3. Health and Public Services Collapse

The protracted war in Sudan has not only destroyed buildings and supply chains — it has systematically dismantled the country’s ability to protect and preserve life. Health systems are both direct targets and collateral victims: hospitals and clinics have been shelled, looted, or occupied by armed groups; ambulances have been stopped or fired upon; and supply lines for medicines, oxygen, vaccines, and medical consumables have been severed. The results are catastrophic and multifaceted. Below we unpack, in expanded detail, the immediate failures, the cascading secondary effects, and the long-term generational consequences of this collapse.

A detailed humanitarian infographic showing the Sudan Health Cluster’s medical response as of July 2025, including the number of people in need, people reached, funding gaps, health service coverage, outbreaks, state-by-state beneficiary distribution, and the functional status of health facilities across Sudan. The graphic includes maps highlighting affected states, charts on partners involved, and performance metrics for consultations, vaccinations, maternal care, and emergency kits.
Infographic: Sudan Health Cluster Humanitarian Response – July 2025 Overview 
Source: Sudan Health Cluster Humanitarian Response (July 2025)

3.1 Direct damage to health infrastructure

Hospitals, clinics, primary health centres, laboratories and blood banks have been damaged or rendered non-functional in multiple regions. Damage takes several forms:

  • Physical destruction: Artillery strikes, air or drone attacks, and nearby fighting cause structural collapse or make facilities unsafe to operate.
  • Occupation & looting: Armed units often occupy wards, remove equipment, or steal drugs and supplies; this both halts services and introduces violence into healing spaces.
  • Power and water cuts: Destruction of local utilities — power substations, water pumps, sanitation systems — makes even intact clinics unable to sterilize instruments, run refrigeration for vaccines, or provide safe deliveries.

Expanded explanation: a single referral hospital out of service does not merely remove one point of care — it removes an entire referral chain. Emergency patients who formerly would be stabilized and referred to that hospital now face longer transport times, overburdened neighbouring facilities, or no care at all. With critical care units offline, treatable conditions (severe infections, obstetric complications, trauma) become lethal. Laboratory closures also mean that disease surveillance collapses: outbreaks are recognized late, diagnostics are delayed, and public health responses lag behind transmission.

3.2 Health workforce depletion and protection risks

Medical personnel are suffering severe and compounding risks that undermine service delivery:

  • Death, injury and flight: Doctors, nurses, midwives, and community health workers have been killed, injured, detained, or forced to flee their posts for safety.
  • Staff shortages and skill gaps: The exodus of experienced clinicians leaves facilities staffed by junior or non-specialist staff, reducing the quality of care for complex cases.
  • Psychological toll and burnout: Remaining staff face unbearable workloads, moral injury, and trauma, increasing errors and reducing capacity for sustained care.

Expanded explanation: human capital is the most difficult part of any healthcare system to replace. Training a surgeon, a neonatal intensive care nurse, or a laboratory technician takes years — and wartime losses mean that even if infrastructure were rebuilt quickly, the skilled workforce might not return. In the interim, mortality from childbirth, neonatal conditions, trauma and complex infections is likely to rise sharply.

3.3 Cholera, malaria, measles and communicable disease outbreaks

The environmental and social conditions created by war — crowded, unsanitary camps; contaminated water supplies; interrupted vaccination programs; and reduced vector control — are perfect incubators for infectious disease. The main disease threats include:

  • Cholera and acute watery diarrhoea: Water supply and sanitation breakdowns produce explosive cholera outbreaks, which kill rapidly without prompt rehydration and antibiotics.
  • Malaria resurgence: Disruption of insecticide spraying, bednet distribution and antimalarial treatment increases transmission and severe disease, particularly among children.
  • Measles outbreaks: Suspension of routine immunization leaves children vulnerable — measles spreads quickly in crowded shelters and has high mortality where nutrition is poor.
  • Other infectious threats: Respiratory infections, tetanus (due to injuries), hepatitis, and vector-borne zoonoses all rise when health services and surveillance fail.

Expanded explanation: beyond immediate case counts, infectious disease outbreaks perpetuate a vicious cycle. Cholera and diarrhoeal disease worsen malnutrition, which in turn increases susceptibility to measles and other infections. Malaria in pregnancy raises risks of stillbirth and low birthweight, with lifetime consequences for children’s growth, cognitive development and economic prospects. Without functioning surveillance, by the time authorities notice a spike in cases it is often too late for targeted interventions; mass campaigns are costlier and less effective when delayed.

3.4 Severe shortages: medicines, oxygen, surgical supplies

Wartime supply chain breakdowns cause acute shortages across essential commodities:

  • Essential medicines: Antibiotics, antihypertensives, insulin, antiretrovirals and treatments for chronic diseases become intermittent or unavailable.
  • Oxygen and consumables: Oxygen cylinders, concentrators, tubing and masks are in critical shortage; this is catastrophic for treating severe pneumonia, obstetric haemorrhage, trauma and COVID/respiratory patients.
  • Surgical supplies and blood: Sterile kits, sutures, analgesics and safe blood stocks fall below minimal levels, turning otherwise survivable surgical emergencies into deaths.

Expanded explanation: even if a surgical theatre remains physically intact and staffed by a surgeon, without sterile supplies and blood the risk of postoperative infection and peri-operative death increases dramatically. Chronic disease patients (diabetics, hypertensives, people living with HIV) face accelerated morbidity when their lifelong medicines are interrupted — leading to heart attacks, strokes, and preventable deaths that further erode community resilience.

3.5 Maternal, neonatal and child health impacts

Women and children bear a disproportionate share of the health burden in war:

  • Maternal mortality: The collapse of obstetric services increases maternal deaths from haemorrhage, sepsis, obstructed labour and hypertensive disorders.
  • Neonatal care gaps: With limited neonatal intensive care, premature and low birthweight babies face much higher mortality.
  • Child malnutrition: Food insecurity and repeated infections produce acute and chronic malnutrition, stunting physical and cognitive development.

Expanded explanation: maternal and child health losses are not only tragic but transmissible across generations: the death of a mother increases the child’s risk of death and abandonment, and malnutrition undermines schooling and future productivity. These losses compound to reduce the nation’s human capital for decades after the conflict ends.

3.6 Mental health and psychosocial consequences

Trauma, grief, chronic stress and the breakdown of social networks drive a parallel epidemic of mental health needs:

  • Acute psychological distress: Survivors of attacks, witnesses of violence, and those who lost family members show high levels of anxiety, depression and post-traumatic stress.
  • Children and adolescents: Young people exposed to violence display behavioural problems, learning difficulties and long-term cognitive impacts.
  • Limited services: Mental health support is rarely prioritized during emergencies and is severely under-resourced in Sudan, leaving most people without psychosocial care.

Expanded explanation: the invisibility of mental health means its effects are often underestimated. Untreated trauma increases suicide risk, domestic violence, substance misuse and community breakdown — all of which hinder recovery and reconciliation. Community-based psychosocial interventions (safe spaces, child-friendly activities, counseling) are low-cost, high-impact responses that are currently scarce in many affected areas.

3.7 Public health surveillance and disease control collapse

Effective public health requires functioning surveillance, labs, cold chains and reporting systems — all of which are heavily impaired. The consequences include late detection of epidemics, failure to contain outbreaks, and inability to monitor vaccination coverage or track displaced populations’ health needs.

Expanded explanation: without surveillance, humanitarian actors cannot prioritize resources efficiently. Donors may not realise the full scale of nutrition crises or epidemic spread until irreversible damage has occurred. Re-establishing surveillance — even basic community reporting — is a critical first step for any recovery plan.

3.8 Long-term generational consequences

The health system collapse will reverberate long after active hostilities cease:

  • Lost childhoods: Years of poor nutrition and interrupted schooling damage lifetime earnings and societal productivity.
  • Chronic disease burden: Uncontrolled hypertension, diabetes and infectious disease sequelae will raise the chronic care burden for decades.
  • Reconstruction complexity: Rebuilding buildings is feasible; rebuilding trust, training professionals, and restoring routine immunization and chronic care systems takes a generation.

Expanded explanation: international reconstruction that focuses only on bricks and mortar will fall short. Sustainable recovery requires long-term investments in workforce training, public health systems, supply chains, and community reconciliation. Without this, the cycle of vulnerability and disease can persist across generations, undermining peace dividends and economic recovery.

Key Point: The destruction of Sudan's healthcare system is not merely a symptom of war — it is a multiplier of suffering. Reconstructing health services must be a central pillar of any peace plan, prioritizing immediate lifesaving supplies and personnel protection while planning for long-term workforce rebuilding, surveillance restoration, and resilient primary care systems that can withstand future shocks.

Immediate priorities (first 0–3 months): protect hospitals and ambulances, open humanitarian corridors for medicines and oxygen, deploy emergency mobile clinics, restart vaccination catch-up campaigns, supply rehydration and cholera kits, and provide mental-health first aid.

Medium term (3–18 months): reconstitute referral networks, rehabilitate damaged facilities, re-stock blood banks and surgical kits, re-train displaced health workers, and scale up community-based nutrition and maternal health programs.

Long term (18 months+): invest in medical education and retention, rebuild laboratory and surveillance capacity, modernize health information systems, strengthen primary health networks, and institutionalize protections for healthcare in national law and international agreements.