Nairobi, January Friday 15, 2024 – On December 15, the Rapid Support Forces (RSF) launched an attack on Wad Madani, Sudan, and took control of several other cities and areas in Al Jazirah state within days. Since then, more than half a million people have fled the fighting and ensuing insecurity, including about 234,000
The chaos following the evolving conflict dynamics and the severe insecurity and widespread violence created an environment in which Médecins Sans Frontières/Doctors Without Borders (MSF) could no longer operate in Wad Madani. MSF had to suspend all activities and evacuate its staff from Wad Madani on December 19, leaving behind a population with even less access to basic medical services. We also had to evacuate staff from Damazine, Um Rakuba in Gedaref state, and Doka. In Damazine, we reduced activities.
MSF had been present in Wad Madani since May 2023. Conditions were already dire for the half a million internally displaced people living there, which made up 8 per cent of all internally displaced people in Sudan—already the world’s largest internal displacement crisis, with more than 6 million forced from their homes within the country in addition to more than 1.4
“Through its mobile clinics, MSF diagnosed and referred 66 children suffering from severe acute malnutrition with serious complications in the past six months—cases that could be fatal if not treated in a hospital urgently,” says Slaymen Ammar, MSF medical coordinator for Sudan. “But health facilities were overwhelmed. As the population of the city had increased by 30 per cent, there were more and more patients, but considerable supply and staffing challenges. And as prices soared for all goods, access to lifesaving services was an obstacle for both displaced people and regular residents. Nowadays, with the departure of most international organisations—and despite efforts of local volunteer health workers—we can only assume it has worsened.”
During the last month, MSF teams in Gedaref and Kassala states—where MSF has been operational since 2021 in response to the Ethiopian Tigray crisis—witnessed the arrival of thousands of people from Wad Madani
The conflict in Sudan has caused immeasurable suffering, displaced millions, killed thousands, and injured countless others. For many displaced people, Gedaref and Kassala are just the latest stops in a long journey to seek safety, during which they have suffered violence and have endured a lack of essential needs such as food, clean water, sanitation, and access to medical care.
“We are originally from Darfur, but because of the violent clashes and the crisis over there, we went to Khartoum. But the war followed us to Khartoum, so we went to Wad Madani. And then, the story continues,” says Salem
“We were six people in the house, and at that time my wife was pregnant. Our house was destroyed. I was hit on my arm, but my child got a much worse injury on his head. We managed to take him to the hospital, because he needed urgent lifesaving surgery. But as soon as he was discharged, we had to flee the city because of insecurity. We arrived in the internally displaced camp in Wad Madani, and she delivered there,” he continues.
In mid-December, he and her family fled once again to Gedaref: “Clashes started, and we started hearing sounds of fires and those armed men fighting again. Immediately, we decided to leave. I started thinking where we should go now. Nowhere was safe at that time.”
In a region where healthcare and essential medicine were already extremely limited, displaced populations are now suffering from growing health demands, stemming from direct and indirect effects of violence. Basic needs are now further escalating and need an urgent response.
"At the gathering sites in Kassala city, displaced people told our teams they haven’t received any assistance since their arrival in mid to late December,” explains Pauline Lenglart, MSF emergency project coordinator in Sudan. “Families are sleeping on the ground, access to healthcare is still severely restricted, there are few working medical facilities, and medicines aren't provided for free. Many people have told us that they are unable to afford items like food and medicine, forcing them to choose between these necessities. The MSF team is constantly evaluating the needs at new sites that are opening to house recently displaced people. In all these places, we see that the amount of humanitarian assistance provided is still woefully inadequate to meet people's basic needs and ensure them dignified living conditions."
MSF has worked in Sudan since 1979. We currently work in 9 states in Sudan, including Khartoum city and state, and White Nile, Blue Nile, River Nile, Al Gedaref, West Darfur, North Darfur, Central Darfur, and South Darfur states.
On January 13, as a result of discussions MSF had with the GoS and RSF to assure staff access and the impartiality of our medical mission. An MSF team has returned to Wad Madani to assess the needs and evaluate the feasibility of carrying out activities in the city.
MSF teams in Sudan are treating people injured in the fighting, including blast injuries and gunshot wounds, as well as treating communicable and non-communicable diseases, providing maternal and pediatric care, running mobile clinics in IDP gathering locations and hospitals in refugee camps, providing water and sanitation support, and supporting healthcare facilities through donations. MSF is also continuing the majority of its activities that were in place before the start of the conflict.
MSF Sudan´s emergency response operates with a budget of 76 million euros for 2023 and a team of 1,145 Sudanese staff and 57 international staff in Sudan. MSF is also paying incentives to 1,358 Ministry of Health staff, as well as providing training and logistical support.
Souad Abdullah shared with us a brave story;
I came all the way from Mayo, south Khartoum to Wad Madani in journey of three days. Riding Caro (which is a wooden cart pulled by a donkey) along with my Six children and she was five months pregnant at the time.
When we arrived here, we were suffering; there were no bathrooms, water, food, or drinking water. The organizations then arrived and intervened, providing us with water, soap, and buckets, and our conditions improved slightly.
Doctors Without Borders intervened and took care of us from the beginning, as the children suffered from sunstroke. The organization was present throughout the week. They also help me delivering my baby girl and did their best
I have no prospect of returning to Khartoum because of the huge destruction that has occurred there, as well as the demolition of institutions and hospitals.
Al Bakri Al Taher Malik
“The war brought nothing but destruction and the separation of families. We lost our home, and we lost our city Khartoum.” - says is Al Bakri Al Taher Malik, who used to live in Al Engaz, South Khartoum.
I survived death twice, when I got injured the first time with bullet and the second time with shrapnel due to bombed by planes.
Therefore, I have decided to leave Khartoum to receive treatment, due to the challenges of reaching the nearest center.
I have lost my nephew. He died on the first day of the Ramadan Eid by a Shell (Dana 120). He was divided into three parts.
He was performing ablution to go to the mosque when he died in front of the door of his house, in addition to three other neighbours who died in front of the mosque.
“I have three children, and I am concerned about their education, which has been disrupted by the war. I am unable to meet their needs because of difficult economic circumstances.”
When the pictures were taken, early December, Al Bakri couldn’t wait to go back home to Khartoum. “I'm waiting for the day when the war is declared over; even if I have nothing to return home, I'll go, even if I had to walk on foot.”, he said at the time.
On December 17, conflict erupted in Madani and Albakri had to leave again. He went on a three-day journey back to Khartoum. He feels pain in his injuries, particularly in wintertime.
Marry Monga arrived on 15th of May from Al Samarab, Bahri.
“This is my first time here in Wad Madani. I lived my entire life in Khartoum from my birth until I got married, and I gave birth to my children there.”
The situation here is very chaotic. My baby is a month old, and he doesn't look like one month old cause I don't have any milk.
There is no education or healthy food here, there is no controlled environment to take care of the children, and there is also no healthy environment with the crowding and mixing of people.
This environment causes diseases such as infectious diseases and cholera.
Marry had a call for a better environment and support through her strong understanding of the surrounding situations; “We need aid, such as soap, so that children do not get dirty. Since we came here, we are suffering from a scarcity of aid and resources. unlike Khartoum, we had a life where we used to work and provide our needs.
She also added: “There is no support or even enough money to buy a meal. My child is currently sick, and I can only get him treatment through organisations.”
“When I think about the future, I want my children to receive an education. I don't want my children to go through what we went through. If children do not receive education, they will become thieves, perhaps distracted by life. Unlike what happened in Khartoum, we were able to take care of our children, their study, in a healthy environment. Nowadays, we live on the street, they can eat unhealthy food and get poisoned.”
Malak Seed at Fadasi camp, Wd Madani said
“I was in the market when I got injured by bomb splinters as a result of the clashes that escalated in Jebel Awulia”
Every day, the situation rapidly got worse, we have decided to move to a safer place.
When the pictures were taken, early December Malak was missing home “I’m feeling homeless and waiting patiently to get back home. I hope things improve and the war end soon.”
On December 17, battle occurred in Wad Madani, and Malak managed to return to Khartoum. She stated that "we are suffering from a lack of services, as most of the shops are closed." She said, "The situation in Wad Madni was better than here.".