As the new moon marking the beginning of Eid festivities rose on Thursday evening, people in the Sudanese capital of Khartoum sheltered from bullets and explosions as prayers that a ceasefire to honour the end of the holy month of Ramandan would take effect went unanswered. 

At least 400 people have been killed in a clash between two powerful military leaders in Africa’s third-largest country that broke out a week ago. The fighting has forced 70% of the hospitals in the conflict zones to shut down, leaving thousands of injured civilians with nowhere to go. Nine hospitals have been bombed and 16 were forcibly evacuated by military forces, the Central Committee of Sudanese Doctors (CCSD) reported. 

Hospitals that remain operational are overwhelmed, understaffed, and under-supplied. Critical supplies of oxygen, blood and life-saving medicines are running out, and the few medical workers that remain are struggling to access hospitals and medical centres due to the intensity of the fighting. 

“The lack of safe access to electricity, food, water, personnel, and the diminishing medical supplies are making it nearly impossible for many health facilities to function at the exact time when there are thousands injured and in need of urgent care,” World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus said.

Health workers have also been caught in the crossfire. At least three health workers have been killed as well as three World Food Programme staff. A doctor working in one of the remaining hospitals in Khartoum told the BBC he and his colleagues are “expecting … to get shot”. 

“Humanitarian operations in Sudan are virtually impossible at this moment,” United Nations Secretary-General Antonio Guterres said. “Targeting humanitarian workers and humanitarian assets must end.”

.@WHO urges all parties to the conflict in #Sudan to respect the neutrality of health care and ensure unrestricted access to health facilities for those injured in the hostilities and everyone in need of urgent medical care. Full statement: https://t.co/n8vPZlaOXf

— Tedros Adhanom Ghebreyesus (@DrTedros) April 17, 2023

The WHO said it has received reports of sexual assaults on humanitarian workers, attacks on doctors, military occupations and looting of hospitals, and ambulance hijackings. 

“The situation is catastrophic. We are still hearing gunfire from our compound as I speak. It is very unsafe because of the shooting and the shelling,” Médecins Sans Frontières (MSF) Sudan project coordinator Cyrus Paye said from an MSF-supported hospital in the western city of El Fasher. “The majority of the wounded are civilians who were hit by stray bullets, and many of them are children.”

On Thursday, military forces looted the paediatric hospital that Paye and his colleagues relied on to provide care to babies with sepsis or born prematurely. All the other hospitals in the city have been forced to close.

“Health facilities are running out of supplies and staff cannot get to work. Health workers, relief workers and rescue workers have all become immobilized by the fighting and people are dying as a result,” Paye said. “Access [to supplies] is what will change this. That, and a guarantee from the warring parties that they will spare civilians’ lives.”

❗ Update from Sudan ❗

As of this morning our teams have received a total of 279 people at South Hospital in El Fasher; 44 people have died.

The hospital has enough supplies to last for 3 weeks if we continue to receive patients at the same rate.

— MSF International (@MSF) April 21, 2023

The situation in the capital is just as dire. 

“Hospitals are running out of not just food, but medicine too. The internet cuts in and out. Electricity comes and goes,” said Germain Mwehu, a spokesperson for the International Committee of the Red Cross (ICRC) based in Khartoum. “It’s a matter of life and death that we deliver help. This is what people need most urgently.”

Airport closures have so far stymied efforts by the WHO and others to airlift emergency medical supplies to Sudan to alleviate the shortages. Dr Ahmed Al Mandhari, WHO’s regional director for the Eastern Mediterranean, said the UN health agency’s emergency response teams are on standby. 

“As soon as travel restrictions to Sudan are lifted, additional WHO specialist staff for trauma care, public health, logistics and security are available. Further supplies are on standby to be airlifted from our logistics hub in Dubai,” Al Mandhari said. “We are really hopeful that … the leaders [will] put rationalism and wisdom above personal interests and ego, which sometimes unfortunately prevail over everything else.”

Nearly 16 million people in Sudan, a third of the country’s population, were in need of humanitarian assistance before the onset of the violence. Millions more are at risk of being driven into hunger if the conflict continues, the World Food Programme said, worsening the impact of the ongoing food crisis across the greater Horn of Africa.

The United Nations estimates around 20,000 people, mostly women and children, have already fled Sudan to the relative safety of neighbouring Chad, adding to the 3.7 million people internally displaced in the country.

“We are observing a traumatic deterioration in what is already a very difficult humanitarian situation,” Al Mandhari said. “The longer the fighting continues, the greater the consequences for the health and wellbeing of millions of people.” 

“There are no winners in this war,” he added, “and the biggest losers are the nation, the people, and the citizens.”