A war on people: The catastrophic toll of violence in Sudan

The report, A War on People: The Human Cost of Conflict and Violence in Sudan, describes how both the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF), along with allied groups, are inflicting horrendous violence on people across the country. The war has wrought a catastrophic toll since fighting began in April 2023, with hospitals attacked, markets bombed, and houses razed to the ground.

Estimates of the total number of people injured or killed in the war vary. MSF teams working across Sudan have treated thousands of patients for conflict-related injuries since the start of the war, most injured by explosions, gunshots, and stabbings.  In just one of the hospitals MSF supports—Al Nao Hospital in Omdurman, Khartoum state—6,776 patients were treated for injuries caused by violence between August 15, 2023 and April 30, 2024. That’s an average of 26 people per day.

A health care worker at the hospital described the aftermath of shelling in a residential area of the city: “About 20 people arrived and died straight after; some arrived already dead. Most of them came with hands or legs hanging, already severed. Some only had a small piece of skin keeping two limbs together. One patient came with an severed leg; their caregiver followed behind, carrying their missing limb in their hand."

The human cost of war in Sudan 

More than a year of full-blown conflict has had disastrous consequences on the health and wellbeing of people in Sudan, leaving physical and mental wounds exacerbated by the collapse of the health system and the paucity of the international humanitarian response. 

Sexual violence

MSF's report contains shocking accounts of sexual violence, which has become a defining feature of the war in Sudan and especially in Darfur. Data from MSF facilities supporting Sudanese refugees in neighboring Chad suggest the widespread use of sexual violence as a form of warfare, particularly targeting women and girls. 

MSF surveyed 135 survivors treated by our teams between July and December 2023 in Chad, finding that 90 percent had been abused by an armed perpetrator, 50 percent were abused in their own homes, and 40 percent were raped by multiple attackers. These findings are consistent with testimonies of survivors still in Sudan.

“Two young girls from Sariba, our neighborhood, disappeared,” said an MSF patient, describing events in Gedaref in March 2024. “Later my brother was abducted and when he came back home, he said that the two girls were in the same house where he was detained and that the girls had been there for two months. He said that he heard bad things being done to them, the kind of bad things they do to girls.”   

Targeted ethnic violence 

The report contains testimonies detailing targeted ethnic violence against people in Darfur. In Nyala, South Darfur, people described how in the summer of 2023, RSF and allied militias went house to house looting, beating, and killing people, targeting people from the Masalit ethnic group and other non-Arab ethnicities. 

"The men were armed with guns and dressed in RSF camouflage," a patient in Nyala told MSF. "I was stabbed many times and fell to the ground. As they exited my house, they looked at me laying on the ground; I was barely conscious. I could hear them say, ‘he will die, don’t waste your bullets’ as one of them pressed his foot on me.” 

Attacks on health care

Throughout the war, hospitals have been routinely looted and attacked. In June, the World Health Organization reported that in hard to reach areas, only 20 to 30 percent of health facilities remain functional, and those that remain are operating only at minimal levels.

MSF has documented at least 60 incidents of violence and attacks on our staff, assets, and infrastructure. Al Nao Hospital, for example, has been shelled on three separate occasions, further reducing the availability of lifesaving services. At Baker Nahar Pediatric Hospital in El Fasher, which MSF also supports, a blast caused by an airstrike in May killed two children when the roof of the ICU collapsed  The hospital was forced to close. 

In July 2023, a health care worker at the MSF-supported Al-Saudi Maternity Hospital was shot dead inside the maternity ward, leading to the closure of the facility. Nowhere is safe for people trapped in Sudan’s conflict hotspots. 

Bureaucratic obstructions 

Despite the dire state of the health system in Sudan and its struggles to meet people’s needs, humanitarian and medical organizations have often been blocked from providing support.  Although authorities have begun issuing visas for humanitarian staff more readily, attempts to provide essential medical care are still regularly impeded by bureaucratic blockages such as refusals to issue travel permits to allow the passage of people and essential supplies.  

“The violence of the warring parties is compounded by obstructions,” said Vickie Hawkins, MSF general director. “By blocking, interfering with, and choking services at a time when people need them most, stamps and signatures can be just as deadly as bullets and bombs in Sudan.” 

“We call on all warring parties to facilitate the scale up of humanitarian aid and, above all, to stop this senseless war on people by immediately ceasing attacks on civilians, civilian infrastructure and residential areas.”  

What MSF is calling for 

• Warring parties must cease attacks on residential neighborhoods, allow safe passage for people seeking protection, and protect vital infrastructure from further destruction and looting; to stop all targeted forms of violence including sexual and ethnic violence; and to immediately facilitate aid and allow unhindered humanitarian access so assistance can reach people in need across borders and front lines. 
• Vested partner states and regional bodies must increase pressure on the warring parties to abide by their obligations regarding civilian protection and hold those violating civilian protections to account.  
• The United Nations must reiterate and amplify messages regarding the promotion and respect of international humanitarian and human rights laws, increase field presence of UN senior staff, and ensure that protection responses are scaled up and adequately coordinated. 
• Humanitarian organizations must scale up programming and adapt their response the complexity of the operational context in Sudan across all sectors.