Sudan conflict: Saving lives while looking over your shoulder

In this series on Sudan conflict, a humanitarian worker describes the scene of their assignment amid risks of death.

This was my second mission to Sudan. It's true that once you've worked there, you have a connection to the country. We came with a small team from Ethiopia. We crossed the border because it was one of the only ways to enter the country.

The change in the country is shocking. On the road between Wad Madani and Khartoum you can see the tanks and some buildings have been destroyed. There are many checkpoints. Security is not the same. Food prices are rising. If you have electricity, you are lucky. Everything is critical. 

Also read: Sudan conflict: A tale from the war rescue front

We arrived at Bashair Hospital in Khartoum. It was almost empty. We started working with the material and people we found there. This is a normal hospital with different departments: maternity, vaccination, emergency, internal medicine and so on. Because of the war, most of the departments are not functioning. When there is war in a country, there are needs everywhere, but surgery is something very technical and I think that MSF has something to add with the experience that we have.

All the time we were working, we could hear the sounds of war. There were planes circling. They would fly over and within a few minutes or an hour the bombing would start. The bombs coming in and then the response with heavy weapons from the ground. In between the explosions there would be the sound of gunfire coming from the streets.

If it was very close, you could feel the walls shaking, the windows shaking. And the smoke... a lot of smoke around the hospital. Several times members of the team lost family members in the bombing. We didn't sleep much, but sometimes during the night we weren't sure if it was real or not, because it starts to be a bit of a mix between your dreams and reality. 

I was impressed by the dynamism of the volunteers we worked with. I've never seen that anywhere else. We stayed in the hospital with them and tried to organise things together. There were many medical students, nurses, doctors and different profiles.

Some of them were dedicated to data, some were moving patients from one area to another, some were cleaning the surgical ward. Some were very helpful in translating between the patients and the medical team. We have built something together with the Sudanese colleagues. We really built something.

We admitted all the patients who needed surgery. We did all the life-saving operations that we could. It could be an amputation for a diabetic, for example. I remember we had a little child, three or four years old, who had swallowed a nail. It's something that happens, a domestic accident.

We admitted the patient and operated. Because of the conflict, it has become extremely difficult for patients with chronic diseases to get their treatment. Almost every day someone would come to me and ask for insulin. We also had a lot of patients with asthma crises, especially at night. We had some medicines for diseases like hypertension, asthma and HIV. So we were able to do a bit more.

One day a father came with two of his sons. It was after a big explosion. We heard the explosion and went to the emergency room. A few minutes later he arrived with the two children. One of them had shrapnel in his abdomen. He was critical. Within minutes we had him in the operating theatre. The other had a very serious leg injury. The limb was destroyed with no hope of repair.

I had to discuss this with the father because we needed his consent to amputate. With great dignity, he cried and refused. I felt a lot of emotion when I saw the suffering in this father's eyes. In the end, I told him that if it was my own son, I would consent because it was the only way to save his life. Both children survived the operation and were later transferred with their father to a hospital outside Khartoum for further treatment. 

Coralie Schaukens, an MSF nurse, first worked in Sudan in 2021. In May this year, she returned as medical team leader in the Bashair Teaching Hospital in Khartoum, Sudan. Coralie has previously worked with MSF in Burundi, CAR, Guinea, DRC, Yemen and Afghanistan. 

Testimony: Sudan was my most challenging assignment with MSF

Jessica Comi is an operating theatre nurse who has worked with MSF in several contexts. She recently spent two months as part of an MSF surgical project in Khartoum, Sudan, where MSF works in several major hospitals. She describes what she saw and how she felt working in this challenging context.

Let's make it work

I was excited because I knew it was the right place to be at that moment. I knew I could be useful professionally. But there was also fear because of what we were hearing about the situation. We had two days on the road to get to know each other as a team before arriving at Bashair Teaching Hospital in Khartoum.

When the conflict started, many of the hospital staff left, so the volunteers stepped in to get things up and running again.  There were also challenges with supplies. We were also in the middle of a conflict. We had a wonderful welcome because everyone was so happy to have us there, but it was not going to be easy. There were a lot of different emotions.

At the same time, we knew what the needs were. It's like something clicks in your head and you say, "OK, we've got water. Sometimes we will have electricity. So let's make it work.

We arrived in Khartoum on 8 May 2023 and started work the following day at noon. That first week was incredibly challenging.

Before we arrived, there were no more than ten patients in the hospital. By the end of June, some days we had over 58 patients. This seemed like an impossible place to work, and together with the volunteers we made it possible. It is an amazing feeling.

Local volunteers

There was one volunteer who helped as an interpreter in the operating theatre. She was an English translator. She saw that we needed people, so she just came and asked to join us. She didn't have any experience of working in an operating theatre, but she's just a great person. So many people came and said "I don't need money, I just want to work with MSF for now because I know it's needed for my community". It was incredible. 

After a while, the volunteers really started to trust us and see how we were growing together. They started to help us with logistics, for example. We had someone who was always in charge of the oxygen. They were the ones who were really managing and helping us to make connections within the community.

War Surgery

There can be a lot of challenges in working with wounded patients. It's really difficult if you're not used to doing war surgery. When you are used to it, you know the potential risk to a patient if they are not treated immediately. Risks like infection or loss of a limb or bleeding. You have to act very quickly and it is complex. Experience and expertise make all the difference.

As the conflict continued and more people heard that this hospital was open and could reach us, we started to see more children and women. 

We tried never to close the door to an emergency. But we had limits. And every patient we operated on meant we needed capacity for post-operative care. We expanded the intensive care unit, but it was a challenge to find enough staff to run it properly.

Mass casualty incidents

Every time we heard explosions, we were preparing for a mass casualty incident - a situation where a lot of patients arrive at the same time. You never know if there will be 20, 40 or 100 patients. The pressure got worse as some of the other hospitals in the city began to close.

One day, 127 patients arrived in a short space of time after a series of explosions. Volunteers sent out messages to their networks saying that Bashair Hospital needed people to help, and people immediately started arriving to help.

We ran two operating theatres, trying to deal with the most complex cases in one and the less complex in the other. That day we ran the theatre until four or five in the morning.

In a case like this, all the operations scheduled for that day have to be postponed. It has a domino effect. It can take a week to get back to normal activities.

Helping people recover

Depending on the type of wound, some patients also need multiple operations and many days to recover. Some need longer treatment - weeks or sometimes months. Sometimes we have been able to provide patients with crutches or walking aids. We tried to teach them how to walk with the crutches so they could go home and come back for treatment. Surgery can change people's lives. Amputation is one of the most common surgeries we perform. Patients can come in with a right leg and come out of surgery without a right leg.

In an ideal world, we would be able to connect patients with mental health support, physiotherapy and other resources to help them rehabilitate. While I was in Khartoum, this was not yet possible. That is what I want most for this project.

Working in Sudan has been a unique challenge. I have worked in many war zones. My assignment in Sudan was unique, even compared to my work in Iraq, in Mosul in 2017.The contexts were similar, but in Iraq we didn't face the same challenges and there were a lot more people. 

This was probably my most challenging assignment. But it was also special how the team worked together to overcome all the challenges. You could feel that we were all working for one reason, to save lives. The fact that we've done it all together has been absolutely fantastic for me.