Preventing the Quiet Deaths of Sudan’s War

When war broke out in Sudan in 2023, Dr. Wala Mahgob quickly began to see patients with hemophilia, a genetic bleeding disorder, die for lack of treatment.

Medical stockpiles of clotting factor were lost to looting and outbreaks of violent conflict, said Dr. Mahgob, head of the Hemophilia Unit run by Sudan's Federal Ministry of Health.

Replacing them was impossible, she told Direct Relief. Supply chains had been decimated. People with complex chronic or genetic diseases were not "the priority of war" in the humanitarian world.

"We need to change the name from non-communicable diseases to neglected diseases," Dr. Mahgob said. "No one cares about these patients."

People with hemophilia began receiving blood transfusions instead of clotting factor as treatment. In areas where militias had gained control, and the government could not operate health facilities, this led to devastating consequences: Dr. Mahgob described a 13-year-old girl who, receiving treatment at an unregulated facility in RSF-controlled territory, received a blood transfusion contaminated with HIV. The blood she'd been given hadn't been screened, likely because power outages made it impossible.

The girl developed HIV as a result.

"The Only Organization"

Dr. Mahgob had never heard of Direct Relief until a Ministry of Health official called to inform her that the organization was providing Factor VIII, a lifesaving clotting medication for patients with hemophilia.

"You are the only organization that has supported us" in treating the often life-threatening genetic condition, she told Direct Relief staff.

Before the war began, Sudan's extensive public health system provided free care for diseases like hemophilia. Dr. Mahgob said that, before April of 2023, the national Hemophilia Unit generally saw one or two patient deaths a year - but from causes like aging or car accidents, not the disease itself. Since then, there have been dozens of hemophilia-related deaths alone each year.

Since April of 2023, Direct Relief has provided $35 million in medical material support for specialty medicine, non-communicable disease treatment, antenatal and nutritional support, infection care, and much more to partners in Sudan.

That support has included clotting factors for patients with hemophilia, growth hormones for children and adults with growth failure, surgical medicines and anesthesia, insulin and diabetes management supplies, and dialysis and transplant support for patients with chronic kidney disease - a life-threatening condition that can become much more dangerous in conflict settings, when patients lose access to dialysis, transplant medications, blood pressure medicines, diabetes care, or regular clinical monitoring. (Kidney disease is also much more common in many conflict settings, as unmanaged diabetes or hypertension can cause kidney disease over time.)

In multiple shipments in 2026 alone, Direct Relief delivered more than $3.6 million in specialty medicine to Sudanese partners. A May shipment to the regional NGO MedGlobal Sudan included anticoagulants, surgical anesthesia, and a medication used to treat epilepsy and bipolar disorder.

Direct Relief has also allocated more than $240,000 in grant funding to outfit a dialysis center with resilient solar power, transport hemodialysis equipment, and procure medications for transplant.

"The Beating Heart of the Country"

Dr. Aman Alawad, a physician country director for the MedGlobal Sudan, said that Sudan has recovered much of its ability to provide specialty and tertiary care, such as advanced surgery, oncology, and treatment for genetic diseases.

The biggest and most frustrating difficulty isn't finding physicians or running facilities, he explained. It's getting the medicines that these physicians and facilities need to save lives.

"The facilities end up running out of these drugs," he explained. "The availability of supplies is the main issue we have to address."

The fighting in Khartoum, Sudan's capital, destroyed specialty medicine facilities and a huge amount of the country's national medical stockpile early on in the war - a calamity Dr. Alawad said continues to have devastating impacts.

"Basically, [conflict] took out the beating heart of the country with all the stock and supplies and everything," he said.

While Sudan does receive humanitarian aid, it's not enough to match the scale of the need - and support often focuses on primary care and infectious disease, not non-communicable diseases or complex conditions.

MedGlobal operates hospitals and health facilities in Sudan, including in Darfur, conducts mobile clinics across conflict-affected areas and areas with significant numbers of internally displaced people, and works closely with the Federal Ministry of Health to procure and place lifesaving medications, among other interventions. Dr. Alawad said Direct Relief's partnership - and ability to source the most urgently needed medicines - has been invaluable.

"We prioritize [these medications] because, for us, it doesn't cost much to bring it in and it actually saves a lot of lives," he said. "This is not something [doctors[ can find in a pharmacy or just buy in a private hospital."

The toll of Sudan's war has been devastating: Estimates range from 15,000 to 400,000 violent deaths alone, with many more dying from indirect causes like malnutrition or lack of access to healthcare.

As in other conflict situations, instability and displacement create other urgent health risks while compromising the infrastructure that can fight them: Cholera has killed many displaced Sudanese people. Ebola, while currently not an issue in Sudan, poses a deadly threat to the region.

Dr. Alawad says that the impacts on health in Sudan - a country he said worked strategically over years to build out its public health capacity after decades of civil war - have been cataclysmic. Infectious diseases like HIV and TB are on the rise, as is dengue, and malaria is becoming "too big to control."

In these circumstances, he said, controlling infectious disease often squeezes out other urgent health needs, especially more complex ones.

As a public health specialist who spent his early career working in conflict zones like Yemen and Ethiopia, Dr. Alawad said it's been disorienting to see war break out again in Sudan.

"The same thing that I was studying, the same thing that I did my Master's on, is happening in my home country. It feels good to at least try to give something back," he said. The war is "kind of at a stalemate now. Nobody's paying attention to it."

"When I Get Tired, I Think of Her"

MedGlobal Sudan has responded by building out clinical and sanitary capacity in some of the hardest-hit areas. That includes getting medicine and other clinical support into hospitals in Darfur, the area of the country most severely affected by violence, and providing medical and infrastructure support settings like the Al-Afad camp, where tens of thousands of Sudan's internally displaced people have sought shelter.

Amal Elhadi, a health officer in the nearby town of Al-Dabbah who cares for patients in the Al-Dabbah camp, described mothers who give thank-you gifts of precious food after their lives are saved by C-sections and surgeons forced by local militias to treat patients at gunpoint. One mother arrived from Khartoum, about 250 miles away, with a severely malnourished child who had developed wasting disease and needed specialty care.

"When I get tired, I think of her," she said.

It's not uncommon for surgeons and physicians to contact Elhadi in the middle of the night, urgently seeking lifesaving medicines for emergent patients.

"Just write the prescription and I will do it. Even if I will buy it from my own money, I will do it," she said she tells them.

"Hospital capabilities are low…[doctors] brave the danger every day" in this area of Sudan, she said. "The health system [here] is near to collapse but we stand because of our faith in ourselves."

Dr. Hatim Hassan, a Sudanese-American nephrologist at the Mayo Clinic, founded the Habib Al Rahman Charity Organization, which provides dialysis treatment, transplants, and other renal care at specialized centers in Sudan.

He said a widespread lack of access to diabetes and blood pressure medications has increased the already high incidence of chronic kidney disease, because patients who don't receive medication through a humanitarian source can't access it.

Sudanese patients can't afford to buy food and clean water, he said: "If they have high blood pressure or diabetes, they're not going to buy any medication."

"A Human is a Human"

For Dr. Alawad, expanding the scope of available medicines during wartime is an urgent priority.

"I had the same issue in Yemen, where I'm saying that the hospital I've been working in needs anesthesia medicines, and I have dialysis patients and I have hemophilia patients," he recalled. The medicines he needed were unavailable then too, and often not on the lists of priority medication available to conflict zones.

Rebuilding supply chains and building partnerships focused on specialty care are key to restoring the country's healthcare access, even against a background of war, he told Direct Relief.

"A human is a human, and a need is a need," he said. "Everybody needs to be accounted for."