Fighting in Sudan threatens its already fragile healthcare system

Trainee anaesthetist Mazin Abd-alaal Helali was attending an emergency surgery at the government run Khartoum North Teaching Hospital in the Sudanese capital when three bullets pierced the glass windows of the operating theatre. While 29 year old Helali was busy moving the patient to the recovery room, minutes later a bomb fell on the septic theatre, a floor above.

“The patient in the septic theatre suffered minor injuries by the shelling but he was shifted out immediately,” Helali told The BMJ. “We were petrified to witness such bombing on the hospital. We never saw this before.”

More than 530 people, including 11 healthcare staff, have been killed and 4000 others injured in this African country of 47.9 million people, after violence between the Sudanese armed forces and the paramilitary Rapid Support Force (RSF) broke out on 15 April over power sharing.1 Besides the cities of Khartoum and Omdurman in Khartoum state,2 the conflict has escalated in North Darfur, North Kordofan, South Darfur, and Kassala.3

A chronically under-resourced and fragmented healthcare system with a high infant mortality rate (38 deaths per 1000 live births4), high maternal mortality rate (295 deaths per 100 000 live births5), and low life expectancy (66 years6) has become the biggest collateral damage of the violence (box 1). Of the 820 hospitals across 18 states in Sudan, 134 are in Khartoum state, where the violence is at its worst.