The ongoing war in Sudan has led to a catastrophic collapse in the protection of civilians, with communities facing indiscriminate violence, killings, torture, and sexual violence, according to a report released by Médecins Sans Frontières (MSF). The report, titled "A War on People – The Human Cost of Conflict and Violence in Sudan," details how the fighting between Sudanese Armed Forces (SAF), the Rapid Support Forces (RSF), is inflicting severe violence across the country. Since fighting began in April 2023, hospitals have been attacked, markets bombed, and homes razed mainly by RSF militias. MSF, which operates in eight states across Sudan, provided alarming statistics. In Al Nao Hospital in Omdurman, Khartoum state, 6,776 patients were treated for violence-related injuries between 15 August 2023 and 30 April 2024, averaging 26 people per day. The majority of injuries were caused by explosions, gunshots, and stabbings. A healthcare worker at Al Nao Hospital recounted the aftermath of shelling in a residential area. "About 20 people arrived and died straight after; some arrived already dead. Most came with hanging hands or legs, already amputated. One patient had an amputated leg, with their caregiver carrying the missing limb," they said. The report also highlights shocking instances of sexual and gender-based violence, particularly in Darfur. An MSF survey of 135 survivors treated between July and December 2023 in refugee camps in Chad revealed that 90% were abused by armed perpetrators. Half were attacked in their homes, and 40% were raped by multiple assailants. These findings align with testimonies from survivors still in Sudan, demonstrating the prevalence of sexual violence against women in their homes and along displacement routes. One MSF patient from Gedaref described the abduction of two young girls from their neighbourhood in March 2024. The patient's brother, who was also abducted, reported that the girls had been detained and subjected to abuse for two months. The report also includes accounts of ethnic violence in Darfur. In mid-2023, RSF and allied militias reportedly targeted Masalit and other non-Arab ethnicities in Nyala, South Darfur, looting, beating, and killing residents. A patient in Nyala described being stabbed multiple times by men in RSF camouflage. "As they exited my house, they looked at me lying on the ground, barely conscious, and said, 'he will die, don't waste your bullets,'" the patient recalled. Throughout the conflict, hospitals have been routinely looted and attacked. In June, the World Health Organization reported that only 20 to 30% of health facilities in hard-to-reach areas remained functional. MSF has documented at least 60 incidents of violence and attacks on its staff, assets, and infrastructure. The MSF-supported Al Nao Hospital in Omdurman has been shelled three times. In May, an airstrike caused the roof of the intensive care unit at the MSF-supported Baker Nahar Paediatric Hospital in El Fasher to collapse, killing two children and forcing the hospital to close. Despite the dire state of the health system, humanitarian and medical organisations often face significant obstacles in providing support. Although authorities have begun issuing visas for humanitarian staff more readily, bureaucratic blockages such as travel permit refusals continue to impede essential medical care. "The violence of the warring parties is compounded by obstructions," said Vickie Hawkins, MSF General Director. "By blocking, interfering, and choking services when people need them most, withholding 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," Hawkins added. "Above all, to stop this senseless war on people by immediately ceasing attacks on civilians, civilian infrastructure, and residential areas."
