Sudanese struggle with a medical meltdown as doctors flee and hospitals close

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The conflict in Sudan has left more than 12,000 dialysis patients, pictured (main) at the Soba Hospital in southern Khartoum, at grave risk as hospitals across the country have run out of medications. (AFP)
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This picture taken on May 2, 2023 shows a destroyed medical storage in Nyala, the capital of South Darfur province, on the third week of fighting between rival generals' forces. (AFP)
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A patient is transported on a gurney at the Medani Heart Center hospital in Wad Madani, the capital of the Al-Jazirah state in east-central Sudan, on May 25, 2023, amid fighting between rival generals' forces. (AFP)
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Relatives stand by a patient at a makeshift emergency room installed by Sudanese volunteers in a school building in Omdurman, the capital's twin city, on May 27, 2023, amid fighting between the forces of two rival generals. (AFP)
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Updated 05 July 2023
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Sudanese struggle with a medical meltdown as doctors flee and hospitals close

  • ICRC estimates just 20 percent of health facilities in Khartoum are still operational after weeks of fighting
  • Health centers have been occupied, medicines and supplies looted, and medical professionals driven out

CAIRO: Hospitals across Sudan have been bombed, looted and occupied by armed factions since fighting broke out more than two months ago between the Sudanese military and the Rapid Support Forces (RSF), a paramilitary group. As a result, millions of civilians are being denied vital healthcare.

Medical supplies rapidly dwindled after the conflict began on April 15, with shipments of medicines and other medical supplies stolen or undelivered. Meanwhile, scores of health professionals have been killed, wounded or forced to leave the country.

Dr. Adel Mohsen Badawi Abdelkadir Khalil, 65, is among the many medics who chose to flee with their families, abandoning the private clinic in the capital Khartoum he had managed for more than 15 years.




Dr. Adel Mohsen Badawi Abdelkadir Khalil at his new refuge in Cairo. (AN photo)

On April 21, fearing he would be conscripted by the RSF to treat the paramilitary group’s wounded, he made the painful decision to join the flood of refugees making the perilous journey north to the border with Egypt.

“I was inside my clinic preparing my tickets to go to Cairo when I saw attacks outside. People were yelling and weeping,” Mohsen told Arab News from an apartment in the Egyptian capital he shares with other displaced Sudanese families.

“I immediately locked all my doors and turned off the lights and hid there. If the RSF know you’re a doctor, they will take you to tend to their army.”

Mohsen said that when he and his family caught the bus to Egypt, he was careful not to tell officials or fellow passengers he was a health professional, instead concealing his 30 years of medical experience for his own safety.




A video screengrab from social media shows the East Nile Hospital in Khartoum, one of many medical facilities damaged in the fighting since April 15. (Reuters)

The public-health sector has long been fragile in Sudan, where 65 percent of the population lives in poverty. With the departure of so many medical workers, aid agencies have warned that the nation is facing a major health emergency. According to the International Committee of the Red Cross, only 20 percent of health facilities are still operational in Khartoum.

“We have been witnessing the near collapse of the health system in Sudan,” Alyona Synenko, the Africa region spokesperson for the organization, told Arab News.

 

 

Those unable or unwilling to flee Khartoum have been forced to hunker down in their homes with little or no access to clean water or electricity. According to several Sudanese Arab News spoke to in Cairo, many of those who remained behind face the threat of dehydration and starvation, such is the scale of the need for aid in Khartoum and nearby cities.

The collapse of basic utilities and other public infrastructure is having an especially serious effect on hospitals by undermining their hygiene protocols, rendering vital medical equipment inoperative, and depriving chronically sick people of potentially life-sustaining treatment.

“Besides the departure of some of the medical personnel and the shortages of medical supplies, hospitals are suffering from a lack of food, clean water and electricity,” said Synenko.

 




Hundreds of medical centers had closed in Khartoum since war erupted between Sudan’s army and the paramilitary RSF group in in mid-April. (AFP)

The fighting has, for example, left 12,000 dialysis patients at mortal risk as hospitals have run out of the medications they need and the fuel to power generators, according to the trade union that represents the country’s doctors. It has also impeded the delivery of humanitarian aid that 25 million people — more than half the population — now desperately need.

In addition, there are fears that the summer rainy season will bring with it seasonal epidemics such as malaria, which wreaks havoc in Sudan every year, and a shortage of drinking water could cause a cholera outbreak.

“Sudanese health workers and the volunteers of the Sudanese Red Crescent Society have been accomplishing the impossible, working in such extreme conditions,” said Synenko.

 

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It is believed that fewer than 20 percent of health facilities in Khartoum are still operational.

As of late May, 14 medical professionals had been killed, 21 hospitals evacuated and 18 bombed, according to a doctors’ union.

“While we are working with the Ministry of Health to deliver urgent surgical supplies to hospitals, we are also calling on all actors to respect and protect medical facilities and personnel. This is not only an obligation under international humanitarian law, it is a moral imperative because numerous lives depend on their work.”

Dr. Atia Abdalla Atia, secretary-general of the Sudan Doctors trade union, told Arab News that he and his colleagues have documented the deaths of at least 14 medical professionals since the fighting began. The union has also confirmed the evacuation of 21 hospitals, the bombardment of 18, and one case of a doctor going missing, he added.

On Saturday, the trade union accused the RSF of raiding the Shuhada hospital, one of the few still operating in the violence-torn country, and killing a staff member. The RSF denied the accusation.




View of an abandoned hospital in El-Geneina, the capital of West Darfur, on May 1, 2023 as deadly fighting continued in Sudan between rival generals’ forces. (AFP)

The targeting of health facilities and medical personnel during a conflict is considered a war crime under international humanitarian law. The RSF has reportedly seized control of several hospitals to use as bases of operation.

During a meeting of the UN Security Council on May 22, Volker Perthes, the UN’s special representative for Sudan, highlighted reports of such activities and said the “use of health facilities as military positions is unacceptable.”

In a report published by medical journal The Lancet, aid agency Doctors Without Borders said that health professionals at facilities across Sudan have been repeatedly confronted by fighters who steal medicines, other health supplies and vehicles.

Jean-Nicolas Armstrong Dangelser, the agency’s emergency preparedness coordinator in Port Sudan, told the journal that although some instances of looting are financially motivated, others appear callously calculated to deliberately deprive patients of care.

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In Khartoum, for example, medical warehouses were raided several days in a row. When staff were able to return, they found fridges unplugged and medicines spilled on the floor.

“The entire cold chain was ruined so the medicines are spoiled and can’t be used to treat anyone. We are shaken and appalled by these deplorable attacks,” said Armstrong Dangelser.

“We are experiencing a violation of humanitarian principles and the space for humanitarians to work is shrinking on a scale I’ve rarely seen before … People are in a desperate situation and the need for healthcare is critical, but these attacks make it so much harder for healthcare workers to help.”

Clashes between the military and the RSF intensified on Sunday as the fighting in Khartoum and the western regions entered its 12th week, according to a Reuters news agency report.

Air and artillery strikes as well as small-arms fire could be heard, particularly in the city of Omdurman, as well as in Khartoum, the report said.

More than 2,000 people have been killed since fighting broke out on April 15, according to the Armed Conflict Location and Event Data Project, which collects data on conflicts and other violence worldwide.

The UN estimates that upwards of 1.2 million people have been displaced, out of whom at least 425,000 have fled abroad.

Last week, military chief Gen. Abdel Fattah Al-Burhan called on young men to join the fight against the RSF and, on Sunday, the army posted photos it said were of new recruits.

Saudi Arabia took the lead in efforts to evacuate thousands of foreigners from Sudan in the early days of the conflict. The Kingdom’s diplomats have also been working with their US counterparts to help broker a lasting ceasefire in the country.

A five-day extension of the last truce expired last month with little sign of a let-up in the violence. That ceasefire did, however, allow surgical supplies donated by the International Committee of the Red Cross to be distributed to seven hospitals in Khartoum by the Ministry of Health, including anesthetics, antibiotics, dressings, sutures and infusions.

 

 

But according to Atia, the doctors who chose to remain in Sudan are generally working with only the most basic of medical equipment and supplies, which is putting patients at risk, and many of the remaining medical staff are desperate to leave.

“Everyone is asking where they can go to escape this,” he said.

In many areas, field hospitals staffed by volunteers have been set up in schools and other public buildings in an attempt to make up for the lack of operational state institutions, and help treat the chronically sick and, increasingly, those who succumb to the effects of dehydration and malnutrition.

“Everything has been left in the hands of civilians and the few doctors and hospitals that are left,” said Atia.

“We are trying to focus on the chronic diseases (and) also at home where people are dying due to lack of water, food and no access to drugs.”

 


Israeli ‘aggression’ targets Syria’s Homs countryside, state news agency says

Updated 54 min 11 sec ago
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Israeli ‘aggression’ targets Syria’s Homs countryside, state news agency says

  • Blasts had been heard in the vicinity of Homs city and that the cause was under investigation

HOMS: Initial reports indicate that an Israeli “aggression” targeted two villages in northern and western areas of Syria’s Homs province, the Syrian state news agency said on Tuesday.
Earlier, Syrian state television said blasts had been heard in the vicinity of Homs city and that the cause was under investigation.
Israel has been carrying out strikes against Iran-linked targets in Syria for years but has ramped up such raids since the Oct. 7, 2023, assault on southern Israel by Hamas-led militants.


Saudi Arabia sends aircraft loaded with food, medical supplies to Lebanon

Updated 26 November 2024
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Saudi Arabia sends aircraft loaded with food, medical supplies to Lebanon

  • Saudi aid agency KSrelief has transported hundreds of tonnes of aid to region since October

RIYADH: Saudi Arabia sent its 24th relief plane to Lebanon on Tuesday with humanitarian supplies including food and medical aid.

The conflict between Israel and Iran-backed Hezbollah has intensified of late, forcing thousands of Lebanese to flee their villages and neighborhoods while under fire in southern Lebanon and the country’s capital, Beirut.

Arab nations like Saudi Arabia and the UAE have sent aid supplies to Lebanon to help those displaced.

The aid plane flying the latest mission took off from King Khalid International Airport near Riyadh and headed to Rafic Hariri International Airport in Beirut, the Saudi Press Agency reported.

A statement from the Saudi aid agency KSrelief said the aid deliveries showed that the Kingdom was “standing with needy and affected countries … in the face of crises and difficulties.”

KSrelief launched an initiative in October to transport hundreds of tonnes of medical supplies and food aid to Lebanon.


Childhood cancer patients in Lebanon must battle disease while under fire

Doctor Dolly Noun, a pediatric hematologist and oncologist, checks Carol Zeghayer, 9, a girl who suffers from leukaemia ahead of
Updated 26 November 2024
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Childhood cancer patients in Lebanon must battle disease while under fire

  • More than war, parents fear that their children will miss life saving chemotherapy treatment
  • Among the tens of thousands fleeing their homes among them are families with children battling cancer

BEIRUT: Carol Zeghayer gripped her IV as she hurried down the brightly lit hallway of Beirut’s children’s cancer center. The 9-year-old’s face brightened when she spotted her playmates from the oncology ward.
Diagnosed with cancer just months before the conflict between Hezbollah and Israel erupted in October 2023, Carol relies on weekly trips to the center in the Lebanese capital for treatment.
But what used to be a 90-minute drive, now takes up to three hours on a mountainous road to skirt the heavy bombardment in south Lebanon, but still not without danger from Israeli airstrikes. The family is just one among many across Lebanon now grappling with the hardships of both illness and war.
“She’s just a child. When they strike, she asks me, ‘Mama, was that far?’” said her mother, Sindus Hamra.
The family lives in Hasbaya, a province in southeastern Lebanon where the rumble of Israeli airstrikes has become part of daily life. Just 15 minutes away from their home, in the front-line town of Khiam, Israeli troops and Hezbollah fighters clash amidst relentless bombardments.
On the morning of a recent trip to Beirut for her treatment, the family heard a rocket roar and its deafening impact as they left their home. Israeli airstrikes have also hit vehicles along the Damascus-Beirut highway, which Carol and her mother have to cross.
The bombardment hasn’t let up even as hopes grew in recent days that a ceasefire might soon be agreed.
More than war, Hamra fears that Carol will miss chemotherapy.
“Her situation is very tricky — her cancer can spread to her head,” Hamra said, her eyes filling with tears. Her daughter, diagnosed first with cancer of the lymph nodes and later leukemia, has completed a third of her treatment, with many months still ahead.
While Carol’s family remains in their home, many in Lebanon have been displaced by an intensified Israeli bombardment that began in late September. Tens of thousands fled their homes in southern and eastern Lebanon, as well as Beirut’s southern suburbs — among them were families with children battling cancer.
The Children’s Cancer Center of Lebanon quickly identified each patient’s location to ensure treatments remained uninterrupted, sometimes facilitating them at hospitals closer to the families’ new locations, said Zeina El Chami, the center’s fundraising and events executive.
During the first days of the escalation, the center admitted some patients for emergency care and kept them there as it was unsafe to send them home, said Dolly Noun, a pediatric hematologist and oncologist.
“They had no place to go,” she added. “We’ve had patients getting admitted for panic attacks. It has not been easy.”
The war has not only deepened the struggles of young patients.
“Many physicians have had to relocate,” Noun said. “I know physicians, who work here, who haven’t seen their parents in like six weeks because the roads are very dangerous.”
Since 2019, Lebanon has been battered by cascading crises — economic collapse, the devastating Beirut port explosion in 2020, and now a relentless war — leaving institutions like the cancer center struggling to secure the funds needed to save lives.
“Cancer waits for no one,” Chami said. The crises have affected the center’s ability to hold fundraising events in recent years, leaving it in urgent need of donations, she added.
The facility is currently treating more than 400 patients aged from few days to 18 years old, Chami said. It treats around 60 percent of children with cancer in Lebanon.
For Carol, the war is sometimes a topic of conversation with her friends at the cancer center. Her mother hears her recount hearing the booms and how the house shook.
For others, the moments with their friends in the center’s playroom provide a brief escape from the grim reality outside.
Eight-year-old Mohammad Mousawi darts around the playroom, giggling as he hides objects and books for his playmate to find. Too absorbed by the game, he barely answers questions, before the nurse calls him for his weekly chemotherapy treatment.
His family lived in Ghobeiry, a neighborhood in Beirut’s southern suburbs. Their house was marked for destruction in an Israeli evacuation warning weeks ago, his mother said.
“But till now, they haven’t struck it,” said his mother, Suzan Mousawi. “They have hit (buildings) around it — two behind it and two in front of it.”
The family has relocated three times. They first moved to the mountains, but the bitter cold weakened Mohammad’s already fragile immune system.
Now they’ve settled in Ain el-Rummaneh, not far from their home in the southern Beirut suburbs known as Dahiyeh, which has come under significant bombardment. As the Israeli military widened the radius of its bombardment, some buildings hit were less than 500 meters (yards) from their current home.
The Mousawis have lived their entire lives in Dahiyeh, Suzan Mousawi said, until the war uprooted them. Her parents’ home was bombed. “All our memories are gone,” she said.
Mohammad has 15 weeks of treatment left, and his family is praying it will be successful. But the war has stolen some of their dreams.
“When Mohammad fell ill, we bought a house,” she said. “It wasn’t big, but it was something. I bought him an electric scooter and set up a pool, telling myself we’d take him there once he finishes treatment.”
She fears the house, bought with every penny she had saved, could be lost at any moment.
For some families, this kind of conflict is not new. Asinat Al Lahham, a 9-year-old patient of the cancer center, is a refugee whose family fled Syria.
“We escaped one war to another,” Asinat’s mother, Fatima, added.
As her father, Aouni, drove home from her chemotherapy treatment weeks ago, an airstrike happened. He cranked up the music in the car, trying to drown out the deafening sound of the attack.
Asinat sat in the back seat, clutching her favorite toy. “I wanted to distract her, to make her hear less of it,” he said.
In the medical ward on a recent day, Asinat sat in a chair hooked to an IV drip, negotiating with her doctor. “Just two or three small pinches,” she pleaded, asking for flavoring for her instant noodles that she is not supposed to have.
“I don’t feel safe … nowhere is safe … not Lebanon, not Syria, not Palestine,” Asinat said. “The sonic booms are scary, but the noodles make it better,” she added with a mischievous grin.
The family has no choice but to stay in Lebanon. Returning to Syria, where their home is gone, would mean giving up Asinat’s treatment.
“We can’t leave here,” her mother said. “This war, her illness … it’s like there’s no escape.”


Why has Israel increased its attacks on Syria?

Updated 26 November 2024
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Why has Israel increased its attacks on Syria?

  • The Syrian Observatory for Human Rights war monitor has recorded at least 86 Israeli attacks, with 199 Iran-backed fighters, Syrian soldiers and 39 civilians killed
  • Observatory head Rami Abdel Rahman said Israel has mainly hit border crossings, Damascus apartments, and the positions of Iran-backed groups

BEIRUT: Last week Israel launched its deadliest strikes on Iran-backed groups in Syria, killing more than 100 fighters in the latest escalation since two months of full-blown Israel-Hezbollah war spilled over.
What are the reasons for this escalation, and what exactly is Israel targeting in Lebanon’s neighbor Syria?
Israel intensified its strikes against Syria from September 26, days after launching an intense bombing campaign mainly targeting Hezbollah strongholds in Lebanon.
Since then, the Syrian Observatory for Human Rights war monitor has recorded at least 86 Israeli attacks, with 199 Iran-backed fighters, Syrian soldiers and 39 civilians killed.
On November 20, Israeli strikes on the city of Palmyra killed 106 Tehran-backed fighters, with one raid targeting a meeting of commanders.
It was the deadliest Israeli attack on Iran-backed groups since Syria’s war erupted in 2011, said the Britain-based Observatory which has a network of sources inside the country.
The casualties included 73 pro-Iran Syrian fighters, 11 of whom worked for Hezbollah which also lost four Lebanese members. The remaining 29 casualties were mostly from Iraq’s Al-Nujaba group.
On Monday, Israel struck again, this time at a crossing on the Syria-Lebanon border, the latest in a wave of attacks targeting such routes since September.
Observatory head Rami Abdel Rahman said Israel has mainly hit border crossings, Damascus apartments, and the positions of Iran-backed groups, including Hezbollah weapons and ammunition depots.
“Syria today has become a de facto part of Israel’s battlefield,” he said.
On November 19, Syrian Foreign Minister Bassam Sabbagh visited ally Tehran and condemned “more than 130” Israeli attacks on his country since the Gaza war started in October 2023.
These included an April 1 attack on an Iranian diplomatic building in Damascus that killed seven Islamic Republic Guard Corps members including two generals, triggering Iran’s first ever attack on Israel.
Since 2011, Israel has carried out hundreds of strikes in Syria, mainly targeting the army and Iran-backed groups.
Israel rarely comments on such strikes, but has repeatedly said it will not allow Iran to expand its presence there.
Israel’s military said Monday’s strikes targeted “smuggling routes to transfer weapons to” Hezbollah, and follow other operations against “Syrian regime smuggling routes” in recent weeks.
For Century Foundation analyst Sam Heller, “the deterrent balance that had existed between Hezbollah and Israel has broken down” since the Lebanon war.
“Israel is now bombing Lebanon at will, and additionally hitting what are purportedly Hezbollah and Iran-linked targets in Syria without fear of real reprisal” by the group.
“This all seems like an attempt by Israel to sustainably weaken Hezbollah,” as it pounds its “logistical lines via Syria and pushes for a resolution to the war that will prevent Hezbollah from resupplying and rebuilding,” Heller added.
Renad Mansour of Chatham House said Israel’s Syria strikes “targeted the financial and military supply chains that fuel the axis of resistance” — Iran-backed armed groups that include Hezbollah and Palestinian, Yemeni and Iraqi militants.
On Sunday, UN special envoy for Syria Geir Pedersen said it was “extremely critical” to end the Lebanon and Gaza fighting to avoid dragging Syria into a regional war.
Escalating Israeli attacks have added to the country’s woes after 13 years of conflict and successive economic crises compounded by Western sanctions.
Damascus has not responded to Israel’s attacks and has tried to distance itself from the Gaza and Lebanon wars.
“Any counterattack against Israel would invite massive retaliation against Syria’s leadership or essential infrastructure,” Heller said.
A source close to Hezbollah said “Syria’s role is not to attack Israel, but rather to serve... as a supply line from Iran and Iraq to Hezbollah.”
Tehran and Baghdad fear that Israeli strikes, which have already hit Yemen’s Houthi militants, could hit their territory even if a ceasefire is agreed, the source said, requesting anonymity to discuss sensitive matters.
Last week, Israel called on the UN Security Council to pressure Iraq into halting attacks launched by Iran-backed groups from its soil.
Tehran-backed Iraqi factions have claimed near-daily drone attacks on Israel in solidarity with allies Hamas and Hezbollah. Most of the attacks were intercepted.
The Baghdad government, which is dominated by pro-Iran parties, has accused Israel of trying to legitimize attacking Iraq, saying it was already taking measures to prevent attacks on Israel launched from its territory.
For more than a year, “Iraq has managed to stay relatively insulated from this wider regional war,” Mansour told AFP, adding that Iran and the United States also pushed for this.
But “in this time of transition between US President (Joe) Biden and (Donald) Trump, the Iraqi government is concerned that (Israeli Prime Minister Benjamin) Netanyahu has even more of a free hand to go after all the axis of resistance,” he said.


UK campaigners file emergency injunction over F-35 exports to Israel

Updated 26 November 2024
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UK campaigners file emergency injunction over F-35 exports to Israel

  • Move follows ICC issuing of warrants for Netanyahu, Gallant
  • ‘UK is now arming suspected war criminals,’ says Global Legal Action Network lawyer

LONDON: Campaigners in the UK seeking to block the sale of F-35 parts to Israel are applying for an emergency high court injunction after the International Criminal Court issued an arrest warrant for Israeli Prime Minister Benjamin Netanyahu.

The government has until Friday to file a defense against the campaigners from Global Legal Action Network and Al-Haq.

It is “unconscionable” that British manufacturers of F-35 parts continue to sell weapons systems that are used to kill Palestinians in Gaza, campaigners said.

On Nov. 18 at a high court hearing, the government admitted that potential damage to the UK-US relationship played a role in the continuation of exports.

In earlier hearings, ministers, some of whom have admitted that Israel is in breach of international law, were asked about the rationale for continuing exports.

The court was set to hear the case again in January next year.

Government ministers have said that F-35 parts enter a general export pool and that it is impossible to determine the destination of each part.

The Labour government reversed a decision by the former Conservative government to allow some arms export licenses to Israel to remain in place, finding a risk that the exports could be used to breach international humanitarian law.

GLAN lawyer Charlotte Andrews-Briscoe said: “It is unconscionable that the UK continues to allow British-made components for F-35s to be used in Israel’s extermination campaign against Palestinians.

“As of Thursday, the UK is now arming suspected war criminals who have been indicted by the world’s preeminent criminal court.

“For 13 months, GLAN and Al-Haq have argued that weapons sales to Israel are unlawful. When will it be enough? Does the UK government have any red lines?”

The emergency injunction follows the ICC’s issuing of arrest warrants for Netanyahu; former Israeli Defense Minister Yoav Gallant; and Hamas military chief Mohammed Deif.

The Israeli leader condemned the court’s decision as “antisemitic.”

GLAN and Al-Haq’s injunction is a sign of the impact caused by the ICC warrants.

Al-Haq spokesperson Zainah El-Haroun said: “The latest arrest warrants issued against Israeli Prime Minister Netanyahu and former Defense Minister Gallant for the commission of war crimes and crimes against humanity add to the insurmountable evidence that British weapons, particularly F-35 components, are being used to commit international crimes, including genocide.”