In Sudan, health systems are under attack as government and paramilitary forces battle for control of the country in a new conflict that began on April 15. As the crisis enters its third week, health care professionals in Sudan fear a total collapse of the health care system. Hospitals especially are on the brink. Dr. Ahmed Al-Mandhari, regional director of the World Health Organization's office for the Eastern Mediterranean said that 61% of the medical institutes in Khartoum have stopped offering services due to the direct military attacks and occupation, according to AfricaNews, while the IRC reported that only 16% of hospitals are functional. The situation for the most vulnerable is dire, and it is estimated that in the next few weeks, approximately 24,000 women will deliver babies without access to maternal care.
“Both sides in this conflict — Sudan Armed Forces and Rapid Support Forces — appear to be engaged in gross violations of the law of armed conflict. Most notably, there are credible reports that hospitals have been targeted, aid factories have been ransacked, and civilians have been caught in the crossfire, unable to access basic humanitarian services as required by the Geneva Convention,” said Nathaniel Raymond, executive director of the Humanitarian Research Lab (HRL) at the Yale School of Public Health (YSPH) and a lecturer in the Department of the Epidemiology of Microbial Diseases at YSPH. He adds, “Although this is an internal conflict, the core tenets of the Geneva Convention apply and both sides must allow humanitarian aid workers to do their jobs now when the people of Sudan need them the most.” Almost 413 people have died in the fighting and almost 3,200 more have been wounded, according to the World Health Organization’s most recent updates, but officials believe the real number to be much higher.
Human rights violations, including violence against health care workers, lead to concerns about the broader public health system crumbling. As chaos engulfs the capital city of Khartoum and spreads across several other states across the country, including Darfur and North Kordofan, public health researchers fear what might come as a result.
“There are multiple public health issues of high priority that need our attention,” said Kaveh Khoshnood, associate professor of Epidemiology (Microbial Diseases) and faculty director of the HRL at the Yale School of Public Health. “One is potential outbreaks of infectious diseases, including cholera.”
Since 2016, Sudan has witnessed recurring cholera outbreaks. The current conflict is expected to exacerbate the situation by limiting access to safe drinking water, sanitation facilities, and other hygiene resources, leading to a potential surge in cholera cases. Moreover, in 2020, Sudan faced a measles outbreak, which could resurface from the current conflict's disruptive effects on supply chain and cold chain systems, resulting in reduced access to vaccinations, health care services, and laboratory capacities.
Compounding these concerns, on April 25, the WHO reported that there is a “high risk of biological hazard” in Khartoum after one side seized a laboratory holding measles and cholera pathogens and other hazardous materials. Nima Saeed Abid, the WHO's representative in the country, stated that the main issue is that lab technicians do not have safe access to the lab to contain the biological material and substances.
The conflict has worsened Sudan’s complex displacement crisis, creating a surge in the number of internally displaced persons (IDPs) within Sudan. This “could make them even more vulnerable to diseases such as diarrhea, respiratory infections, and malnutrition,” said Khoshnood. On Monday, 1 May, the UN warned that 80,000 people may flee the country.
The crisis hits close to home at the Yale School of Public Health. We have a strong partnership with several leading educational institutions in Sudan, including Ahfad University for Women, the University of Gezira, the University of Khartoum, Neelain University, and the Public Health Institute of Sudan. This partnership, the Yale-Sudan Program for Research Leadership in Public Health, has been supported by the U.S. Embassy in Sudan as well as a Hecht Award from the Yale Institute for Global Health. “Now is an urgent time for us to reach out to our Sudanese colleagues and ask how we can support them to deal with their wide range of public health challenges,” Khoshnood said.