Sudanese medics have described seeing piles of bodies in the streets of the capital, Khartoum, people drinking polluted water, and doctors working under bombardments as the battle between the country’s two warring generals continues despite a threadbare ceasefire.
Intense explosions and shelling were audible in Omdurman, Khartoum’s twin city across the Nile, on Monday and there were reports of further explosions and clashes in the Bahri and Kafouri districts of Khartoum North. In the south of Khartoum, residents reported that the paramilitary Rapid Support Forces (RSF) fired anti-aircraft missiles in response to bombardments by the Sudanese Armed Forces (SAF).
Critical shortages of basic goods including water, food and fuel began to take hold amid rising violence, which has so far killed more than 500 people.
Sudan’s doctors’ union described “an environmental catastrophe” as the number of corpses piled in the streets mounted. With water supplies disrupted across parts of Khartoum, particularly in Bahri, cases of severe disease have risen as desperate people have sought to relieve their thirst by drinking directly from the Nile.
Fighting continued to rage as the UN’s special representative for Sudan, Volker Perthes, said the SAF and the RSF were willing to send parties for talks, possibly in Saudi Arabia. Perthes said the talks would begin with a focus on full enforcement of a ceasefire, as multiple temporary truces have seen little enforcement since the two sides began battling across the streets of the capital more than two weeks ago.
Gen Mohamed Hamdan Dagalo, known as Hemedti, who heads the RSF, told the BBC days ago that he would agree to talks only after a full ceasefire had been implemented. The RSF has made no public announcement of its willingness to join negotiations.
More than 800,000 people could flee into neighbouring countries, the UN’s refugee agency has warned. “UNHCR, with governments and partners, is preparing for the possibility that over 800,000 people may flee the fighting in Sudan for neighbouring countries,” the agency’s chief, Filippo Grandi, said in a tweet. “We hope it doesn’t come to that, but if violence doesn’t stop we will see more people forced to flee Sudan seeking safety.”
As civilians across the Sudanese capital became increasingly isolated and vital supplies ran low, doctors and aid organisations said the country’s healthcare system was on the verge of collapse. Many essential services and evacuations have moved to the town of Port Sudan, 500 miles away on the Red Sea coast, which became the country’s temporary administrative capital as it sheltered thousands who had fled fighting that has overtaken Khartoum, Omdurman and parts of Darfur.
“The scale and speed of what is unfolding is unprecedented in Sudan,” said Stéphane Dujarric, a spokesperson for the UN secretary general.
The World Health Organization (WHO), the International Committee of the Red Cross (ICRC) and Sudanese doctors said the healthcare system could collapse, with many hospitals close to the frontlines unable to fully function or having shut down completely.
Just 16% of hospitals in the Sudanese capital, the centre of the fighting, were functioning at full capacity, according to the WHO, with most closed after direct attacks during the fighting.
Dr Houida El-Hassan said she had gathered with colleagues to reopen a facility in Khartoum on the third day of the fighting, now operating on a skeleton staff bereft of anaesthesiologists. “We just took the risk and went out to do this job. People are dying every day, and they need our help,” she said. “We haven’t left the hospital since then. We are extremely tired, exhausted, we don’t know if we can continue like this.”
The hospital initially reopened only for emergencies, treating bullet wounds and injuries from shrapnel, but began to receive people giving birth, and cases of kidney failure and diabetes. “Sometimes I say I’d prefer to die from a rocket strike rather than failing to help a patient who dies due to lack of access to medicines,” said El-Hassan.
Her facility has also treated rising numbers of stab wounds. “Looting and robbery became a major problem, so we get a lot of those cases,” she said. “Sadly we lose two to four people a day where we simply cannot save their lives.”
She added: “You can’t walk two minutes without being robbed, it has become impossible in this area and we don’t have fuel to fill up our cars. The good thing is the people who live close to the hospital allow us to stay with them.”
Callout
Citizens across the capital described how relatives had died in their homes due to being unable to access basic medical care. A 33-year-old woman died of dengue fever last week when her family were unable to locate a functioning hospital in Omdurman. One facility in the area reopened and then closed after it was shelled, killing one person and injuring 11 others.
Sudan’s doctors’ union highlighted how medical staff were struggling to work under bombardments, adding that the health system’s capacity to deal with the crisis and respond to mass casualties was “deteriorating by the hour”.
Sixteen hospitals had been subjected to bombardments and shelling, they said, while a national laboratory and 19 hospitals had been forcibly evacuated by military forces, some to use for their operations. Six ambulances were attacked while trying to carry patients. A video purportedly of a paediatric surgery ward of a key hospital in central Khartoum, which could not be immediately verified, showed gaping holes in the roof directly above hospital beds covered in debris and holes from shrapnel dotted the walls.
The medical union said 70% of hospitals “in and around the areas used as battlegrounds are out of service,” while others were operating at a limited capacity and only able to provide the most basic first aid due to the lack of supplies. “These hospitals are currently threatened with a complete shutdown, due to lack of supplies, shortage of health staff and lack of water and electricity,” it said.
The ICRC said its first airlift of vital medical supplies landed in Port Sudan on Sunday but it warned of difficulties in transporting aid to hospitals on the frontlines in the capital. “The healthcare system is on the verge of collapse as many hospitals and other health facilities closed their doors, they simply can’t function any more,” said Alyona Synenko, an Africa spokesperson for the ICRC.
“Healthcare personnel can’t reach their place of work, some fled due to the lack of water, electricity and medical supplies. There are serious grounds to worry at the moment that unless urgent help arrives, the entire system may collapse, and the consequences of that would be catastrophic: we’re talking about thousands of wounded people, the population needs basic healthcare.”
She said the situation was critical in Khartoum as well as in the Darfur region, where a major teaching hospital in West Darfur was forced to close due to ongoing fighting and looting. “It’s what we feared and are now witnessing in Khartoum. Hospitals are functioning without water and electricity there, fuel prices are skyrocketing and so there are acute shortages of fuel which means issues with generators and water pumps. Without fuel to run those things, how can you provide healthcare or clean running water?” Synenko said.
Martin Griffiths, the UN undersecretary for humanitarian affairs, warned of an impending crisis. “Two weeks since clashes erupted in Khartoum and around Sudan, the humanitarian situation is reaching breaking point,” he said. The UN has reported increasing attacks and looting at its offices across Sudan, as well as attacks on aid workers.
Dr Ahmed Abbas, who previously worked at the main hospital in Omdurman before he was evacuated to the UK, said the facility was now functioning at its minimum capacity. “When we asked the ministry for help, they refused, and even ordered to shut down some hospitals,” he said.
Abbas previously lived in Khartoum North, an area that has endured heavy bombardments by the SAF. “It became impossible for me to stay in Khartoum North, I had to leave the country,” he said.
