On 15 April 2023, intense fighting broke out between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) in Khartoum and across most of Sudan. Since then, the fighting has killed and injured thousands of people. Large parts of Sudan have experienced ongoing violence, including intense urban warfare, gunfire, shelling and airstrikes.
When the current war in Sudan erupted, the Darfur region was already in the grip of violence, which exacerbated the ongoing humanitarian crisis. Around this time last year, ethnically targeted violence in West Darfur led to two major massacres, horrific war injuries being endured, and a massive exodus of people from El Geneina into Eastern Chad was documented. Having been trapped in El Geneina for two months, finally, in June 2023, people managed to escape.
One MSF staff shares the reality of living in El Geneina, the reality of a civilian caught up in harsh conflict.
“It has been a year since the first massacre happened here in El Geneina. The situation was disastrous due to mass violence that severely restricted all movement. There was a significant shortage of medical staff to provide emergency medical support to people, and I couldn't guarantee my own safety if I went outside my home.
At the war's start, El Geneina Teaching Hospital was shut down as it was caught in the middle of these clashes. When the tension started to ease a bit, the local medical experts who remained in the city, convened a meeting to discuss reopening the hospital because of its vital importance to the community. Consequently, the decision was made to reopen it. By June 2023, I was working on my own capacity, and doing all I can, coordinating to keep parts of the hospital running, and when MSF team managed to return and realized I was one of their staff, they appointed me as their focal person for many services. I never left. It is a duty.”
El Geneina Teaching Hospital serves local populations and displaced people, mostly women and children.
This central facility is the only tertiary and secondary healthcare facility in this area, which is critical given the frequent conflicts and high humanitarian needs. Despite being looted and out of service in the early weeks of the April 2023 war. It has remained the main hospital in West Darfur, providing dire, lifesaving, free of charge, medical care to vulnerable populations.
At El Geneina Hospital, MSF delivers a comprehensive package of paediatric care on both outpatient and inpatient bases and run an inpatient therapeutic feeding center for severely malnourished children. MSF also supports the Ministry of Health staff in the hospital through incentives so that they can sustain a range of medical services essential for addressing emergency healthcare. From January to May 2024, our MSF team conducted approximately 23,000 outpatient consultations.
The malnutrition situation in West Darfur, mirroring conditions in the greater Darfur state, remains critical. The number of admissions to the Inpatient Therapeutic Feeding Centre in the hospital has doubled from January to April 2024. Initially, the hospital had 20 beds; this number was increased to 34 in mid-March, and subsequently to 50 beds in April 2024.
In response to malnutrition increase, MSF launched community door to door screening for malnutrition in villages distant from El Geneina, where abandoned health facilities underscore the urgency for the population. This lack of medical services prompted MSF team to conduct exploration assessments to extend medical support. In May 2024, MSF outreach team visited locations such as Jabal Moon, Sirba, Beida, Habila, and Fora Baranga, where they conducted nutritional screenings, treated severe malnutrition, assessed rural healthcare facilities, and distributed medical and nutritional supplies. This period marked an increase in consultations, admissions, and overall workload, likely due to the lean season and a spike in malnutrition cases.
Treating mental invisible wounds inflicted on both patients and staff due to the last year violence in El Geneina is another key activity. “ An armed conflict like the one happening in Sudan has a major impact on people's lives, and having psychosocial and mental health support can help prevent normal reactions from turning into more severe symptoms.” Cynthia Matildes, MSF psychologist who had several missions in El Geneina.
The voices from afar are also those of the Sudanese refugees, who fled to the neighbouring country: Chad. Among them are MSF staff who fled for their lives, escaping from El Geneina to Adré, where they have been sheltering with no hope of returning.
In the volatile contexts of wars and inter-communal violence, wounds are not only physical but also deeply etched mentally on the souls and minds of those affected. This impact extends to both the patients and the humanitarians working in these environments.
Aisha Bilal is a health promoter with MSF who previously worked in El Geneina and has now joined our team in Adré transit camp. She explains her role within the refugee community at the camp, emphasizing her commitment to enhancing health education and awareness among the displaced populations.
“We had no choice but to flee because living conditions in El Geneina had become unbearable. Since the start of the war in Sudan in April, it had been impossible to leave our house. We had to stay hidden, without water or food, and under constant threat. Even though living in a shelter in an unofficial camp in East Chad is not easy, we are grateful for the welcome at Adré transit camp and the presence of MSF. At El Geneina, I was already working as an awareness-raiser because I studied community development. So, I’m in my position as an MSF health promoter. My role is to help patients and medical teams understand each other. As a refugee myself, I have the same needs as all the people who come to the health center for treatment. In the morning, as soon as it opens, my outreach colleagues and I are in the triage tent to explain to the people waiting what medical services are available to them and the different stages of care.”
The displacement from El Geneina to Adré continues, driven not only by violence but increasingly by severe food shortages. Many cross into Adré seeking sustenance, water, and rest, some with the hope of returning to El Geneina, while others remain to escape the dire conditions in the city.
Nafissa fled the brutal attacks in El Geneina in June 2023. She found refuge in Eastern Chad and currently lives with two of her children in Aboutengué refugee camp. Her husband was killed in 2022 during a previous period of violence.
“The war escalated last year, but there was violence in our region before that. In recent years my house was set on fire four times. One of my sons was killed in May 2023. My son was only 10. He was shot in the street and died from his wounds in the hospital three days later. So, when I heard about new attacks coming to our neighbourhood [in June 2023], I left my home with my last two children and I’ve never gone back.”
Her journey to Chad was harassing and so dangerous. “We heard gunshots, armed men started shooting at the crowd, people were running everywhere. That was when I lost my daughter. The day after, I was walking on the road with my son when armed men stopped us. They tried to hurt him with a knife, but I wrapped a cloth around my hand and managed to deflect the blade and protect him. I couldn’t believe it when we reached the border in Adré. The day we fled, I never thought we would get there alive. At the border, I found my daughter again, she was exhausted and scared, but I felt so relieved that she was alive. Arriving in Adré, I could barely take another step. A few weeks later, we were moved to Aboutengué refugee camp.”
Nearly a year has passed since the ethnic-based violence and subsequent exodus from El Geneina to Adré. In June 2024, another area of Darfur, El Fasher, is experiencing a violent turmoil, leading to displacement and loss of hundreds of lives.
In contrast to the extreme violence, massive displacement and terrible survival conditions endured by the population in the Darfur region 20 years ago, today the unfolding humanitarian and medical needs in the entire state are being met with blind international attention. For months, we have been the main medical care provider in most areas of Darfur.
Our activities in El Geneina Teaching Hospital have extended into areas usually covered by UN agencies, such as providing water and power. MSF stepped into the limited response of others humanitarian partners. The question remains: till when?
© 2026 MSF
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