On April 15, 2023, extreme fighting in Khartoum and other parts of Sudan began between the Sudanese Armed Forces (SAF) led by General Abdel Fattah al-Burhan (de-facto leader of Sudan) and a paramilitary group called the Rapid Support Forces (RSF) led by General Mohamed Hamdan Dagalo “Hemedti” (Burhan’s former deputy). The two had previously worked together during the 2021 coup to dissolve the sovereign council and transitional government that was in place after ousting former President Omar al-Bashir.
Though it remains unclear which side prompted the fighting, tensions over authority have been rising in recent months. As of May 9th, the death toll in Sudan is 604 people, with 5,100 injured. Moreover, the fighting has caused over 700,000 people to flee their homes.
One impact of the fighting has been the severe decline in healthcare availability, accessibility, and quality in Sudan over the past four weeks. Movement restrictions caused by ongoing violence and insecurity have compromised the accessibility of healthcare facilities. Personnel shortages and a lack of life-saving medical supplies have rendered many medical services unavailable. Several organizations have reported attacks on healthcare facilities, personnel, and transport in Sudan. The Central Committee of Sudanese Doctors (CCSD) reported 39 out of 59 hospitals in Khartoum and nearby states are out of service, while Sudan’s Health Ministry reported that 16 hospitals were damaged. Insecurity Insight published a list of incidents that occurred between April 15 – 19, including the murder of a doctor, multiple healthcare facilities being looted, and instances of violence preventing ambulances from reaching their intended destinations. Currently, the RSF are strategically occupying the Omdurman Maternity Hospital to take cover from airstrikes. Given the frequency of electricity and internet outages in Sudan, there is a high likelihood that more incidents are occurring unreported.
Attacks on healthcare facilities, personnel, and patients are prohibited by International Humanitarian Law (IHL) and are considered war crimes. The Geneva Conventions of 1949 and the Additional Protocols of 1977 mandate ensured specific protections for medical facilities, personnel, transports, and the right of access to care. Nevertheless, the right to health during conflict is not confined to health services only. The Committee on Economic, Social and Cultural Rights General Comment No. 14 emphasized the connection between the right to health and underlying determinants of health like food and water—both of which have been reported insufficient in Sudan for a long time.
In response to the ongoing violence, Sudanese people have shown an exceptional sense of community to overcome the current situation. Social media platforms like Twitter and What’s App became tools to help the Sudanese community share information in an attempt to realize the right to health amidst the chaos. For instance, individuals tweet using #حوجة_الخرطوم (Translation: #Needed_Khartoum) to share information about which hospitals are open and the availability of healthcare supplies like insulin and oxygen tanks. Sudanese communities living abroad have also mobilized to provide support. For instance, the Sudanese Doctors Association in Qatar has launched a campaign to provide a hotline for medical consultations through What’s App for patients unable to access healthcare services.
Although the right to health of the Sudanese people is protected under international law, more efforts are needed to ensure that these laws are respected on the ground. Similar situations have been observed in several countries, including Ukraine and Palestine. The latest Safeguarding Health in Conflict Coalition report in 2021 identified 1,335 incidents of violence or obstruction against healthcare officials. Unfortunately, international support has been limited to failed attempts at a truce and condemnations. There has been a heavy focus on evacuating foreign nationals, leaving Sudanese citizens to their fate.
On April 18, the World Health Organization “strongly condemned” attacks on Sudan’s health personnel, health facilities, and ambulances, identifying them as a violation of international law and the right to health. However, condemnations are not enough. The international community should use different mechanisms to reinforce IHL and warn all sides that referrals can be made to the UN Security Council, International Criminal Court, or other tribunals, as has been done in recent conflicts.
In the midst of the Russian invasion of Ukraine, internal conflicts across multiple countries in West Africa and West Asia, natural disasters, and climate change crises, it may be easy to overlook the latest news from Sudan. However, doing so would be a mistake. The effects of conflicts, like pandemics, cross borders and impact us all. Both need to be addressed through stronger international cooperation and solidarity.
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