Since the April 2023 outbreak of war in Sudan between Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF), millions of Sudanese people have been internally displaced or fled the country, with many areas facing severe challenges, including malnutrition and lack of resources.
Prior to the escalation of conflict, the Darfur region was already facing a humanitarian crisis. In June 2023, following nearly two months of blockade and large-scale violence in El Geneina, thousands of people sought refuge in Chad.
In El Geneina, the capital of West Darfur state near Sudan’s eastern border with Chad, El Geneina Teaching Hospital is the main facility for specialized care, serving local people as well as people displaced by conflict, mostly women and children.
While it was looted and out of service after the outbreak of war in April 2023, it has since remained the only hospital in the city, providing free lifesaving medical care and addressing the dire consequences of this year’s mass violence and the escalation of humanitarian needs.
The Doctors Without Borders/Médecins Sans Frontières (MSF) team in El Geneina Teaching Hospital has been providing crucial medical assistance, electricity, and water supplies despite the evacuation of some staff in April last year. From January to May 2024, our team conducted approximately 23,000 outpatient consultations. In April and May alone, the hospital saw an 11 percent increase in the number of patients compared to the first three months of this year. This increase coincides with the start of the “lean season” and food insecurity.
The malnutrition situation in West Darfur remains critical
"Data from MSF-supported pediatric outpatient and inpatient departments at El Geneina Teaching Hospital show increased levels of severe acute malnutrition at an average of 5 percent, moderate acute malnutrition at 16 per cent, and global acute malnutrition at 21 percent, among children screened for acute malnutrition between January and May 2024," said Dr. Habib Baharldeen, MSF medical activity manager.
At El Geneina hospital, we provide comprehensive outpatient and inpatient pediatric care, and run an inpatient therapeutic feeding center for severely malnourished children. MSF also provides financial support to the Ministry of Health staff in the hospital so that they can sustain a range of medical services essential for emergency health care.
“The number of admissions to the inpatient therapeutic feeding center has also doubled from January to April 2024,” said Dr. Baharldeen. “Initially, the hospital had 20 beds; this number was increased to 34 in mid-March and to 50 in April 2024.”
In response to the increase, MSF has launched community door-to-door malnutrition screening, as part of active case finding and treatment, for children between the ages of 6 and 59 months (about five years). MSF screened twice as many children in March and April as in January and February.
At the war's start, El Geneina Teaching Hospital was shut down as it was caught in the middle of these clashes. When the tension started to ease a bit, a local medical staff member who remained in the city convened a meeting to discuss reopening the hospital because of its vital importance to the community.
Consequently, the decision was made to reopen it. By June 2023, I was working in my own capacity, and doing all I could to keep parts of the hospital running. When the MSF team managed to return, they appointed me as their focal person for many services. I never left. It is a duty.”
— Anonymous MSF staff member
Invisible wounds
The conflict has impacted MSF teams; some have evacuated and are working remotely, while many of those remaining have also been displaced. They are doing everything they can to keep activities running while ensuring their own safety and needs are met.
In the volatile contexts of wars and inter-communal violence, wounds are not only physical but also deeply etched on the minds of those affected, patients and humanitarian workers alike.
“Many of the people in Geneina are survivors of violence, whether it was inflicted directly on them, or on people close to them, or they witnessed it,” said MSF psychologist Cynthia Matildes, who has worked at El Geneina Teaching Hospital three times—first in 2021, then in 2023, and most recently in 2024, where she observed the invisible wounds inflicted on both patients and staff due to the violence in El Geneina.
“Mental and psychosocial support is essential since health must be treated in a comprehensive way. We must remember that health is a state of wellbeing, and this includes psychological, emotional, and social health,” she added.
People keep crossing the borders
More than half a million Sudanese people, predominantly from Darfur and El Geneina, have crossed the border to seek refuge in eastern Chad. Since July 2023, our teams have been responding to the refugee influx in camps like Adré transit camp, which alone hosts over 180,000 refugees as of May 2024, per the UN.
In Adré, MSF is the primary provider of water and sanitation, supplying 80 per cent of the camp's water needs. Our two clinics in the camp offer 300 to 500 daily consultations, with 53,748 from January to April. Services include vaccinations, specialized malnutrition treatment, sexual and reproductive health care, mental health consultations, and hepatitis E screening and treatment.
“The needs of Sudanese refugees are immense in eastern Chad, with water, sanitation, shelter and food all in short supply,” said Beatriz Martinez de la Fuente, former MSF project coordinator in Aboutengué camp where around 47,000 refugees settled.
The displacement from El Geneina to Adré continues, driven not only by violence but also increasingly by severe food shortages. Many people cross into Adré seeking sustenance, water, and rest, some with the hope of returning to El Geneina, while others remain to escape the dire conditions in the city.
My role is to help patients and medical teams understand each other. As a refugee myself, I have the same needs as all the people who come to the health center for treatment. In the morning, as soon as it opens, my outreach colleagues and I are in the triage tent to explain to the people waiting what medical services are available to them and the different stages of care.”
— Aisha Bilal, MSF a health promoter in Adré transit camp in eastern Chad
A massive scale-up is needed
Nearly a year has passed since the violence escalated, and as the fighting between the two warring parties of Sudan continues to ravage El Fasher, the city’s hospitals are damaged and shut down. Meanwhile, thousands of people have been fleeing in search of safety, with many arriving at Zamzam camp, where there is already an acute malnutrition crisis.
For months, MSF has been the main health provider in most areas of Darfur due to a severe lack of international attention.
Our activities in El Geneina Teaching Hospital have extended into areas usually covered by United Nations agencies, such as providing water and electricity. MSF stepped into the limited response of others humanitarian partners. The question remains: until when?
