Pharmacist Al-Samani Alhaj felt blood flowing from his head when he heard gunshots from an adjacent room in his busy hospital in northern Khartoum.
Fighters from the paramilitary Rapid Support Forces (RSF) had stormed the building, accused doctors of treating the Sudanese Army and hit Alhaj when he told them the facility was only used by civilians. He stumbled into the next room and found the body of his friend, Musaab, on the floor.
“He was swimming in his own blood,” Alhaj told Deutsche Welle for a video report posted in January. “His chest was open. We could see his lungs sticking out.”
Before the war, there were dozens of medical facilities in the twin cities of Omdurman and Khartoum. Almost all of them are closed now, as the “Generals’ War” rages into its second year. Gen. Abdel Fattah al-Burhan leads the Sudanese Armed Forces (SAF), and Gen. Mohamed Hamdan Dagalo, better known as Hemedti, leads the opposing RSF. Whether they were attacked or bombed by RSF fighters or hit by SAF artillery or airstrikes, an estimated 80% of health centers across the country are not operational, according to the United Nations. Human rights organizations and the U.N. have accused both sides of attacking health centers. Both sides deny the allegations.
Since fighting began April 2023, the World Health Organization (WHO) has verified at least 119 attacks on medical facilities across Sudan, as medical and humanitarian aid workers have been killed by both warring parties. Dr. Hanan Balkhy, regional director for the Eastern Mediterranean, said the WHO believes that the number of attacks is likely much higher than what is currently verifiable.
“For each attack, there is a human cost that is borne by the entire community,” she said in a 2024 statement. “In times of extreme violence, as we are unfortunately witnessing in Sudan today, it becomes even more crucial to have a functional health system. But instead, we not only see facilities but also health workers — the caregivers to the most vulnerable in society — targeted, despite their inspirational commitment to serve.”
According to data collected by Insecurity Insight, a Swiss research institute, there have been 521 attacks on Sudan’s health care system between April 2023 and November 2024.
“Around two thirds of these incidents were attributed to the RSF. SAF forces were also named, but less often,” the institute wrote in a January 13 situation report. “At least 119 health workers, including doctors, nurses and pharmacists were killed while working inside hospitals, clinics or their homes. Health facilities were damaged 129 times, mostly by RSF-launched explosive weapons.”
Reports by aid groups also claim the RSF is targeting health care facilities and workers intentionally, frequently accusing them of helping the SAF.
Supported by medical charity Doctors without Borders, Al Nao hospital lies in an area controlled by the SAF and has been attacked repeatedly since the start of the war. RSF artillery shells killed six people and wounded 38 in the most recent attack on February 4.
“This is a war against civilians. There are no soldiers here,” Jamal Mohamed, director of Al Nao hospital, told DW.
In late January, the RSF attacked the only functional hospital in El Fasher, North Darfur, killing 70 people and wounding dozens. Regional Gov. Minni Minnawi posted on social media site X that an RSF drone struck the emergency department, killing patients, including women and children.
African Union officials recently called Sudan’s civil war the “worst humanitarian crisis in the world,” as the conflict ripples across all aspects of health care. Wilson Almeida Adao, a senior AU official for child welfare, said that hospital admissions for malnutrition rose by 44% in 2024, with more than 431,000 children receiving treatment.
Alhaj has continued to work at the only functional hospital in Omdurman, a few kilometers from the abandoned medical center where he was attacked. Fear is a constant companion, he said.
“We are afraid that something could happen at any time, even today,” he said with tears filling his eyes.
Despite the trauma, Alhaj said the death of his colleague has motivated him and others to continue the work:
“Losing someone like Musaab, who provided medical care to people during this war and died while doing it … how could we stop now?”
