As Sudan’s brutal war between its military junta’s Sudanese Armed Forces (SAF) and the paramilitary group Rapid Support Forces (RSF) continues into its second year, the resulting violence has laid siege to hospitals across the country on a catastrophic scale. Since April 2023, the World Health Organization (WHO) has verified at least 119 attacks on medical facilities across Sudan, while medical and humanitarian aid workers have been attacked and killed by both warring parties. Both the SAF and the RSF have been accused of committing war crimes, and the RSF has additionally been accused of committing genocide against the Massalit people in West Darfur.
Sudan has been mired in political turmoil since the deposition of its long-time head of state, Omar Albashir, in a 2019 military coup. Its government was again overthrown in a second coup in 2021. With no indications of a possible transition to a civilian government in sight, infighting between the coup’s leaders over the integration of the RSF into the SAF escalated into civil war in 2023. Conflict over control of Sudan’s military has since heightened into a bloodbath over territorial control, strategic infrastructure, and key resources like gold and oil.
Relying on geospatial analysis and satellite imagery, physicians and public health experts at Yale University’s Humanitarian Research Lab and the Sudanese American Physicians Association (SAPA), which is active throughout Sudan, are collecting mounting evidence of war crimes committed by both the SAF and the RSF. Recent documentation by SAPA reveals the extent of destruction to life-saving facilities in Khartoum State, including crucial damage to maternity wards, children’s hospitals, cancer treatment, and neurosurgery and dialysis centers. Some, like Albuluk Children’s Hospital in Karrari and the Radiation and Isotopes Center Khartoum-Alzarra, have been repeatedly attacked. Medical supplies are in severe shortage, while satellite imagery of the area reveals roofs collapsed in airstrikes, shadows of shelling, and smoke and debris littering hospital grounds.
“This is only the damage that can be seen from space,” says Danielle Poole, Associate Research Scientist and Director of Research at the Yale Humanitarian Research Lab. “What is really shocking and devastating is the impact that this has on peoples’ access to health care.”
According to SAPA—whose representatives did not respond to a request for comment by the time of publication—700,000 people in Khartoum State were affected by the destruction of hospitals between April 2023 and August 2024 alone. This data can be used for further forensic analysis to implicate Sudanese military and paramilitary leaders in war crimes: attacks on hospitals and health care workers violate international humanitarian law and the Jeddah Declaration of May 2023, which is intended to ensure the protection of civilians and safe delivery of humanitarian assistance by both warring parties. “All of these incidents,” Poole tells The Progressive, “represent potential violations of international humanitarian law.”
According to Poole, Yale and SAPA are expanding documentation to include hospitals across Sudan, as fighting has expanded to other regions.
On January 20, the RSF issued an ultimatum to forces allied with the Sudanese military to leave El Fasher ahead of an imminent assault. United Nations Human Rights Office Spokesperson Seif Magango responded by calling for de-escalation and urgent protection of civilians. Four days later, a drone strike hit the only functioning hospital in El Fasher, the capital and largest city of Sudan’s North Darfur region, as doctors and nurses were providing care to patients. Seventy people, including four children, were killed in the attack, according to WHO Director-General Tedros Adhanom Ghebreyesus, while nineteen suffered non-fatal injuries. According to UNICEF, the children were being treated for injuries from previous bombings.
Two months prior, the RSF attacked numerous medical facilities north of Wad Madani in the state of Al Jazirah, evicting patients and attacking and killing medical workers. In January, the United Nations Office for the Coordination of Humanitarian Affairs reported that Wad Madani’s blood bank had been destroyed.
The Safeguarding Health in Conflict Coalition has reported that combatants have occasionally occupied medical facilities for weeks, transforming hospitals into military bases with snipers on the roofs and armed personnel inside while attacking health workers with impunity.
“Some are deliberately attacked for providing life-saving assistance to populations under siege,” Christina Wille, director of Geneva-based conflict monitor Insecurity Insight, tells The Progressive. “Others are mistakenly targeted because their activities are perceived as military in nature—for instance, traveling in convoys or working in locations where large groups of civilians gather to receive aid.”
Despite progress like the reopening of Abu Haraz Hospital in the state of North Kordofan in January, Iman Ahmed, a public health expert formerly with the U.N. High Commissioner for Refugees (UNHCR) describes the situation as draining and unsustainable, noting that there has not yet been any form of accountability for those involved.
“Our doctors on the ground have lived through attacks on health care throughout the thirty years of Omar Albashir’s regime,” Ahmed tells The Progressive. “This time around, the attacks are at a massive scale. This has been a very sad game of musical chairs, where the forces of good, including Sudanese doctors in the diaspora, invest funds, technical support, and feet on the ground to reopen hospitals, only for the warring parties to re-attack, damage and destroy these facilities, and for the RSF specifically to—time and again—loot assets.”
Making matters worse, President Donald Trump has called for a freeze on foreign aid through an executive order signed in January, throwing local aid efforts throughout the world into chaos. While a judicial stay has placed a temporary pause on the grant freeze for United States Agency for International Development (USAID) programs, and Secretary of State Marco Rubio has approved an additional waiver for core life-saving humanitarian assistance for limited exceptions, Rubio also stated that “no new contracts shall be entered into.” Earlier this month, the Trump Administration further targeted USAID with mass layoffs, significantly curtailing the organization’s ability to provide life-saving assistance. As of January 31, a USAID spokesperson did not confirm with The Progressive whether any of the agency’s spared programs are related to Sudan.
The defunding of USAID has dire implications for Sudan, which is in need of significantly more international aid. The United Nations stated that its $2.7 billion humanitarian appeal for Sudan in 2024 was only 57 percent funded at the year’s end. The U.N.’s humanitarian response plan for 2025 requires $4.2 billion to support the 20.9 million people affected by the war. Last year, the U.S. accounted for 45 percent of global relief funds for Sudan, with the majority going to food security, nutrition and health.
International aid organizations cutting jobs for Sudanese aid workers only months after the war erupted has further incapacitated the country’s frontline response. A lack of life-saving medications and equipment has resulted in outbreaks of preventable diseases including cholera, dengue fever, malaria, and polio.
“Any suspension of financial support to aid efforts not only jeopardizes the provision of essential medical and humanitarian services but also increases the risks faced by health and aid workers,” Wille told The Progressive in the wake of Trump’s executive order.
With no ceasefire in sight, grassroots emergency response rooms (ERRs) continue to provide critical aid, even as volunteers are arbitrarily detained or killed by Sudanese military and paramilitary combatants. But ERRs, which lack the equipment and capacity to deliver specialized care like cancer treatment and dialysis, cannot adequately care for the staggering eleven million people in Sudan who need urgent medical care.
Ahmed emphasized the U.N.’s commitment to upholding its principle of Accountability to the Affected Population (AAP) and the Humanitarian Grand Bargain of 2016, which require community involvement in decision making to prevent abuse by intermediaries and 25 percent of pooled global aid funds to go toward local actors like ERRs. “Investing in these frontliners will contribute to long term development goals of strengthening local capacity, supporting local peace initiatives, enhancing good governance and oversight, and effectively localizing the humanitarian response,” says Ahmed.
As entire life-saving specialties have been destroyed in Sudan, Poole emphasizes the need for capacity-building for ERRs. “Ideally, these volunteers would be professionalized and compensated for their work, so they could have ongoing training and support, as well as the required materials and equipment,” she says.
Yasser Essa, a governance, peacebuilding, and development practitioner and specialist in humanitarian emergency response who worked with numerous NGOs and UN agencies in Sudan, says that ERRs are vital lifelines for those in urgent need.
“Often, this assistance is short-lived and reliant on external donor sources that can shift with the winds of international policy,” Essa says, referring to a troubling cycle of dependency on international aid. “To truly tackle this medical crisis head-on, ERRs must be woven into broader, sustainable programs powered by international organizations, along with ongoing financial support that can strengthen their operational capabilities.”