Sudan’s healthcare system has been fragile for decades due to the low governmental expenditure in the sector for the past 30 years. When the war broke out in April of last year, 70% of hospitals were out of service by May. Of the 59 hospitals out of service in conflict zones, 17 were attacked by artillery and 20 were evacuated, of which 12 have been forcibly militarized and converted into barracks by the RSF.

The Sudanese American Physicians in the US SAPA, a not-for-profit, scientific professional, non-partisan, and humanitarian membership-based organization established in January 2019, were among the first groups to respond to the humanitarian crisis resulting from the war.

Before the eruption of the war, SAPA had many programs running in different locations in Sudan, however, the nature of the war changed the scope and magnitude of their intervention. In this article, we will look at their response to the humanitarian crisis in Sudan. This article is based on an X space that was held on April, 24th 2024 and you can listen to the recording on X here, or on SoundCloud here.

Overview

Eighty three percent (83%) of the health sector in Khartoum stopped in the first month of the war, more than 70% of healthcare facilities in Sudan are not operating and the remaining 30% are working on a partial basis. After the war broke out, SAPA worked at maintaining its already existing projects, in addition to starting new projects to respond to increasing humanitarian needs. Its ongoing projects could be summarized in the following main categories:

1. Medical care

• Direct health care: through physical consultations with doctors and nurses
• Online medical consultations through Whatsapp.
• Sexual and reproductive health and rights for women and mothers.
• Vaccines for newborns and children.

1. Environmental sanitation

• Managing waste
• Providing water supply

1. Food aid

• Therapeutic food aid for malnourished children, pregnant women, and breastfeeding mothers.

1. Protection

• for vulnerable communities including IDPs

1. Psychological support

• Psychological support and protection programs for vulnerable communities and GBV victims

SAPA supports several hospitals in Sudan in addition to establishing mobile clinics in areas where there are no operating healthcare facilities. In addition to this, SAPA also works in the capacity building of local health workers to provide healthcare services and support for emergency cases. Most importantly, SAPA works towards enhancing the coordination of active orgnizations, groups and initiatives whether it be INGOs, NNGOs, UN agencies or grassroots.

Challenges

SAPA and other organizations and groups working in humanitarian aid in Sudan run into many challenges due to different reasons, mainly the safety and security situation and the constantly changing reality. Below are the main challenges faced by SAPA over the past year and how they affect their interventions.

• Security situation: hurdles the reach of aid and support in conflict-affected areas.
• Mobility and work permits: are difficult to acquire and maintain due to the rapidly changing context of the war.
• Shortage in resources: both human and economic.
• Disruption of supply chains hurdles the efforts of aid delivery especially among the most vulnerable communities and in conflict-affected areas.
• Coordination: with governmental entities and within organizations due to the ongoing change in the context of the war.
• The psychological impact of working in conflict-affected areas for the workers and volunteers: the feelings of anxiety, stress, fear and depression as a result of being exposed to violence, destruction and death.

It is noteworthy that the majority of recruits at SAPA are IDPs. Despite the significant challenges posed by this fact, it has a positive aspect, as they have a keen understanding of the pressing needs of IDPs, owing to their personal experiences and profound knowledge of the situation. Furthermore, they can adapt the response and programs to suit the local context.

Collaborations

In the previous year, SAPA worked with different NGOs, NNGOs and UN agencies such as the ERRs, 7adreen, Kolana Qiyaum, and UNICEF to just mention a few. These collaborations happen in the form of;

• Sharing updates and information on the security status in the different areas and locations.
• Building collaboration based on the geographical presence and influence of each entity, to ensure the equitable distribution of services and aid across the country.

Different Needs

The needs of people vary depending on their location and situation, such as whether they are internally displaced persons (IDPs) or part of a hosting community, or living in areas affected by conflict versus those that are not. These needs are determined through a needs assessment system.

It is widely acknowledged that the needs of internally displaced persons (IDPs) differ from those of the communities hosting them. However, this may not always be the case, especially in places like Alshamaliya (Northern) State, where hosting families may accommodate up to five families in their homes. In such cases, the hosting family is also affected by the war, even though they may not have experienced war and displacement firsthand.

SAPA’s mission is to offer emergency and primary health care equally. This differs from one location to the other and is through;

• Supporting hospitals
• Establishing healthcare centers
• Holding capacity-building and training sessions

The needs of the people affected by the conflict have changed over time. Initially, the response focused on providing urgent care to those in critical need, such as pregnant women. However, as the conflict continued into its second year, the focus shifted towards more sustainable interventions and programming that could have a long-term impact.

Long-term and Sustainable Strategies

Because of the constantly changing context of the war, it is not always easy to sustain efforts. An example of that could be when SAPA opened a hospital in Madani that had to cease operations because of the RSF attacks on Jazeera state since December 2023.

In light of the very limited resources, SAPA works towards sustaining its operations and programs that already exist.

Staff Safety, Psychological Support and Resilience

Through its network of partners and collaborators, SAPA plans the safe spaces where it can mobilize its staff and volunteers without jeopardizing their safety. This does not contradict the fact that they may have to compromise on safety to reach vulnerable communities and groups. SAPA also tries to provide psychological support through online counselling over WhatsApp for its staff and volunteers to reduce stress and anxiety as much as possible. They are also striving to offer full-rounded health insurance to all staff members, however, because of the absence of the required infrastructure, this project is currently on hold.

Ongoing Projects and Programs

1. Albuluk Hospital: SAPA provides support for Al-Buluk, the only children's hospital operating in Omdurman with programs in the areas of child and mother support. This project was running before the war, and after April 15th it was renewed until the end of 2023 when UNICEF also became a partner to support the project’s sustainability. This program offers medical and health care services to +7000 persons per month as of July 2023. In addition to offering vaccination and healthcare education and awareness.
2. Mobile clinics in Ash-Shamaliya: SAPA has 7 mobile clinics in Ash-Shamaliya in addition to a fixed healthcare center in Dongola.
3. Hasai Awely Primary Health Centre in Red Sea State: SAPA recently signed a memorandum of understanding with the state’s government to establish a healthcare center in Hassai, which will be launched in a couple of weeks.
4. Food items assistance: in collaboration with the Save Al-Genina Initiative, SAPA provide food to 1000 children daily in Al Malik Refugee Camp in Adre, Chad.

Community Support

The community’s role in supporting humanitarian efforts could be summarized as:

1. Advocacy

Raising awareness through amplifying the voices of people speaking about the Sudan crisis, and sharing information about the situation through offline discussions and on social media. Sharing SAPA and other organizations' information as a resource where people could donate or offer their time through volunteering. In addition, putting pressure on policymakers and governments around the world to take action through organizing protests, signing petitions and so on.

1. Donation

SAPA receives direct donations and crowdfunding to support its interventions and projects. Individuals may also volunteer on the ground to provide medical care

1. Partnership

1. Sharing information

The humanitarian situation in Sudan gets worse by the minute, half the country’s population (about 25 million people) require humanitarian assistance, and there are 729,000 children with severe acute malnutrition in Sudan; a child is dying every hour because of hunger. Not to mention the great internal displacement crisis that’s putting a burden on the very fragile infrastructure, the spread of diseases and accessibility to clean water, hygiene products and other basic needs. In light of this miserable situation, we ask you to follow SAPA and other similar organizations that are working on alleviating people's suffering and support their efforts through donating and volunteering your time and expertise.