On 15 December, the Rapid Support Forces (RSF) launched an attack on Wad Madani, Sudan, and took control of several other cities and areas in Al Jazirah state within days. Since then, more than half a million people have fled the fighting and insecurity, including about 234,000 displaced peopleInternational Organizaton for Migration (IOM) Displacement Tracking Matrix (DTM) Focused Flash Alert. Jan 8, 2024 who had previously sought refuge in Wad Madani as violence in Khartoum intensified.  

The chaos following the evolving conflict and the severe insecurity and widespread violence created an environment in which Médecins Sans Frontières (MSF) could no longer operate in Wad Madani. 

As a result, we had to suspend all activities and evacuate our staff from Wad Madani on 19 December, leaving behind people with even less access to basic medical services. We also had to evacuate staff from Damazine, Um Rakuba in Gedaref state, and Doka. In Damazine, we reduced activities.

Our teams had been present in Wad Madani since May 2023. Conditions were already dire for the half a million displaced people living there, which made up 8 per cent of all internally displaced people in Sudan. Sudan was already home to the world’s largest internal displacement crisis, with more than six million people forced from their homes within the country in addition to more than 1.4  millionAccording to the International Organization for Migration Displacement Tracking Matrix (IOM DTM), and UN refugee agency (UNHCR). Jan 15, 2024 who have fled across borders. 

Between May and November, our teams performed 18,390 medical consultations (40 per cent of them for children under 15 years old) in several of the hundreds of locations hosting displaced people across the state of Al Jazirah, some in schools or old public buildings.  

Through our mobile clinics, our teams diagnosed and referred 66 children suffering from severe acute malnutrition with serious complications in the past six months – cases that could be fatal if not treated in a hospital urgently.

“Health facilities were overwhelmed. As the number of people in the city had increased by 30 per cent, there were more and more patients, but considerable supply and staffing challenges,” says Slaymen Ammar, MSF medical coordinator for Sudan

“And as prices soared for all goods, access to lifesaving services was an obstacle for both displaced people and regular residents. Nowadays, with the departure of most international organisations – and despite efforts from local volunteer health workers – we can only assume it has worsened.” 

During the past month, in Gedaref and Kassala states – where we have been operational since 2021 in response to the Ethiopian Tigray crisis – MSF teams witnessed the arrival of thousands of people from Wad Madani64,000 IDPs arrived in Gedaref and 30,000 in Kassala since December 15th, according to the UN.  , and are currently assessing and responding to the escalating health and humanitarian needs. 

In Tanideba (Gedaref), we have started a short-term emergency intervention for newly displaced Ethiopian refugees and newly displaced Sudanese citizens, covering basic healthcare, water and sanitation, as well as food rations. This included one-off distributions and donations. However, activities in Tanideba were temporarily reduced due to the escalation of conflict in Wad Madani.

The conflict in Sudan has caused immeasurable suffering, displaced millions, killed thousands, and injured countless others. For many displaced people, Gedaref and Kassala are just the latest stops in a long journey to seek safety, during which they have suffered violence and been without basic items, such as food, clean water, sanitation and access to medical care.  

“We are originally from Darfur, but because of the violent clashes and the crisis over there, we went to Khartoum. But the war followed us to Khartoum, so we went to Wad Madani. And then, the story continues,” says Salem*, a displaced man who arrived with his family in a gathering site in the Al Mufaza locality, Gedaref two weeks ago from Wad Madani.

Salem and his family fled Khartoum eight months ago, after shelling hit their home and severely injured one of Salem's children.  

“We were six people in the house and at that time my wife was pregnant. Our house was destroyed. I was hit on my arm, but my child got a much worse injury on his head,” he says. 

“We managed to take him to the hospital because he needed urgent lifesaving surgery. But as soon as he was discharged, we had to flee the city because of insecurity. We arrived to the camp in Wad Madani, and my wife delivered there,” he says.

In mid-December, Maha and her family fled once again to Tanideba.

“Clashes started and we began hearing sounds of fires and armed men fighting again. We decided to leave immediately. I started thinking about where we should go. Nowhere was safe at that time.” 

In a region where healthcare and essential medicine were already extremely limited, displaced people are now suffering from growing health demands, stemming from direct and indirect effects of violence. Basic needs are not being met and an urgent response is desperately needed.  

“At the gathering sites in Kassala city, people who have been displaced told our teams they haven’t received any assistance since their arrival in mid to late December,” says Pauline Lenglart, MSF emergency project coordinator in Sudan.  

“Families are sleeping on the ground, access to healthcare is still severely restricted, there are few working medical facilities and medicines aren't provided for free,” says Lenglart. 

“Many people have told us that they are unable to afford items like food and medicine, forcing them to choose between these necessities. Our team is constantly evaluating the needs at new sites that are opening to house recently displaced people. 

“In all these places, we see that the amount of humanitarian assistance provided is still woefully inadequate to meet people’s basic needs and ensure dignified living conditions,” says Lenglart. 

*Name changed to protect identity.