Mayhem Prevails in Khartoum’s Hospitals

Four doctors detail the profound challenges and harrowing realities of providing health care amid the ongoing conflict in Sudan

Mayhem Prevails in Khartoum’s Hospitals
Relatives sit by a patient at a makeshift emergency room set up by Sudanese volunteers in a school in Omdurman, the capital’s twin city, on May 27, 2023. (AFP via Getty Images)

In April of this year, a firefight erupted in Khartoum between the Sudanese Armed Forces (SAF) and the paramilitary Rapid Support Forces (RSF), near the residence of the SAF’s leader General Abdel Fattah al-Burhan. Since then, fighting has engulfed the Sudanese capital, leaving civilians trapped in their homes, unable to access medical care. As more and more civilians are caught in the crossfire, doctors are struggling to treat the rapidly increasing number of casualties.

“Three days after the war started, we were out in an ambulance delivering medicine when we got caught between the army bombing and RSF shooting,” Dr. Alnameir Gibril Ibrahim, a 46-year-old cardiac surgeon, tells New Lines.

“We had to stop because if we continued driving, the planes would think we were a target,” he continues. “We were right in the middle, stuck there under fire for 20 minutes, just dust around us from the fighting.”

Eventually, Ibrahim and his team were able to deliver the medicine. But when they returned to Al Shaab Teaching Hospital, it had been bombed twice. “We had to evacuate all our staff and patients and move to a different hospital,” he explains.

Damage to Al Shaab Teaching Hospital in Khartoum, Sudan, after it came under attack on April 17. (Photograph taken by a doctor at the hospital and supplied to New Lines by Dr. Alnameir Gibril Ibrahim)

As of May 20, 39 of Khartoum’s 59 hospitals had been shut down by artillery fire and aerial bombardment, while 60 of 110 hospitals in Khartoum and neighboring states were similarly destroyed, forcing physicians like Ibrahim to abandon their places of work and consolidate their operations in a shrinking number of makeshift hospitals across the country. No medical facilities are functioning in the city of El Geneina in Sudan’s West Darfur region, according to the Sudanese Doctors Union. In the 29 hospitals still operating in the country, electricity and water are scarce, medical supplies are running dangerously low and fuel is astronomically expensive and nearly impossible to find. Hospitals have no food and doctors are working around the clock to care for patients in a health sector on the brink of collapse.

Four doctors spoke to New Lines about the desperate situation they find themselves in and the challenges they face in delivering health care amid the ongoing conflict.

“In a day it all changed. Some said they saw the RSF moving in. But I didn’t see them. It just seemed like a normal day, and I went home at 1 a.m. like usual. The next day, I woke up to war.”

“Khartoum was beautiful,” Ibrahim recalls sadly, as the heavy boom of bombing and the rattle of gunfire outside drown out the buzz of the overwhelmed Bashair Teaching Hospital.

“You would wake to the sound of the birds singing as they dived about the Nile River. Now, all we hear is the sound of shooting and fighter jets. I wake up every morning and hope for a ceasefire. Sometimes, for a moment, there is silence, and I think the ceasefire has come,” he says, pausing. “Then I hear the planes again.”

On the morning that I speak with Ibrahim, he is distracted. He hasn’t been able to get in touch with one of the ambulances that left earlier that day. He is worried that it has been caught up in the fighting or that the doctors have been kidnapped.

“My job is everything, sending ambulances out to collect or deliver supplies, trying to get electricity and water for the hospital, working to bring our doctors and volunteers safely to our hospital,” he says. “I am just doing whatever we need to keep this hospital running now.”

Damage to Al Shaab Teaching Hospital in Khartoum, Sudan, after it came under attack on April 17. (Photograph taken by a doctor at the hospital and supplied to New Lines by Dr. Alnameir Gibril Ibrahim)

Since the clashes first broke out in April, 950 civilians have been killed and more than 4,700 have been injured. Every day, it becomes more difficult to treat patients, as supplies dwindle and more and more hospitals close. 21 doctors, medical staff and medical students have been killed since April 15, according to the Sudanese Doctors Union.

“Right now we have 100 beds full. In one day, we received 61 patients wounded in the fighting,” Ibrahim continues. Today is quieter — “only” eight new patients have arrived. Even so, treating them is overwhelming, especially on top of the patients who are already there.

“We only have anesthesia masks or local anesthetic,” he continues, explaining that the hospital desperately needs blood bags and anesthetic drugs. “We are treating every injury … but we have no anesthetic to give them.” Yet they have to proceed with surgery for those in critical condition. Meanwhile, ordinary patients cannot leave their homes and are not coming to the hospital for treatment. “Even those with emergencies don’t know where to go,” Ibrahim says, briefly excusing himself to try to call the ambulance that left earlier that morning.

Electricity is another ongoing problem, as are food, water and medical supplies.

“For one month we had no electricity for 20 days because the towers were bombed, so we were operating with torches on our phones,” Ibrahim says, explaining that the electricity was restored just two days ago after a 10-day outage. “The price of gasoline to run our generator went from 2,500 Sudanese pounds before the war to 40,000, and it can only be bought on the black market. Ninety percent of the food in the markets is gone, and the hospital has no clean water, so volunteers take the risk to go outside and bring water back for us.”

Now, the doctors sleep in the hospital. There are no shifts anymore. No one is receiving their salary. Nevertheless, Ibrahim is continuing to train new nurses and volunteers because the hospital needs more staff to cope with the daily onslaught of new patients.

“Now what we need most is safe roads for our ambulances to travel,” he says, adding that this has become particularly deadly for doctors. “Doctors are being stopped on the roads by militant groups trying to force us to give them our ambulances,” he continues. “The doctors can’t come here in their own cars or the groups will try to kidnap them because they know they are doctors and they need a doctor to treat their men’s injuries.”

According to Doctors Without Borders, some groups are even attacking and looting hospitals, taking what scarce medical supplies they have and setting up bases inside hospitals across the country.

“Every day is a mix of feelings, fear, no hope,” Ibrahim continues. “It’s everything at once. In the first few days we had some hope that this war would end soon. Now it’s hard to keep that hope four weeks later, when we are running out of everything and the casualties don’t stop.”

“We have lost our sense of time. It feels there is no start or end to a day. The days and nights blur into one. There are no shifts. We just continue working until every patient has been treated. This is our work. But right now, we really need a ceasefire.”

“I just hear the heavy bombs and the air force jets … the whole day.”

Some doctors have been targeted for their political involvement, forcing them to stay home or flee the country for their own safety.

“I am a pro-democracy activist,” says Dr. Alaaeldin Nogod, a liver and transplant surgeon at the Ibn Sina Specialized Hospital in Khartoum. “In 2018, I was very involved in the revolution, and I was treating the protesters, so my name is well known.”

In April, the hospital where Nogod works was bombed three times in one day, forcing all of the patients and staff to evacuate. But it wasn’t until May, when a message started circulating on social media that Nogod was a rebel, working with the Rapid Support Forces, that he felt like he could no longer go to the hospital.

“They called me a disbeliever, because the Muslim Brotherhood believes they are the only one believing in Allah and god and everyone else is a disbeliever,” he shares. “Many of my colleagues and political activists asked me not to show up in the hospital anymore, and stay in a safe place.”

After receiving the message, Nogod sent his family away for their own safety. He stayed home from the hospital, keeping busy by working with patients from home, and supporting staff if needed.

Nogod and a few of his colleagues have also created WhatsApp groups with lists of doctors with a wide range of specialties and their contact information, making it easier for patients to seek treatment if needed, given the hospital closures.

“There is also a list of pharmacies which can deliver medicine to people’s homes if they are residing nearby,” he continues, describing the way that he and his colleagues have adapted to the difficult circumstances.

“When there is no internet, it’s a disaster,” he says. “It stops the doctors’ group which helps the citizens in their homes, it stops us from knowing the situation at the hospitals and their needs, we don’t know if they need people dispatched there, many things are affected.”

Nogod is not the only one of his colleagues who has been receiving threats. Many are also accused of treating RSF fighters. “But doctors are neutral,” he clarifies. “We treat anyone who is injured and comes through our doors.”

For now, some hospitals remain open despite fighting on their literal doorsteps. “It’s absolute chaos,” he says. Doctors are working around the clock and many of his colleagues have not been home for more than a month. It is also incredibly dangerous. Ambulances from his hospital have been targeted with gunfire on six separate occasions and 11 of Nogod’s colleagues have been killed since the fighting began.

Even finding the opportunity to properly bury the bodies of the dead is a challenge.

“There is no morgue in the hospitals anymore,” Nogod says, describing how, on one occasion, a group of Khartoum University students had to bury one of their peers under the university football pitch because they had no way of safely leaving the university for several days.

“There are dead bodies in the streets, starting to decompose. Even during the ceasefire, when there was an evacuation of the foreign delegates, there were some volunteers who collected these bodies but there was no way to take them to the morgue or do identification and proper burial. They just bury them anywhere and when they have the chance.

When the war first broke out in August of last year, Nogod thought that it would be over in a matter of days.

“Although there was an escalation of tension between the two sides, we were not expecting it to erupt that much,” says Nogod. “I think the Muslim Brotherhood was waiting for this for a long time.”

Burhan and General Mohamed Hamden Dagolo, who heads the RSF, have a history of collaborating. They both played a role in the country’s counterinsurgency against Darfur rebels in 2003. Later, they allied to topple Omar al-Bashir’s government in 2019, as well as the civilian government that came afterward in 2021. Yet the power vacuum left after the most recent coup soured their relations and the situation deteriorated as a deadline to form a new civilian government approached.

When the clashes erupted in April, these tensions boiled over and the violence quickly escalated. Nogod says that fighting is now much more intense than it was during the revolution in 2018.

“Right now, the difference is that the air force is bombing,” he says. “During the protests, it was only Kalashnikovs.”

From Nogod’s perspective, the people responsible for the war are the Muslim Brotherhood, a faction inside the army. “They lost their power in the revolution in 2018 and now they have erupted this war between the RSF and the Sudan Armed Forces, and they are targeting the hospitals. They are also bombing neighborhoods where there is a strong resistance community that were very involved in the revolution and resisted the previous regime.”

Nogod says that many doctors feel like they, and the hospitals they work in, are being specifically targeted due to the role that outspoken doctors played in the 2018 revolution.

“The doctors were a very strong body in the first revolution in 2018, and made 271 days of strike against Omar al-Bashir, so it feels like these people are taking revenge right now on the doctors and the resistance community,” he says. “I think it’s targeted.”

While Nogod feels that many Sudanese people were optimistic about the direction that the country was going in after the coup that toppled Bashir, that hope has since been lost. “There was a lot of aspiration and people were hopeful to have a civilian prime minister and for Sudan to be off the list of terrorist countries. We started to build a good external relationship, people are working towards a better future and we have many big projects in infrastructure with First World countries’ delegates coming to make investments here. So, there was great hope.”

Then, it all changed in a day.

“It’s terrible to think about war in the capital of the city, but still doctors in the hospital are still working and there is much light at the end of the tunnel and it’s this light that is making us continue.”

“The medical staff are overworked, they are stressed, they are overthinking and we can no longer follow guidelines and protocols, we just do what we think is right for the patient.”

Meanwhile, Dr. Duria Rayis never thought she would find herself leaving Khartoum. But after 32 years as an obstetric gynecologist, she is on the long journey to Cairo, fleeing her hometown, her work and her patients. The guilt weighs on her heavily.

When the war started, the 58-year-old Rayis could not get to her job at the Saad Abualle Maternity Hospital in the Faculty of Medicine at the University of Khartoum. “I couldn’t go because my home was in the middle of the clashes and all the bridges were closed. And there were missiles coming down on the streets and our homes,” she says over the phone, the signal frequently cutting out.

Given that the hospital was also in the middle of the fighting — and was soon forced to close when it was hit by missiles — Rayis moved to another part of the city and started working at the nearby Alsaudi maternity hospital.

“Pregnant ladies cannot access prenatal or antenatal care and they are not able to go to an emergency room if anything happens to them, because of the lack of transport, and insecurity in the streets,” says Dr Rayis from the busy border crossing between Egypt and Sudan. “We are seeing hospitals closing every day and the number of hospitals with maternity wards is getting less and less.”

More than 1.1 million women in Sudan are believed to be pregnant. Of an estimated 219,000 pregnant women in Khartoum, 24,000 are expected to give birth in the coming weeks, all of whom need care.

Before the fighting started, Rayis’ hospital was delivering 50 babies each day. Now, with a huge number of patients forced to use only a few remaining maternity hospitals, that number has tripled. “The situation in Sudan is living in a nightmare,” she continues, saying that many medical staff members are staying at the hospitals because they don’t want to risk going outside in the streets. On May 5, Farida Abdelmonem, a resident physician at the Omdurman Maternity Hospital, was killed by the RSF’s gunfire, according to the Sudanese Ministry of Health.

“The medical staff are overworked, they are stressed, they are overthinking and we can no longer follow guidelines and protocols, we just do what we think is right for the patient,” says Rayis. This can often mean making difficult choices about whose life to save. Often, she does cesarean sections to save a mother’s life over the baby’s, as she has no equipment to support the newborn.

In other maternity wards in the capital, midwives report babies dying due to a lack of oxygen supplies.

“Sometimes I do cesarean section for a patient instead of a vaginal birth, because I do not have enough medical staff to help her during labor. I do not have enough CTGs, the machine to monitor the baby, working for every patient,” she says. She and her colleagues are often forced to discharge patients mere hours, as opposed to days, after completing a cesarean section.

It is also impossible to support patients at home. “If [a patient] has high blood pressure, it is far better to terminate the pregnancy so she does not have a seizure from preeclampsia outside where she will not be able to get care.” She explains that more than 50% of pregnant women have to leave Khartoum to get care. Many spend two or three days traveling to Egypt by bus to give birth.

“The maternal mortality in Sudan is one of the highest in the world,” she continues. “I think this war has increased this rate by double.” The last she heard from her colleagues on June 14, there were four maternity hospitals still open in the capital and one partially operational.

“These are my people and this is our city, which we love.”

On the other side of the city, a young doctor has just arrived for his shift. He asks not to be named but tells me he often remembers the busy markets of Khartoum before the war and the rapidly growing number of skyscrapers that were reshaping the skyline. “It once exploded with life.” Now all he hears are fighter jets. “Sometimes, in a moment of silence, I hear a memory of what the city once was.” Even though his family have now left Sudan, he has vowed to stay.

“I don’t know when my family will be able to return or when I will see them again. To be honest, the thought is too heavy and the only way to move forward from it, mentally, to focus my thoughts, is to do my job.”

“We are watching bullets come through the windows of our wards and bombs tear through the roof, but every day there are people who need immediate help and that is why I am here, to do what I can, for everyone in need,” he says. “These are my people and this is our city, which we love.”

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