VIOLENCE is threatening Al Nao hospital, a vital lifeline for people in Omdurman, to the north west of Khartoum, as the conflict in Sudan enters its fifth month, causing immense suffering for people in Khartoum and elsewhere across the country, says Médecins Sans Frontières (MSF).
Fighting in Omdurman has been particularly intense in recent weeks with airstrikes, gun battles and shelling, causing intense pain, suffering and death. Hundreds of men, women and children are being injured, and the unabated violence makes it dangerous and difficult for people in desperate need of healthcare to reach the few functioning facilities in the area.
‘Last week, a family came in who had been caught up in an exchange of shelling. The mother died, a young daughter died, another daughter lost a leg and a son was severely injured,’ said Omer on Thursday, an MSF medic working in Al Nao hospital in Omdurman.
‘Another family brought in three of their children who had suffered gunshots. A nine-year-old who was shot in the back and a six-year-old who was shot in the right eye, both survived, but their four-year-old passed away,’ says Omer.
In the two weeks from 29 July to 11 August, MSF staff working in Al Nao, alongside teams from the Sudanese Ministry of Health, provided emergency trauma care to 808 patients, 447 of whom had suffered injuries caused by gunshots, shrapnel from explosions or stabbings.
In the same period, the hospital treated 787 patients for other medical, non-trauma related, health conditions such as diabetes, respiratory infections, hypertension and other cardiovascular diseases, among others.
Each day, on average, the medical staff in Al Nao hospital treated 34 patients with violent trauma injuries and 77 with other medical conditions.
Al Nao hospital remains one of the last health facilities open in Omdurman, which explains the high number of patients. Al Nao is the only trauma emergency room and hospital with surgical capacity in north Omdurman, so all wounded patients are brought there.
On 4 July, a Ministry of Health staff member at the MSF-supported Al Saudi Maternity Hospital in Omdurman died after being shot while moving within the hospital compound, forcing the hospital to close. The hospital staff moved their activities to Al Nao hospital so that pregnant women in the area still had a safe place to give birth.
Heavy fighting in nearby neighbourhoods impacts people immensely. Two out of three war-wounded patients in Al Nao have gunshot wounds – this includes females, males, elderly people, children and newborns. Others have stab wounds or injuries from explosions. Even in the midst of a conflict, accidental injuries and broken legs also still need attention.
Violence is escalating around Al Nao, threatening patients and staff. On 16 August, shells landed to the north and southwest of the hospital. On days when fighting nearby is at its heaviest, Al Nao mostly receives people injured by the violence, although it remains available for patients with other medical emergencies.
Patients, such as those who have suffered strokes, heart attacks or those with gastro-intestinal emergencies, may find it too dangerous to travel or delay seeking healthcare due to fear of being caught in the violence. Some patients reach the hospital too late. The insecurity also affects hospital staff with medics working double shifts when it is too dangerous for their colleagues to travel.
Even those without immediate health needs in Omdurman face consequences of the violence. Daily life is impeded by continuous water and electricity cuts, shortages of fuel for cooking, and people lack cash or any means to provide for themselves. The desperate situation takes a heavy psychological toll.
Like anywhere MSF works, Al Nao hospital provides medical care to people based on their medical needs alone, regardless of whether they are on one side of the conflict or the other, or are simply civilians trapped in the middle of the fighting.
We support eight hospitals in Khartoum state, with our staff working in four hospitals in Khartoum city and Omdurman, on both sides of the frontlines. In addition to Al Nao, we also provide care for wounded patients in Bashair Teaching Hospital and the Turkish Hospital in south Khartoum. In July, 1,770 war wounded patients received trauma care across all three hospitals.
‘People face relentless tragedies from this unspeakable violence,’ says Frauke Ossig MSF emergency coordinator in Sudan. ‘It’s heart-breaking to see that the most vulnerable and innocent are being so devastated by this conflict.’
‘As medics in Al Nao work round the clock, shells are landing nearby, causing yet more horror and threatening the hospital’s lifesaving work,’ says Ossig.
‘We call on warring parties to spare civilians from this unacceptable violence and ensure the protection of hospitals and healthcare workers. If hospitals can’t function there will be even more misery and suffering.’
- Médecins Sans Frontières (MSF) teams are recording a concerning rise in measles and malnutrition cases in our facilities in South Sudan, particularly amongst returnees fleeing conflict in Sudan and host communities.
Mohammad Ibrahim, MSF head of mission in South Sudan stated: ‘Our medical facilities in Upper Nile, Unity, Northern Bahr El Ghazal and Warrap states are receiving patients, especially children below five years old, suffering from measles and other critical conditions.
‘As more returnees arrive at border locations, we call on donors and humanitarian actors to urgently improve the surveillance system and scale up the response from the points of entry to the places of resettlement, to ensure dignified conditions for the displaced people and host communities.
‘Measles and nutritional responses must be reinforced immediately. Screening and catch-up vaccination at points of entry must be extended to 24/7.
‘Equally, mobile vaccination teams must be deployed in transit, reception sites and within host communities to ensure continuous screening and catch-up vaccination for new arrivals that have been missed at the border. Community surveillance must be strengthened to prevent the further spread of measles,’ says Ibrahim.
Since the eruption of conflict, over 200,000 people have been registered crossing to South Sudan as of the first week of August. Over 90 per cent of them are South Sudanese, arriving exhausted and extremely vulnerable.
These people, mostly women and children, are either spread across the country struggling to integrate themselves into communities, or at transit centres close to the border; in both cases requiring essential services such as healthcare, access to clean water and sanitation infrastructure, food and non-food items, protection, and shelter.
‘We are in a terrible situation. There is no food. We are living under the trees,’ says Nyakiire Nen, whose two-year-old daughter is receiving treatment for measles at the MSF hospital in Bentiu camp in Unity state.
‘We want three things to survive. The first one is food. The second one is plastic sheets to have a shelter. And thirdly, we need medication,’ said MSF.
‘In view of the alarming influx of measles patients in Renk and Bentiu, our teams have set up dedicated isolation wards, while the capacity of MSF facilities have been expanded to treat more patients in Aweil, Leer and Malakal.
‘In Twic County, we supported the establishment and equipment of a 25-bed measles isolation centre at Mayen Abun Hospital, while supporting the training of frontline healthcare workers on case definition, identification and management of measles in eight general healthcare centres across the County.
‘In Upper Nile state, Renk is the busiest entry point to South Sudan for those escaping the conflict, many originating from White Nile state, Sudan, where in the past month, our teams have identified over 1,300 suspected measles cases. Since 20 June 2023, the isolation ward set up by MSF in Renk County hospital has received 317 patients, more than 75 per cent being returnees.
‘Children are the most affected, with more than 80 per cent of patients being children under four years old. Less than 15 per cent of them have been vaccinated against measles. As these returnees are living together in congested transit centres and travelling in large numbers on crowded trucks or boats, the spread of the disease is enormous.
‘In Paloich, we launched a three-week emergency intervention on 27 July 2023, focusing on addressing the health and nutrition needs of over 3,000 people residing in the returnees’ camp,’ MSF added.
‘My children were healthy when we were in Khartoum. But on the way, they started having diarrhoea and becoming weak,’ said Martha Nyariek about her one-year-old daughter, Nyageng Mawich, and three-year-old son Bol Mawich.
‘We were drinking river water in Malakal, and the colour of it was almost red. When we were moving with the boat from Malakal to Bentiu, the children started having symptoms of measles,’ she says.
‘In Malakal, the humanitarian situation for returnees in Bulukat transit camp remains dire and exacerbated by lack of food and transport to their final destination. They come in large numbers with many sick people, particularly children. A constant increase of malnutrition cases is being recorded in our facilities,’ MSF said.
‘We have started a mobile clinic in the transit camp, while the MSF hospital – the only specialised healthcare facility for children – is working beyond its bed capacity. Similarly, the MSF hospital in Aweil has witnessed a 65 per cent increase in malnutrition cases in the first six months of 2023, compared to the same period last year.’
‘If a child is malnourished, it is easier to be infected by measles and there is a higher risk of death,’ says Dr Ran Jalkuol, MSF medical doctor, adding: ‘Most of our patients are children who are unvaccinated.
‘To prevent measles from taking more lives, there is an urgent need to scale up food support and to conduct catch-up vaccinations to immunise everyone, especially returnees of age six months and above. Children between six months and four years old are the most vulnerable,’ Dr Jalkuol concluded.
South Sudan is already prone to regular measles outbreaks. In 2022, two measles outbreaks were declared by South Sudan’s health authorities, with the latter affecting all the states and administrative areas.
The influx of returnees and growing cases of measles among displaced people and host communities is another burden on a healthcare system that is already inadequate to meet the needs.
