring parties to adhere to International Humanitarian Law and the humanitarian resolutions of the Jeddah declaration by putting in place mechanisms to protect civilians and to ensure safe humanitarian access to all areas of Sudan without exception – including stopping blockages. Doctors Without Borders also calls on the UN to show more boldness in the face of this enormous crisis and to focus on clear results related to increasing access so that they actively contribute towards enabling a rapid and massive scale-up of humanitarian assistance. Doctors Without Borders also urges donors to increase funding for the humanitarian response in Sudan.