MSF director general: Vickie Hawkins  Head of Communication for the MENA Region: Enass AbuKhalaf
Conflict in Sudan

‘A War on People’ – MSF report reveals catastrophic toll of violence in Sudan

Amsterdam, 22 July 2024 - The war in Sudan has led to a collapse in the protection of civilians with communities facing indiscriminate violence, killings, torture and sexual violence amid persistent attacks on health workers and medical facilities according to a report released by Médecins Sans Frontières / Doctors Without Borders (MSF) today.

The report, ‘A war on people – The human cost of conflict and violence in Sudan’ describes how both the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) and their supporters are inflicting horrendous violence on people across the country. The war has wrought a catastrophic toll since fighting began in April 2023 with hospitals attacked, markets bombed, and houses razed to the ground.  
 
Estimates for the total number of people injured or killed during the war vary but MSF, which works in eight states across Sudan, revealed that in just one of the hospitals it supports, Al Nao hospital in Omdurman, Khartoum state, 6,776 patients were treated for injuries caused by violence between 15 August 2023 and 30 April 2024, an average of 26 people per day. MSF has treated thousands of patients for conflict related injuries across the country, most for injuries caused by explosions, gunshots and stabbings.  
 
A healthcare worker in Al Nao hospital describes the aftermath of shelling in a residential area of the city.  
 
“About 20 people arrived and died straight after, some arrived already dead. Most of them came with already hanging hands or legs, already amputated. Some only with a small part of skin keeping two limbs together. One patient came with an amputated leg, their caregiver followed behind, carrying their missing limb in their hand.” 

The report contains shocking reports of sexual and gender-based violence, especially in Darfur. An MSF survey of 135 survivors of sexual violence treated by MSF teams between July and December 2023 in refugee camps in Chad close to the Sudanese border found 90% were abused by an armed perpetrator, 50% were abused in their own homes and 40% were raped by multiple attackers.  
 
These findings are consistent with testimonies from survivors still in Sudan, demonstrating how sexual violence is being perpetrated against women in their homes and along displacement routes, a characteristic feature of the conflict.  
 
An MSF patient, describes events in Gedaref in March 2024. “Two young girls from Sariba, our neighborhood disappeared. Later when my brother was abducted and when he came back home, he said that the two girls were in the same house where he was detained and that the girls had been there for two months. He said that he was hearing bad things done to them, the kind of bad things they do to girls.”  
 
The report contains testimonies detailing targeted ethnic violence against people in Darfur. In Nyala, South Darfur, people described how, in summer 2023, RSF and aligned militia went house to house, looting, beating, and killing people, targeting Masalit and other people of non-Arab ethnicities. 
 
A patient in Nyala, South Darfur, told MSF “The men were armed with guns and dressed in RSF camouflage… I was stabbed many times and fell to the ground. As they exited my house they looked at me laying on the ground, I was barely conscious. I could hear them say ‘he will die, don’t waste your bullets’ as one of them pressed his foot on me.” 
 
Throughout the war hospitals have been routinely looted and attacked. In June the World Health Organization said that in hard to reach areas only 20 to 30 per cent of health facilities remain functional, and even then at minimal levels. MSF has itself documented at least 60 incidents of violence and attacks on MSF staff, assets and infrastructure. The MSF supported Al Nao hospital in Omdurman has been shelled on three separate occasions, while a blast caused by an airstrike in May killed two children after the ICU roof collapsed at the MSF supported Baker Nahar Paediatric hospital in El Fasher. The hospital was forced to close. 
 
Despite the health system struggling to adequately meet the population’s needs, humanitarian and medical organisations have frequently been blocked from providing support.  Although authorities have begun issuing visas for humanitarian staff more readily, attempts to provide essential medical care are still regularly impeded through bureaucratic blockages such as refusals to issue travel permits to allow the passage of people and essential supplies. 
 
Vickie Hawkins, MSF General Director, said: “The violence of the warring parties is compounded by obstructions: by blocking, interfering and choking services when people need them most, stamps and signatures can be just as deadly as bullets and bombs in Sudan.” 
 
“We call on all warring parties to facilitate the scale up of humanitarian aid and, above all, to stop this senseless war on people by immediately ceasing attacks on civilians, civilian infrastructure and residential areas.” 
 

A War on People: The human cost of conflict and violence in Sudan pdf — 15.84 MB

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Executive summary

 

The consequences of over a year of full-blown conflict on the health and wellbeing of people in Sudan are disastrous. The population has faced horrendous levels of violence, succumbing to widespread fighting and surviving repeated attacks, abuse, and exploitation by the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF). Drawing on medical and operational data collected from April 15, 2023, to May 15, 2024, this report highlights the patterns of violence observed by our teams, the features of abuse characterising this conflict, and the ensuing health consequences for affected populations.

 

In active conflict areas in Khartoum and across Darfur states, MSF supports the few remaining hospitals and emergency wards functioning in Sudan. Our teams treat thousands of war-wounded patients in locations affected by crossfire, large-scale bombing, and shelling where homes, health facilities and essential infrastructure were hit, destroyed, and made inoperable. From August 15, 2023, to April 30, 2024, the Al Nao hospital in Omdurman – one of the eight facilities MSF supports in Khartoum state – admitted a total of 6,776 war-wounded patients, on average 26 war-wounded patients per day, for gunshot (53%), shrapnel (42%), and stabbing wounds (5%). At least 399 of them died from their injuries. Women and children have not been spared, comprising almost 30% of the 624 war-wounded treated – in March 2c024 alone.   From May 2023 to April 2024, MSF teams in Bashair Teaching Hospital in Khartoum treated 4,393 patients presenting with trauma-related injuries, corresponding to 42% of all Emergency department consultations across the period of analysis.

Across Sudan, people’s access to lifesaving care has been drastically affected due to critical shortages, widespread obstruction and looting of medical supplies, insecurity and attacks against patients and medical staff, breaches of medical protocols in hospitals, and structural damages to healthcare infrastructure. Al-Nao Hospital was hit by shells on three separate occasions in August, October, and June 2024, leading to a reduction in the availability of lifesaving services. In July 2023, a healthcare worker of the MSF-supported Al-Saudi Maternity Hospital was shot dead inside the maternity ward, leading to the closure of the facility. Nowhere is safe for populations trapped in Sudan’s conflict hotspots, forcing millions to flee. 

In the camps and gathering sites where refugees and displaced populations seek safety, MSF patients recount horrific stories of inhuman treatment and violence perpetrated by armed groups on the civilian population. People’s accounts describe systematic cases of forced eviction, looting and arson, degrading interrogation, arbitrary arrest, abduction and torture – all against the backdrop of heightened suspicion around those attempting to flee and reach safer areas. 

Sexual and gender-based violence is pervasive but critically underreported due to stigma, silence for fear of retaliation, and the void in protection services and confidential spaces conducive to disclosure. Data from MSF facilities supporting Sudanese refugees in Chad hint at the widespread use of sexual violence as a form of warfare, particularly targeting women and girls. Between July and December 2023, 135 survivors turned to our teams in Adre (Chad), disclosing cases of rape, abduction, and exploitation perpetrated in Sudan during the conflict. In 90% of cases, perpetrators were armed men.

In Western Darfur, violence has taken an ethnic dimension, targeted against the Masalit tribe and has included forced displacement, unlawful killing, and other forms of inhuman treatment reportedly by the RSF and affiliated groups. In June 2023, MSF teams in Chad treated over 800 war-wounded patients in three days, most of them Masalit having fled El Geneina city and its surroundings. A retrospective mortality survey conducted by MSF between August and September 2023 in three Sudanese refugee camps in Chad showed excess mortality across the camps; Ourang[1] camp observed a 20-fold increase in mortality rates from April 2023 onwards with a peak in June, compared to pre-crisis rates. Additionally, an MSF survey conducted in South Darfur in February-March 2024 indicated excess crude mortality rates and found that in north Nyala, the conflict is leading to a doubling of the crude mortality rate (CMR), especially during heavy fighting in October 2023.

More than a year of full-blown conflict has had disastrous consequences on the health and well-being of people in Sudan. The physical and mental wounds of violence have been exacerbated by the collapse of the health system and the paucity of the international humanitarian response. MSF teams continue to treat people dying from preventable complications because they were unable to reach any facilities earlier or afford medicine, if available. MSF mental health teams are seeing the tremendous toll of conflict and violence on people’s mental health and psychological well-being, with widespread trauma-related symptoms sometimes leading patients to self-harm.

As MSF continues to respond to urgent medical needs and the consequences of ongoing violence, further exacerbated by lack of humanitarian access and the warring parties’ blatant disregard for human life and international humanitarian law (IHL), MSF calls for:

  • Warring parties to cease attacks on residential neighbourhoods, allow safe passage and routes for people seeking protection, and protect vital infrastructure from further destruction and looting;
  • Warring parties to stop all targeted forms of violence and abuse against populations and ensure that ethnic violence and sexual and gender-based violence are not used as weapons of war;
  • Warring parties to immediately facilitate aid; allow unhindered humanitarian access and ensure supplies and staff reach those in need; assistance must be able to reach people in need across borders and front lines. 
  • Vested partner states and regional bodies to increase pressure on the warring parties in Sudan to abide by their obligations regarding civilian protection and hold those violating civilian protections to account;
  • the United Nations to repeat and amplify messages regarding the promotion and respect of international humanitarian and human rights laws, increase field presence of UN senior staff, and ensure that protection responses are scaled up and adequately coordinated;
  • Humanitarian organisations to scale up programming and adapt the response across all sectors to the complexity of the operational context in Sudan.


[1] Currently known as Aboutenge camp

 
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