Healthcare challenges during civil war in Sudan

This is article no. 2 in a series about global health injustices. Next article: Yemen: a neglected humanitarian crisis. Previous article: Life under occupation in Palestine

Introduction

Welcome to the second article of the Global Health Injustices Series. My previous article focused on the Palestinians and the injustices they face, notably the blockade of food, water and medical supplies in Gaza. This one will focus on Sudan by examining the health inequalities and inequities the wider Sudanese population faces, mainly due to the ongoing civil war between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF). This carries direct and indirect consequences (Figure 1); some of these will be discussed in this article, along with ways forward to advocate and support the Sudanese people after an overview of Sudan’s history and current state.

Sudan: a rich history to modern challenges

Sudan is a country in North Africa bordered by South Sudan, Egypt, the Central African Republic, Libya, Chad to the northwest, Eritrea and Ethiopia. Sudan has had shifts in political power over centuries, notably the joint Egyptian-Ottoman rule beginning over 200 years ago before the British government took control of Sudan during the first half of the 20th century. 

After that, Sudan became independent, and South Sudan gained independence in the 21st century. Through these different shifts, there has been a struggle for representation and power in Sudan, leading to various crises, including the current civil war (Figure 2). Despite this, Sudan maintains its multiple languages and cultural traditions through its resilient population.      

Aside from the SAF and RSF, the civil war in Sudan has arms trade and exports from external governments, particularly the United Arab Emirates (UAE), Russia, and China, have accelerated the civil war. This expansion is crucial because it illustrates how much geopolitics has severe consequences on the health and wellbeing of the Sudanese people.  

Health in Sudan: the consequences of civil war and geopolitics

In a public health situation analysis (PHSA) by the World Health Organisation (WHO) published in 2024, they highlighted four major emergencies in Sudan: food insecurity, displacement, epidemics and conflicts, which are intrinsically linked to detrimental health outcomes like non-communicable diseases (NCDs), trauma and injury, measles and malaria. Moreover, several mortality indicators were noted in the PHSA. For example, the mortality rate among infants is 39 per 1000 people and for children, it is 54 per 1000, both originating from the United Nations Children's Fund (UNICEF).

These outcomes among infants and children are attributed to health conditions, such as those occurring neonatally and lower respiratory infections. Nonetheless, there has been increased vaccine coverage in Sudan to fight the spread of infectious diseases. For example, COVID-19 vaccination reached approximately 12.6 million people (28% of the population) in March 2023, along with improved polio and rotavirus vaccination. However, all of these outcomes highlight the magnitude of the civil war in Sudan, with the impact of the arms trade adding fuel to it. 

Looking at Sudan’s healthcare system, there are several pressures to highlight. One commentary article noted that in conflict areas, less than one third of hospitals are operational, while 70% of them are not. Additionally, the operating hospitals stopped for various reasons, mainly shortages in electricity, medical equipment and healthcare workers. With the aforementioned geopolitical context, these gaps in the healthcare system are amplified and lead to the worsening health outcomes outlined in the PHSA, such as the rise in NCDs.

Not only are NCDs rising in Sudan, but infectious diseases are exacerbated in Sudan with the civil war. One of them is drug-resistant tuberculosis (DR-TB), caused by bacteria. One systematic review found that the prevalence of TB with resistance to drugs was 47%; the ones that are not working on TB with the highest resistance include isoniazid at 32.3%, streptomycin at 31.7% and rifampicin at 29.2% resistance. These values are likely to be higher nowadays, given that arms trade exports into Sudan are increasing and leading to more patients not getting sufficient care to manage or treat DR-TB. 

Another infectious disease that is a significant health problem in Sudan is schistosomiasis, which is caused by parasites. One systematic review included two categories of the disease: Schistosoma haematobium (S. haematobium) and Schistosoma mansoni (S. mansoni). S. haematobium prevalence was 24.83%, and for S. mansoni, it was 19.13%. These signify that although devising preventative strategies against these infections is crucial, it is paramount to consider the broader picture in Sudan: tackling schistosomiasis and other infections begins with understanding the geopolitical context.

Looking at undernutrition among children in Sudan it is another significant health problem. For instance, a meta-analysis found that Sudan had the highest prevalence of stunting among North African countries at 36%; this was also true for wasting, where Sudan had a prevalence of wasting at 14.1% and a prevalence of underweight at 24.6%. Therefore, in a similar sentiment to tackling infectious diseases, understanding the geopolitical context in Sudan is vital to minimising the prevalence of undernutrition among children. 

Reflecting on all the data and sources I used above, gaps and perspectives still need to be addressed and highlighted, specifically in places within Sudan where the ongoing civil war severely impacts research. This signifies the importance of obtaining reliable information to support communities in Sudan facing numerous injustices. In turn, filling these information and perspective gaps may apply to other crises similar to Sudan.  

Protecting health in Sudan: crucial ways forward from NGOs

To move forward, several NGOs, particularly Amnesty International, have made recommendations to protect the Sudanese people:

Therefore, taking these steps on board is essential to upholding human rights and ensuring that the health and wellbeing of the Sudanese people are sustained, particularly during the ongoing civil war. If not, these health inequities and inequalities will only be exacerbated. Moreover, the health outcomes from infectious and chronic diseases outlined are likely worse now, given how much weapons trading has occurred.   

Conclusion: call to action for the international community

Overall, the civil war in Sudan has had devastating impacts on the health and wellbeing of the whole population, particularly the infants and children, among the other injustices. Unfortunately, this crisis has not received a lot of mainstream attention compared to others currently, such as Palestine, which is also a significant injustice. Therefore, Sudan must be addressed just as openly through discussions of justice and advocacy through the voices of the Sudanese people.

Moreover, my statement in the previous article on Palestine rings true:

This is essential to maintain the health and wellbeing of the Sudanese people, particularly to facilitate the recommendations from NGOs such as Amnesty International.

In my next article, I will discuss Yemen because this population is also encountering civil war as one of the many injustices which have been occurring for more than a decade, and Yemen is considered to be going through one of the worst humanitarian crises of our time. Similarly, these impacts on the health and wellbeing of the Yemeni people still need awareness and discussion.

Written by Sam Jarada

Related article: A perspective on well-being

REFERENCES

Crisis in Sudan: What is happening and how to help. The IRC. 2025. Available from: https://www.rescue.org/article/crisis-sudan-what-happening-and-how-help 

Khogali A, Homeida A. Impact of the 2023 armed conflict on Sudan’s healthcare system. Public Health Challenges. 2023 Oct 28;2(4). Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/puh2.134 

Elamin A, Abdullah S, ElAbbadi A, Abdellah A, Hakim A, Wagiallah N, et al. Sudan: from a forgotten war to an abandoned healthcare system. BMJ Global Health. 2024 Oct;9(10):e016406. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11529772/ 

New weapons fuelling the Sudan conflict. Amnesty International. 2024. Available from: https://www.amnesty.org/en/latest/research/2024/07/new-weapons-fuelling-the-sudan-conflict/#:~:text=Shipment%2Dlevel%20trade%20data%20indicates,into%20lethal%20weapons%20in%20Sudan. 

PHSA -Sudan Complex Emergency 030424 SUDAN CONFLICT. World Health Organisation (WHO); 2024. Available from: https://cdn.who.int/media/docs/default-source/documents/emergencies/phsa--sudan-complex-emergency-030424.pdf?sfvrsn=81039842_1&download=true 

Alaa Dafallah, Osman, Ibrahim ME, Elsheikh RE, Blanchet K. Destruction, disruption and disaster: Sudan’s health system amidst armed conflict. Conflict and Health. 2023 Sep 27;17(1). Available from: https://conflictandhealth.biomedcentral.com/articles/10.1186/s13031-023-00542-9 

Hajissa, K., Marzan, M., Idriss, M.I. and Islam, M.A. (2021). Prevalence of Drug-Resistant Tuberculosis in Sudan: A Systematic Review and Meta-Analysis. Antibiotics, 10(8), p.932. doi:https://doi.org/10.3390/antibiotics10080932. 

Yousef Alsaafin, Omer, A., Osama Felemban, Sarra Modawi, Ibrahim, M., Mohammed, A., Ammar Elfaki, Abushara, A. and SalahEldin, M.A. (2024). Prevalence and Risk Factors of Schistosomiasis in Sudan: A Systematic Review and Meta-Analysis. Cureus. doi:https://doi.org/10.7759/cureus.73966. 

Nagwa Farag Elmighrabi, Catharine, Dhami, M.V., Elmabsout, A.A. and Agho, K.E. (2023). A systematic review and meta-analysis of the prevalence of childhood undernutrition in North Africa. PLoS ONE, 18(4), pp.e0283685–e0283685. doi:https://doi.org/10.1371/journal.pone.0283685.