‘Unbearable conditions’: Inside Sudan’s rapidly failing health system

Sudan is facing the world’s largest humanitarian crisis, with over 13 million people displaced and tens of thousands killed.

What began as a political and military confrontation between the Sudanese Armed Forces (SAF) and the paramilitary Rapid Support Forces (RSF) in April 2023 has evolved into a widescale breakdown of public health, basic services, medical infrastructure and civilian safety. 

The health situation in Sudan has deteriorated to an “extremely poor condition,” with some areas experiencing complete system failure, Dr Tunc Demirtas, Horn of Africa researcher and an academic in the Department of International Relations at Mersin University, tells TRT World.

Sudanese officials say hospitals have either been destroyed, evacuated, or are operating under severe duress in Al Fasher, the capital of North Darfur and the site of recent RSF-led massacres.

“Türkiye’s hospital in Nyala remains one of the few functioning facilities in the region, yet it is increasingly constrained by shortages of medicine, anaesthetics, fuel and essential supplies,” says Demirtas. 

“Access routes are unsafe or blocked, making it nearly impossible for civilians, especially wounded patients, pregnant women and children, to reach medical care,” reporter Mohammed Nazar Awad, 25, tells TRT World.

Demirtas emphasises that RSF restrictions, active hostilities and the systematic obstruction of aid deliveries have left civilians without clean water, hygiene materials, or stable access to food.

Collapse of health resilience

According to Sudan’s Ministry of Health, over the past year and a half, the blockade has triggered outbreaks of cholera, diphtheria, malaria, typhoid and dengue fever, while malnutrition has exacerbated vulnerability to these diseases. The cumulative effect has been the collapse of health resilience at a national scale.

The severity of the crisis becomes even clearer in the field testimony of Dr Tijani Muhammad Hassan, a psychological consultant and assistant professor who has worked in Sudan’s health system since 2006. 

He tells TRT World that the war has been a bitter and punishing experience — marked by constant displacement and the daily struggle to navigate personal danger while still supporting civilians living under conditions he describes as unbearable.

At the outset of the conflict, he witnessed the killing of a civilian during a routine transport search in Khartoum. 

“He attempted to explain himself,” he says, “and they shot him dead in front of us.” His account is one of many similar incidents reported by medical professionals working under RSF-controlled zones. 

According to Dr Muhammad, RSF members threatened him directly, criticising his perceived support of SAF and pressuring him to align with them. When he refused, they intensified their threats.

He reports widespread patterns of intimidation: doctors harassed at checkpoints, kidnapped, assaulted, or forced to perform surgeries for senior RSF members. 

Since Muhammad explains that medical workers have faced “kidnapping… to unknown areas” and families were met with “demands… to pay a ransom,” he also says health staff were “forced to perform a charade to send messages that the situation is reassuring and life is normal”. 

According to Muhammad, the situation in Al Fasher during the RSF incursions was catastrophic. He says that as RSF forces expanded their control inside the city, “massacres, ethnic cleansing, sexual violence, and the killing of patients inside hospitals” took place. 

The international outcry that followed included urgent calls for the RSF to be designated as a terrorist organisation. The Sudanese army responded by announcing general mobilisation and declaring that it would prevent the RSF from advancing into the remaining northern regions.

Dr Tijani estimates the death toll in the Al Fasher area to be in the hundreds of thousands—a figure that cannot be independently verified but reflects the scale of fear and destruction witnessed by those who survived.

Lack of medical supplies 

Muhammad describes the humanitarian conditions for displaced communities as extremely severe. He says civilians fleeing Al Fasher towards Tawila, Karnoy, Ambro and Al-Dabba were “attacked, beaten and abused” on the way, with some dying from “gunfire, hunger, thirst or exhaustion.” 

He adds that only a portion managed to reach army-controlled safe areas, where local institutions and communities provided temporary shelter, food and basic medical assistance.

Khartoum faces a different but equally destabilising crisis. Water networks have collapsed, electricity outages are persistent, and refuse accumulation has created conditions that Muhammad says are ideal for the spread of vector-borne and water-borne diseases.

According to UNICEF, more than 7,700 cholera cases and 185 deaths have been recorded in Khartoum State since early 2025 — including over 1,000 infections in children under five — as the disease spreads rapidly in neighbourhoods without functioning water and sanitation systems:

Dengue infections have surged as well. Rights groups citing Federal Ministry of Health data report over 14,000 dengue cases in Khartoum State since January 2025.

The collapse of the health system is equally severe. More than 60 percent of hospitals in greater Khartoum are closed, looted or operating at minimal capacity, according to Save the Children.

Amid this collapse, young Sudanese journalists and civilians are documenting and adapting to the new reality. 

Journalist Awad, who says he had to interrupt his journalism studies due to the war, completed them online as fighting escalated. He contracted dengue fever but has since recovered, noting that the infection “strained people a lot.” 

He describes how many of his colleagues have fled the country and remain unemployed. “I miss sitting in Khartoum very much,” he says, expressing a longing for everyday civic life rather than stability rooted in conflict.

To understand the structural drivers behind this collapse, reporter Awad increasingly refers to the concept of Fourth-Generation Warfare (4GW). The model describes conflicts in which state structures are weakened not only by direct military confrontation, but also through targeted destabilisation — via disinformation, psychological pressure, economic sabotage, ideological manipulation and the mobilisation of internal proxies. 

In Awad’s view, foreign-backed armed groups in Sudan have exploited existing ethnic and political fragmentation, accelerating institutional breakdown and eroding public trust. 

He argues that the RSF’s control over gold mines, trade routes and smuggling corridors — combined with alleged foreign patronage — has enabled the militia to function as a parallel power structure, undermining national sovereignty.

Securing humanitarian corridors

Sudanese doctor and head of the Sudanese Medical Doctors Network, Dr Yasser Ahmed Ibrahim, argues that the current conflict echoes unresolved aspects of Sudan’s past, particularly from the Mahdiyya era (1881–98).

Dr Ibrahim tells TRT World that failing to examine these histories critically has allowed similar patterns of violence, coercion and militarised identity-building to resurface in contemporary Sudan.

Interviewees describe the war’s impact on Sudanese society as profound. Both Dr Tijani, who has treated displaced families fleeing mass violence, and reporter Muhammed Nazar Awad describe the psychological toll as overwhelming. 

Children have been exposed to extreme brutality; women have reported sexual assault in conflict zones; families have been separated; livelihoods have collapsed; and trauma, they warn, is rapidly becoming intergenerational.

The near-total breakdown of mental health services leaves millions without support.

Despite the devastation, field testimonies indicate that Sudanese civilians, doctors, journalists and local institutions continue to sustain the last remnants of societal resilience. Informal networks provide food, shelter and medication when official channels fail. 

Doctors and aid workers say community solidarity has prevented even greater loss of life in some regions.

However, Awad cautions that this resilience is not limitless. In his view, without a significant increase in international engagement — particularly in securing humanitarian corridors, protecting medical workers and restoring essential services — the consequences may become irreversible.

Sudan’s crisis is no longer a forecast; it is unfolding in real time. Analysts say the collapse of its health system is both a symptom and a driver of broader state failure. 

As Dr Tijani warns, the international community now faces a critical decision: intervene meaningfully to prevent further deterioration, or risk witnessing the complete disintegration of a nation whose people have already endured the unendurable.