500 Days of War

August 27, 2024, marked 500 days of war in Sudan and Sudan began to face one of the worst humanitarian crises on earth. The conflict erupted as tensions escalated between different factions within the country, including the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF). These tensions have deep roots in political, ethnic, and economic disparities that have plagued Sudan for decades. The war has resulted in a significant humanitarian crisis, with thousands of casualties and millions displaced. Conservative estimates say the conflict has killed at least 15,000 people, while some estimate as high as 150,000. More than 12 million Sudanese people have been displaced outside of Sudan, with nearly 2 million in Chad, Egypt, and South Sudan, while 7.9 million are internally displaced within Sudan. Sudan has become the largest internal displacement crisis in the world. Infrastructure in many regions has been severely damaged, and essential services like healthcare and education are in a state of collapse. Further, the Integrated Food Security Phase Classification stated in June that between June-September 2024 approximately 25.6 million people across Sudan will likely face high levels of acute food insecurity, and fourteen areas in nine states face a risk of famine in the same period.[1]

International efforts to mediate peace have had limited success, as multiple ceasefire agreements have been short-lived due to deep-seated mistrust among the rival factions. Humanitarian organizations are struggling to provide aid amid the ongoing violence, facing challenges such as limited access to conflict zones, funding shortfalls, and the modern machinations of war. The conflict has also rippled beyond Sudan’s borders, affecting neighboring countries with refugee influxes and cross-border skirmishes. This report will analyze the war through the vantage points of two of its most vicious elements: the destruction of healthcare infrastructure and the warring parties’ use of sexual and gender-based violence as a weapon of war. The basis of this research is witness testimonies collected by SHRH’s team of monitors in the month of June. Our methodology is outlined below.

Hospitals and clinics have been targeted or caught in the crossfire, resulting in significant damage and rendering many facilities inoperative. Medical supplies are perilously low, with deliveries often disrupted by the ongoing violence and blockades. Healthcare professionals face immense challenges as they strive to provide care with limited resources while ensuring their own safety amidst the chaos. The destruction has exacerbated public health emergencies, with rising incidences of diseases, malnutrition, and trauma-related conditions, further overwhelming the already fragile healthcare system. Communities, especially in conflict-ridden areas, are left vulnerable, with little access to necessary medical attention, highlighting the urgent need for concerted international efforts to support healthcare restoration and ensure humanitarian access. According to UNICEF, at least 77 hospitals across Sudan have come under attack since the beginning of the war and over 70% of hospitals in the country are no longer operating.

In addition, the war has seen a significant increase in gender-based sexual violence, a deeply troubling aspect of the humanitarian crisis unfolding in the region. Women and girls are particularly vulnerable, facing heightened risks of sexual assault and exploitation amid the chaos of war. Displacement often forces them into situations where they lack protection, and access to support services is severely limited due to the conflict. Survivors of sexual violence face numerous challenges, including stigma, inadequate access to medical care, and psychological support, which further compound their trauma. Humanitarian organizations, while striving to provide aid, are hindered by security concerns and limited resources, making it difficult to offer comprehensive support to victims.

The stigma associated with sexual violence also discourages many survivors from coming forward, leaving them isolated and without support. This is compounded by cultural and societal barriers that may place blame on victims, rather than holding the perpetrators accountable. Efforts by international organizations and local NGOs aim to provide safe spaces and critical services to survivors, including healthcare, counseling, and legal assistance, but these efforts are often constrained by funding shortages and security challenges. Addressing gender-based sexual violence effectively requires a multifaceted approach, involving not only immediate aid but also long-term strategies for empowering women, rebuilding communities, and instituting strong legal frameworks to ensure justice and protection for vulnerable populations. Precise numbers are difficult to determine due to the ongoing nature of the conflict and the challenges surrounding reporting, it is estimated that thousands of women and girls in Sudan have been affected by gender-based sexual violence during the war. The chaotic environment, combined with limited access to humanitarian assistance and societal stigma, often results in underreporting of such incidents. Organizations working on the ground, including the United Nations and various NGOs, continue to document and assess the situation, advocating for protective measures, support services, and accountability. Nonetheless, the true scale of the issue remains significant and is a major concern for those addressing the humanitarian and human rights dimensions of the conflict.

Methodology

This report relies on thirty individual witness testimonies collected by SHRH’s monitors in June. Our monitors sent out the Google Form we created to ask questions about the impact of healthcare destruction in Khartoum and SGBV in Darfur throughout the course of the war to individuals in their communities and that are a part of our monitors’ civil society activist networks. This sampling method allowed for the procurement of insights from a diverse group of individuals across various professions, age groups, and geographic locations.

Below is a summary of the respondents by age, gender, location, and date of the incident, based on the information provided in the questionnaire:

Age:

· 18-25: 11 respondents

· 25-32: 18 respondents

· 32-39: 6 respondents

· 39-46: 8 respondents

Gender

· Male: 18 respondents

· Female: 15 respondents

Location

· El Geneina, West Darfur: 4 respondents

· El Daein, East Darfur: 2 respondents

· Nyala, South Darfur: 2 respondents

· El Fasher, North Darfur: 8 respondents

· Omdurman, Khartoum: 5 respondents

· Zalingei, Central Darfur: 2 respondents

· Nertiti, Central Darfur: 2 respondents

· Al Jazirah: 4 respondents

· Al Madina Arab, Al Jazirah: 2 respondents

· Other: 4 respondents

Date of Incident

· June 6, 2024: 1 respondent

· June 2, 2024: 1 respondent

· June 10, 2024: 1 respondent

· February 20, 2024: 1 respondent

· April 8, 2024: 1 respondent

· August 6, 2023: 1 respondent

· July 6, 2023: 1 respondent

· December 11, 2023: 1 respondent

· November 14, 2023: 1 respondent

· November 2023: 1 respondent

· November 1, 2023: 1 respondent

· November 8, 2023: 1 respondent

· September 4, 2023: 1 respondent

· October 1, 2023: 1 respondent

· June 14, 2023: 1 respondent

· December 20, 2023: 1 respondent

· September 9, 2023: 1 respondent

· April 15, 2023: 1 respondent

· April 18, 2023: 1 respondentme responses provided multiple locations, and the exact date of

some incidents was not specified. However, this provides a general overview of the respondent demographic and their experiences.

The questionnaire asks questions designed to gather information about five components about the incident: the incident description, contextual information, impact and severity, specific details, and overall trends and patterns. To capture the incident description, impact severity, and the specific details about the incident the forms ask open-ended questions such as: "Can you describe in detail any specific incidents of violence or conflict that you witnessed?”; “What type of incident did you witness?" (e.g., destruction, displacement, etc.) and "What was the immediate consequence of this incident?"; "Can you describe what you saw or heard during the incident?" and "Can you provide specific details about the incident location?" to encourage respondents to provide detailed, personal accounts in their own words, capturing their individual experiences and perspectives. In addition, these questions invite the respondents to elaborate on the impact of the incidents they witnessed, including the nature of the violence, the consequences for people and communities, and the overall impact on the situation. Further, these questions also help locate the specifics of the incident, asking respondents to share their observations about the event. To gather information about the context and the overall trends and patterns evident in the incidents, the form asks closed-ended questions such as: When did this incident occur?" and "Which neighborhood or village did the incident occur?” and “Have you noticed any patterns or trends in violence or human rights violations during the 2023-2024 war in Sudan?” These questions encourage the respondents to pinpoint the location and timeframe of the incidents, providing a geographical and chronological framework for understanding the reported events. The latter question allows respondents to reflect on the broader context of the conflict and identify any emerging patterns or trends in violence.

8tt Jb Attacks and Incidents Nbsp

The destruction of the Healthcare System

The 2023-2024 conflict in Sudan has profoundly impacted multiple aspects of civilian life, with the healthcare infrastructure suffering severe consequences. Extensive damage has been wrought in hospitals and healthcare facilities across the country. Many of these critical infrastructures have been directly targeted or have become collateral damage due to their proximity to combat zones.

The destruction of healthcare infrastructure has exacerbated existing challenges in delivering medical services to the population. Affected hospitals have faced shortages of medical supplies, medication, and basic necessities such as clean water and electricity. Additionally, the lack of security has made it difficult for healthcare workers to reach facilities or continue working under increasingly dangerous conditions. Many healthcare professionals have been forced to flee, leading to a critical shortage of qualified personnel to treat patients.

This devastation has had dire public health implications. The collapse of the healthcare system has given rise to outbreaks of infectious diseases. With damaged sanitation systems and water supply lines, the risk of diseases such as cholera has increased. In August 21, 2024, Al Jazeera reported that over 350 cases of cholera have been recorded in a recent outbreak in Sudan in just a few weeks. The World Health Organization recorded 78 deaths from cholera between the start of the year and July 28, while stating that some 2,400 people have been infected across the country.

Humanitarian efforts have been crucial in attempting to mitigate the impact of this destruction, yet they face significant obstacles. Restricted access to conflict zones and ongoing security threats hinders the delivery of aid and medical supplies. International organizations have called for urgent ceasefires to allow humanitarian aid to reach affected areas, but challenges remain in ensuring the safety and accessibility of such efforts.

The destruction of healthcare infrastructure in Sudan during the 2023-2024 war has left an indelible mark on the country’s ability to provide care and safeguard public health. The human cost of this destruction is portrayed through the lived experiences of those directly impacted, as revealed by the responses to the questionnaire.

The responses paint a chilling picture of targeted attacks against healthcare facilities. The destruction of the Babiker Nahar Hospital in El Fasher, North Darfur, which was mentioned by one respondent, is a stark example of deliberate targeting, highlighting a blatant disregard for the sanctity of healthcare and a cynical strategy to cripple the very institutions designed to provide critical help to an already vulnerable population. The focus on specific locations, such as the "10th Hospital" and the "Airport Hospital," suggests that the conflict's impact is not random, but rather strategic, potentially targeting hospitals located in areas crucial to aid distribution or those perceived as vital centers of care.

“On June 10, 2024 snipers infiltrated the hospital, and a plane targeted the hospital with the help of Rapid Support Forces. Dozens were injured. We saw the destruction and targeting of patients and companions, displacement of minors, destruction of housing, and theft of property. This occurred in the neighborhood of al-Taminat (south El Fasher), west of Taminat cemeteries. The result was that the Children and Southern Hospitals were out of service after ambulances, sums of money, and medicines were stolen. People were kidnapped and others were killed with a sniper.”

Collected on June 10, 2024 (F, 39-46, Retired journalist)

Beyond physical destruction, the conflict creates a logistical nightmare that significantly impedes access to healthcare. Respondents describe displacement due to the conflict, highlighting the challenges of reaching hospitals even if they remain operational. This paints a picture of a city under siege, where the very act of seeking medical assistance becomes a dangerous and daunting task, further exacerbating the healthcare crisis.

The questionnaire also exposes the chilling reality of violence intruding into the sanctuary of healthcare facilities. The accounts of violence within hospitals create a stark image of a breakdown of societal norms and a chilling disregard for the vulnerability of those seeking medical aid. This fear of violence within healthcare settings, evidenced by respondents who mention being "too afraid" to work in healthcare settings, paints a picture of a healthcare system paralyzed by fear and insecurity.

The questionnaire also reveals the dire consequences of logistical disruptions and resource shortages, stemming from the conflict. Reports of looting targeting medical supplies highlight the deliberate efforts to cripple healthcare facilities, leaving them ill-equipped to provide care. The conflict's impact on transportation routes and logistics creates a vicious cycle, further undermining the ability to replenish medical supplies and maintain a functioning healthcare system.

“In Omdurman I witnessed the destruction of healthcare facilities, including the Omdurman Educational Hospital which was targeted with artillery shelling from the RSF, displacing some of the hospital personnel and killing and kidnapping others. Some hospital staff were taken to take care of injured RSF soldiers. Al Walidein Charitable Eye Hospital and the Chinese hospital were also destroyed by the RSF and used as military barracks by them. To this day, Al Nao Hospital in Omdurman (al-Thawra) is still being targeted and is subjected to artillery shelling. It has been out of service several times, even though it is the only hospital that is operating and already suffering from the pressure. Of the violent incidents I saw which were directed at citizens include the spraying of bullets at them in
Souk Omdurman (the big market) and al Souk al-Shaabi and forcing them to carry heavy stolen goods such as corn, sugar which the RSF seized from commercial stores owned by citizens. The RSF humiliated these store owners, deprived them of food, and flogged them with whips.”

Collected on June 9, 2024 (M, 39-46, Journalist and defender of human rights)

“I witnessed the destruction of Omdurman hospital after it was seized by the RSF, the arrest of health personnel by the militia, and their refusal to let in sick and injured from going to the hospital. These are minor violations compared to what is happening and what happened during the media blackout.”

Collected on June 7, 2024 (M, 18-25, Doctor)

“When the April 15 war broke out, I was in Khartoum and the next day I traveled to the city of Nyala. In the first two weeks of the war, the hospitals were operating normally, receiving the wounded, and a truce was obtained from the army and rapid support after the intervention of the city’s notables. Then the violence intensified at the end of May 2023, and the first incident that occurred was the theft of dispensary equipment. There was damage to the Taghlimi Hospital in Nyala as a result of artillery fire from both sides. Staff members from the hospital were kidnapped and laboratory and pharmaceutical equipment were taken. There was also an attack on female doctors and nurses, with the exception of the Turkish Hospital and the Takas South Clinic, because they are far from the site of army and RSF operations.”

Collected on June 12, 2024 (M, 39-46, High school teacher)

In conclusion, the destruction of healthcare infrastructure in Sudan during the 2023-2024 war has left an indelible mark on the country's ability to provide care and safeguard public health. The ongoing challenges illustrated in these responses highlight the critical importance of protecting Sudanese healthcare facilities throughout the ongoing conflict and the need for sustained support to rebuild and enhance the resilience of health systems in affected regions. Only through concerted efforts can the cycle of destruction be broken and a path to recovery.

The impact of gender-based sexual violence

The ongoing conflict in Sudan has unleashed a brutal and devastating reality, one that disproportionately affects women and girls. While the violence in Sudan's war is multifaceted, sexual and gender-based violence (SGBV) stands out as a particularly insidious and pervasive element, leaving a lasting scar on individuals, families, and communities. The questionnaire, although limited in its scope, provides a chilling glimpse into the lived experiences of individuals facing this silent epidemic, revealing the profound impact of SGBV in the context of Sudan's war.

While the responses directly address SGBV in limited instances, a deeper analysis reveals a systemic impact on women and girls, often intertwined with other forms of violence. The responses highlight a climate of fear and insecurity that amplifies their vulnerability. The mention of “displacement” in various contexts, with women and girls often forced to flee their homes, underscores how the conflict disrupts existing social structures and leaves them exposed to heightened risks of violence. This displacement further amplifies their vulnerability, as they are often forced to seek refuge in unfamiliar environments with limited access to protection and support services.

The responses offer glimpses of the pervasive nature of SGBV within the context of the broader conflict. The mention of sexual violence as an element within broader incidents of violence, such as “robbery” or “enslavement,” suggests a correlation between conflict and SGBV, highlighting how it can be used as a tool of control and subjugation.

“On August 6, 2023 in the neighborhood of al-Safa El Daein, East Darfur armed individuals sexually violated women and girls. It started when these girls passed one of the neighborhood streets and the young men started talking to them and when the girls did not respond they threatened them, assaulted them, and beat them.”

Collected on June 13, 2024 (F, 18-25, Civil society activist)

“A humanitarian catastrophe and the genocide of indigenous people in their villages took place throughout the war. I witnessed displacement and enslavement in Darfur and Kordofan and specifically in al-Tadamon El-Geneina, West Darfur. I heard the sounds of bullets inside the neighborhoods. It began with the shooting of civilians and murder, rape, and arson took place.”

Collected on June 7, 2024 (M, 18-25, Freelance)

“On December 20, 2023, after the RSF’s entry following their battle with SAF, the destruction of infrastructure, including hospitals and public facilities, took place. As well as the militarization of children, the robbery and plundering of personal and public property, and killing based on identity.”

Collected on June 5, 2024 (M, 32-39, Professor)

The limited reporting of SGBV in the questionnaire underscores the complexities of documenting and addressing this issue. The fear of stigma, the lack of access to support services, and cultural barriers often prevent survivors from seeking help or reporting their experiences. The silence surrounding SGBV in the responses serves as a stark reminder of the pervasive underreporting and the difficulty of accurately assessing the full extent of the problem. While the responses to the questionnaire offer a limited window into the reality of SGBV in Sudan, they underscore its profound impact on women and girls. This hidden crisis demands a sustained and comprehensive response that prioritizes the safety, well-being, and rights of survivors, and ultimately, a commitment to creating a more just and equitable future for all Sudanese women and girls. The responses underscore the urgent need for greater attention and resources to be dedicated to addressing SGBV in Sudan. The conflict's devastating impact on women and girls requires a multifaceted approach that tackles the root causes of SGBV, provides comprehensive support to survivors, and ensures accountability for perpetrators. This includes addressing the root causes of this systemic issue, providing comprehensive support for survivors of SGBV, enhancing protection mechanisms (such as strengthening the legal framework to hold perpetrators accountable, promoting community-based initiatives to address gender-based violence, and providing support to community leaders and authorities to support victims of SGBV in their communities), and amplifying the voices of survivors.

Conclusion

The harrowing narratives captured in the questionnaire provide a stark and unsettling picture of the devastating impact of Sudan's war on its people and its healthcare infrastructure. The conflict, fueled by deep-rooted political and social tensions, has unleashed a wave of violence that disproportionately affects the most vulnerable members of society, particularly women and girls.

The deliberate targeting and destruction of healthcare facilities, a disturbing trend highlighted by the responses, expose the cynical nature of the conflict, where the very institutions designed to heal are deemed expendable. This deliberate destruction not only deprives communities of essential medical services but also creates a climate of fear and insecurity, hindering access to care and exacerbating the humanitarian crisis.

The responses also reveal the insidious nature of sexual and gender-based violence (SGBV) as a weapon of war. The questionnaire provides a chilling glimpse into the experiences of individuals facing sexual violence, highlighting the complex intersection of violence and displacement that leaves women and girls particularly vulnerable. The systematic underreporting of SGBV,underscored by the responses, emphasizes the need for greater attention, resources, and advocacy to address this pervasive and often silenced issue.

The sheer scale of the destruction and the relentless violence demand a multifaceted approach that tackles the root causes of the conflict, prioritizes humanitarian aid, and seeks to restore a sense of security and justice. Efforts must focus on providing comprehensive support to survivors of violence, including medical care, counseling, and legal assistance. Protecting and empowering women and girls, particularly those displaced by the conflict, must be at the forefront of humanitarian efforts.

While the situation is dire, the responses also offer glimmers of hope, demonstrating the resilience of the Sudanese people and the efforts of humanitarian organizations working to provide aid and support. These efforts, however, are severely hampered by ongoing violence, logistical challenges, and a lack of sufficient resources. The urgency of the situation demands a concerted international response that addresses the multifaceted challenges, including:

· Prioritizing humanitarian relief: Providing essential medical supplies, ensuring access to safe water and sanitation, and offering psychosocial support to those affected by the conflict.

· Working toward a lasting peace agreement: Addressing the root causes of the conflict through dialogue and reconciliation, and implementing measures to ensure accountability for perpetrators of violence.

Strengthening the healthcare system: Supporting the rebuilding of healthcare infrastructure, ensuring access to essential services for all, and promoting the training and education of healthcare professionals.

· Addressing gender-based violence: Recognizing the particular vulnerability of women and girls, implementing measures to protect them from violence, and providing access to specialized support services.

· Amplifying the voices of survivors: Creating platforms for survivors to share their experiences, advocate for their rights, and participate in shaping solutions.

The voices captured in the questionnaire, though limited, serve as a powerful reminder of the human cost of conflict and underscore the urgent need for a comprehensive and sustained response. Only through a collective effort, driven by a commitment to justice and equality, can the scales of destruction be stalled.

[1] IPC, “Sudan: Acute food insecurity snapshot, April 2024 – February 2025,” June 27, 2024.

500 days of War, Sudan

Related contents

Quick Links

Contact Us