Sudan: How a war without rules doesn't spare even hospitals

By Sylvia Chebet

Hospitals in the city of el-Fasher in Sudan's troubled North Darfur region have become the latest casualties of war as renewed fighting between the Sudanese armed forces and the paramilitary RSF breaches the bounds of International Humanitarian Law.

The July 29 attack on Saudi Hospital, supported by the global charity Médecins Sans Frontières (MSF), was the tenth occasion that a healthcare facility in this city teeming with 1.5 million-odd people had suffered a hit since the conflict escalated less than 12 weeks ago.

Three caregivers were killed in the attack, and 25 civilians were wounded, including some displaced people sheltered in a nearby mosque that was also struck.

"We don't know if hospitals are being intentionally targeted, but the strike last week shows that the belligerents certainly aren't taking any precaution against collateral damage," Stéphane Doyon, head of MSF’s emergency response in Sudan, tells TRT Afrika.

"They are not making any efforts to prevent the death of civilians or to ensure the protection of patients and medical staff. As a result, many more lives are being lost."

Even war has rules

Since the earliest wars, the invocation of humanitarian norms to safeguard unarmed people, especially the sick and the wounded, has been one of the cornerstones of civilisation.

The universally accepted principle of International Humanitarian Law, or a set of rules governing conflict of any kind, clearly distinguishes between collateral damage and war crimes.

In Sudan, the spate of attacks recently has been so indiscriminate that even patients undergoing treatment in hospitals and medical staff tending to them haven't been spared the debilitating impact of a war that started on April 15, 2023, and shows no sign of abating.

The repeated attacks on el-Fasher's hospitals have added to the already massive death toll in 15 months of fighting.

At least nine people have been killed in the ten hospital attacks, and 38 others wounded.

MSF, also known as Doctors Without Borders, suspects there is more to the string of attacks on hospitals than just coincidence.

"The warring parties are well aware of the location of Saudi hospital, and they are also well aware that it is the last remaining public hospital in the city with the capacity to treat the wounded," says Doyon.

Of the ten documented attacks over the past three months since hostilities escalated, the target on four occasions was Saudi Hospital.

South Hospital, on the other hand, was attacked five times till June 8. Armed men entered the premises, opened fire, and looted the facility, including an MSF ambulance. Patients and staff escaped the scene, and the hospital has been out of service since.

“There will be nowhere left in the city for the injured, or women in need of life-saving emergency C-sections, if this continues," says Doyon.

"Saudi Hospital is the last remaining refuge for besieged residents needing medical help."

Grave medical crisis

A day after fighting escalated on May 10, Babiker Nahar Paediatric Hospital was hit by an airstrike. The roof above the hospital’s intensive care unit collapsed, killing two children and a caregiver. Another caregiver lost a limb.

"Children in need of treatment are now being treated in a small clinic with limited equipment. If they have war injuries, they are treated in Saudi Hospital," says the head of MSF's emergency response.

MSF has treated over 2,000 wounded people, while 300-odd succumbed to their injuries within the first 80 days of intense fighting in el-Fasher.

The rules of war, etched in the Geneva Convention and ratified by many countries, including Sudan, impose limits on the means and methods of warfare.

In February this year, the UN reported that explosive weapons with wide-area effects, such as missiles fired from fighter jets, unmanned aerial vehicles, anti-aircraft guns and artillery shells, were being used in Sudan's densely populated areas.

The report highlighted an incident in Khartoum, where eight missiles killed at least 45 civilians in April 2023 and another in June, when two artillery shells struck a market in Omdurman, killing at least 15 civilians. In September, ten civilians died when a bomb exploded in a bus station.

Between May and November 2023, 10 attacks were carried out against civilians in el-Geneina, the capital city of West Darfur. Of the thousands killed there, most were from the ethnic Masalit community, according to the UN report.

The report mentioned that in Morni and Ardamata, at least 87 bodies were found in a mass grave.

Supply lines choked

Back in el-Fasher, MSF is concerned about an ongoing blockage of trucks ferrying medical supplies.

"Our trucks left N'djamena in Chad over six weeks ago, and they should have reached el-Fasher by now. But we have no idea when they will be released," Doyon tells TRT Afrika.

"In el-Fasher, we only have enough surgical kits left to treat 100 people. If the casualty numbers continue to increase at the same rate, these supplies will soon run out. We desperately need our trucks to arrive."

Some of the trucks are carrying therapeutic food and medical supplies for children in the Zamzam camp, which has reported a catastrophic malnutrition crisis.

" Already, many children there are at deaths door. These supplies are needed to save their lives. If the blockade on humanitarian aid is not lifted as a matter of urgency, there is going to be an even greater death toll," says Doyon.

With medical stocks running out fast, MSF has been urging Sudan's warring forces to stop attacking hospitals immediately and clear the way for the arrival of medical supplies at el-Fasher. Till now, it's a plea that has gone unheard.

Timeline of hospital attacks:

May 11 - Babiker Nahar Paediatric Hospital: Two children and a caregiver died, while another caregiver lost a limb after the roof of the ICU collapsed following an airstrike

May 19 - Saudi Hospital: Damaged by shelling May 25 - South Hospital: Mortar landed on the ante-natal care unit, killing one person and injuring eight others

May 26 - South Hospital: A shell landed inside the hospital and injured three more people, while fragments from the explosion broke the windows of the delivery room and of the ambulance

May 31- South Hospital: Another shelling damaged the hospital further

June 3 - South Hospital: A patient died while another was wounded in another round of shelling and shooting. The water tank was also hit, cutting off the water supply in the hospital

June 8 - South Hospital: RSF soldiers entered the hospital, opened fire, and looted the facility. Patients and staff fled, and all activities in the hospital came to an end

June 21 - Saudi Hospital: A pharmacist was killed while on her night shift, and the pharmacy building was damaged when the facility was bombed

June 27 - Saudi Hospital: A bomb landed inside the hospital compound, breaking the window and damaging the water tank. Two other bombs landed just 20 metres outside the facility, and a fourth landed 50 metres from MSF's office

July 29 - Saudi Hospital: Two shells hit the hospital, killing three people and injuring 25.