‘Everything was instant warfare’: personal reflections on Sudan from an MSF doctor

Dr Javid Abdelmoneim is an MSF medical team leader. Half Sudanese, half Iranian, he was born in the UK but lived his first eight years in Sudan. He has worked in the country twice since the start of the war, and shares his experience…

In April 2023, I was in Malawi, working with the World Health Organisation (WHO) in response to the cholera epidemic and Cyclone Freddy. Sitting at my desk one day, my phone lit up with a message from my cousin which simply said, ‘your dad’s safe’. I didn’t know what he meant.

At the time, both my cousin and my dad were in Khartoum, Sudan’s capital. I checked the news online. To my shock, videos showed war planes flying over the city, and reports detailed the outbreak of war between the Rapid Support Forces (RSF) and the Sudanese Armed Forces (SAF).

Along with my dad, who likes to spend Ramadan in Sudan, many of my Sudanese family living in diaspora were also there, together with family members who still lived in the country. They were all in Khartoum for the wedding of one of my cousins.

At that point, I hoped that the fighting would only last a day. But what ensued was the total collapse of a nation.

The first assignment

Everything was instant warfare. Those first days of the war were harrowing. Everyone was in lockdown. My cousins' house was shelled. Thankfully, no one was killed.

Throughout my lifetime, Sudan hasn’t been free of war, but the fighting has never been in the city. It was shocking to see shelling and gunfire in the streets of Khartoum.

Over the next week, the family organised five different convoys out of the city, but my dad very nearly missed the last one. We were all deeply stressed until the last convoy left the country. Only then, once my dad was out and safe, did I feel relief.

The same day my dad got out, about ten days after the war started, I got the call from MSF. Was I was available to go to Sudan? With my WHO contract ending imminently, I said yes. The following week I was on a humanitarian flight into Port Sudan with the plan to go on to Omdurman, on the west bank of the River Nile, in Khartoum.

Bureaucratic impediments prevented us from reaching the hospital in Omdurman, where we wanted to start our project. Already four weeks into the war, it was the only functioning hospital in that region.

Despite having the correct permits, we were turned back at the last checkpoint outside the city. Our two Sudanese colleagues had to work alone under the shelling to start the project, and we were only able to support them remotely from Port Sudan.

It was the first time I had been so comprehensively blocked from doing my work. I felt the professional frustration of not being able to do my job as a medical humanitarian.

There was also the personal frustration. I’ve worked in different places for MSF, but as I was getting live reports about the streets which were being bombed, this was the first time the names were not abstract. I knew them all – some were even in my neighbourhood.

I returned home from Sudan, burnt out.

The second assignment

The second time I went to Sudan with MSF was a year and a half later in winter 2024. The project in Omdurman had been successfully started almost exclusively by our Sudanese colleagues.

Perhaps selfishly, for a bit of closure, I still wanted to work there.

I travelled to Omdurman as a Sudanese national. We usually have mixed teams at MSF, with both international and local staff. Here I was with a foot in both worlds. It was a huge privilege.

In Omdurman, we were supporting three hospitals – Saudi Maternity, Albuluk Paediatric, and Al Nao General Hospital, which provide trauma, surgical, and emergency care. These were the only main hospitals functioning at the time.

Our support included logistics, water and sanitation, medical supplies, and fuel to help with generators and staff transport.

Outside of the hospitals, we also supported the Ministry of Health with vaccination campaigns and cholera response.

Challenges

The main challenge was that we were in the middle of a conflict zone, between two military forces shelling each other. It was so close you could hear the gunshots. The risk of stray bullets was very real. While I was there one of the medical directors of Albuluk hospital was hit by a stray bullet as he walked through the hospital. Thankfully, he wasn’t killed, and it wasn’t a life-changing injury.

Throughout January, in the emergency room in Al Nao Hospital we saw shelling victims mass casualty incidents almost every day.

The bureaucratic impediments continued to be a major challenge too, and the systems were so dense that we had to hire extra staff just to manage them. It was a resource drain which affected everything, including medical supplies. It meant patients with exploded limbs would be without plaster casts, painkillers or gauze. The teams were having to wash and reuse gauze to dress wounds, which is far from ideal.

Building a mass casualty plan

A core priority of MSF’s work in Al Nao was to support the hospital administration in building a mass casualty plan. This systems-level approach just wasn’t there before.

Mass casualty events affect nearly all hospital departments, including x-ray, outpatients, inpatients, and the operating theatre. It's not just the emergency room that needs to respond when there's an influx of wounded people. This complex system of different departments needs to pivot instantly from day-to-day work to mass casualty procedures.

We needed to produce a living document that we could learn from and debrief after each event, to make sure we could save more lives and provide better care each time.

For example, my nursing colleagues reported that during mass casualty events, patients weren’t getting the necessary painkillers, usually because of a lack of supply.

Even with this challenge, the nurses were able to make sure that the most severely injured patients were getting at least a half-dose of injectable paracetamol, about a child's dose. That's all there was, and it was better than nothing.

The family graveyard

Despite the challenges, when I was approaching the end of my second MSF assignment in Sudan, I felt glad I went and could make more of a difference. But there was one thing I still wanted to do.

My family graveyard is located about a mile and a half south of where we were living in Omdurman. On my last day in Sudan, I managed to visit.

When I got there, I met the caretaker who knew many members of my family. He explained to me that the graveyard had been a no man's land between the two front lines earlier in the war. The SAF and RSF had been shelling from the high-rise buildings on either side.

Approaching my grandfather’s grave, I could see the wall of the walled garden had been completely destroyed. Over at my grandmother’s side of the cemetery the mausoleum roof had collapsed and all the trees had been chopped down, probably for firewood.

I was so worried that at the graves themselves I would see only bones, but thankfully, they were all intact.

While I was there, I could hear huge booms of fighting in Khartoum. Part of me thought perhaps I shouldn’t be there due to the insecurity, but seeing the graves was important to me.

I thought about my entire family clan living around the world. At that moment there wasn't an Abdelmoneim left in Sudan, except from me in the family graveyard.

I took photos and sent them to all my cousins, explaining the level of damage, but that the graves are intact. “The ancestors are okay,” I told them.

I hope for an end to the war in Sudan as soon as possible. My greatest wish is to spend next Eid in Khartoum with all my family.