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IN SUDAN, DOCTORS FORCED TO OPERATE IN SHIPPING CONTAINERS BURIED
UNDERGROUND  
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Eisa Dafalla
February 2, 2025
Drop Site News
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_ Healthcare facilities have come under heavy attack in the conflict
between the Rapid Support Forces and the Sudanese National Army _

Doctors operate on a patient in a shipping container buried
underground in El-Fasher, Sudan. January 2025. , Photo provided by Dr.
Safaa Nasruddin

 

In a dimly lit makeshift emergency room buried beneath the ground in
the besieged town of El-Fasher in western Sudan, gynecologist Elaf
Mohamed tends to her third patient of the day. The thundering boom of
an explosion shakes the earth as another missile smashes into the
surface above.

“We perform surgeries, sometimes up to 12 procedures a day, in these
underground shelters,” Dr. Elaf told Drop Site News by phone. “We
carry out emergency operations on women with gunshot or shell
injuries, as well as caesarian sections, all while being severely
short of medical equipment.”

Shelling by the Rapid Support Forces (RSF) over El-Fasher has
intensified in recent weeks as the paramilitary group pushes to
capture the capital of North Darfur from the Sudanese National Army
(SNA). Nearly two years of fighting in a bitter power struggle between
the SNA and RSF that erupted in April 2023 has brought Sudan to the
brink of collapse. The conflict has triggered the largest displacement
crisis in the world, with more than 14 million people
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homes, tens of thousands
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country’s civilian infrastructure devastated. Famine is sweeping
parts of the country with over 750,000 people on the brink of
starvation.

El-Fasher, home to nearly one million people, has swelled by
over 700,000 internally-displaced
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fleeing violence elsewhere. Since May, the city has been under siege
by the RSF, with paramilitary forces launching indiscriminate attacks,
killing hundreds of civilians, and systematically targeting hospitals
and medical facilities.

The city’s only functional public hospital — the Al-Saudi Maternal
Teaching Hospital, which provides surgical and reproductive health
services — has been attacked 15 times over the course of the
conflict. Last week, on January 24, a drone attack on the hospital’s
emergency department blamed by local officials on the RSF killed over
70 people. The attack came days after a 48-hour ultimatum
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by the RSF to forces allied to the SNA to vacate the city.

The indiscriminate violence has forced Dr. Elaf and her colleagues
into underground emergency rooms constructed a short distance from the
al-Saudi hospital. Poorly equipped and lit only with flashlights, the
buried hideouts-turned-ERs have become the only safe locations for
medics to provide much needed healthcare in the face of continuous
shelling of the city.

“The shelling is non-stop, and even during operations we can hear
the sound of shells falling,” Dr. Elaf told Drop Site, adding that
20 out of 28 public medical facilities in El-Fasher have been rendered
inoperative by the conflict. The dangers to patients and medical staff
have only increased as the fighting intensifies. “I was once shot in
the leg while working inside the hospital,” Dr. Elaf said.

The underground medical bunkers were built in June, one month into
RSF’s siege of El-Fasher, by a group of volunteers
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according to Hawaa Dawood, a member of the group. “They were set up
after all the main hospitals in the city were attacked, leaving only
one out of the three main hospitals operative, and that one only
partially," Dawood told Drop Site.

Dawood said the underground rooms were created out of shipping
containers left behind at the headquarters of UNAMID, the joint UN and
African Union peacekeeping body set up in the years following the
outbreak of the Sudanese civil war in 2003. UNAMID completed its
mandate in 2020. “Volunteers buried these containers under the
ground, covering them with sandbags to hide them and keep them
safe,” she said.

Dawood added that the volunteer group, along with other humanitarian
organizations, are struggling to offer support and protection to
medical staff and patients. “The situation is extremely dire. An
immediate intervention to salvage the healthcare sector is urgently
needed,” she said.

Amidst repeated attacks on hospitals in El-Fasher, including armed
raids, volunteers have even dug trenches around Al Saudi hospital in
an effort to protect patients and medical staff, according to Awatef
Eshaq, another volunteer.

Volunteers bury a shipping container underground near al-Saudi
hospital in El-Fasher, Sudan. June 2024. Photo provided by the bureau
of the Governor of Darfur Region.

In a statement delivered in September before the Security Council,
Joyce Msuya, Acting Under-Secretary-General for Humanitarian Affairs
and Emergency Relief Coordinator said that all “parties to the
conflict are making no efforts to protect health facilities or the
civilians these facilities host.”

The repeated attacks on Al-Saudi hospital has brought the region’s
only dialysis centre to a halt, Dr. Elaf said, leading to the death of
countless patients. “Even with air-dropped medical supplies, the
resources are nowhere near sufficient,” she said, referring to the
aerial support which the SNA provides on a monthly basis to help
bridge a steep gap in essential medical kits. The SNA initially
air-dropped ammunition and artillery to its forces on the ground in
El-Fasher, but since August, as the situation steadily deteriorated,
they have also dropped medical equipment and supplies.

Yet the United Nations and the human rights organizations have blamed
both sides for indiscriminate attacks that have killed civilians.
Médecins Sans Frontières’ head of emergency operations, Michel
Olivier Lacharité, said in a statement in August
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“shelling from both sides has impacted the city resulting in over
2,500 casualties to MSF-supported hospitals and more than 370 of these
patients passing away from their injuries. The number of victims of
the conflict is unknown.”

According to the director general of the Ministry of Health in North
Darfur, Dr. Ibrahim Khater, the war has left the healthcare sector in
tatters. “The medical staff with the help of volunteers are showing
tremendous resilience but they won’t be able to hold up for much
longer without a consistent and sufficient supply of medical kits, and
protection,” he told Drop Site.

Most of the medical hospital staff at the hospital have stopped
working, driven away by the security risks combined with meager pay
and the ongoing siege, according to Dr. Ayoub Adam, a general
practitioner at Al-Saudi.

“The hospital’s staff consists of six to ten doctors, 30 to 50
nurses, and dozens of general practitioners and specialists,” Dr.
Ayoub told Drop Site. “Today, it operates with a reduced team of
five specialists, four assistant specialists, 10 general
practitioners, and 15 medical interns, along with a small number of
nurses and anesthetic technicians, despite the multiplied work
load,” he said, adding that some patient wards have been converted
into makeshift living quarters to accommodate medical staff who are
forced to live inside the hospital itself due to the risks and
restrictions of movement within the city.

Patients also face immense danger in accessing care. Marwa Ibrahim, a
27-year-old mother, gave birth in one of the underground makeshift
emergency rooms in early January, after what she described as a
“life-threatening journey” to the hospital.

“For nearly 10 miles, the distance from my home to the hospital, I
walked while in labor and dodging RSF drones and armed militants
targeting civilians,” she said, adding that many women have been
raped by RSF fighters when on their way to hospitals. A UN inquiry
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in October accused the RSF and its allied militias of “widespread
sexual and gender-based violence, rape, sexual slavery.” The report
found that both the SNA and the RSF “have committed large-scale
human rights and international humanitarian law violations”
throughout the conflict.

“It was a terrifying journey, but all went well in the end, thanks
to the doctors who performed a C-section to bring out my son,” she
said.

Despite building underground bunkers and trenches to protect
healthcare workers and patients, north Darfur’s only standing public
hospital is grappling to keep serving the community. “Keeping alive
while doing this job is a struggle in itself. But we continue to
fulfill our humanitarian role,” Dr. Elaf said.

_This piece was published in collaboration with Egab
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_EISA DAFALLA is a Sudanese journalist focusing on Darfur's coverage._

_Independent news on politics and war. Founded by Ryan Grim, Jeremy
Scahill, and veterans of The Intercept._

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* Sudan
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* war
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* Health Care
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* emergency rooms
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* starvation
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* displaced people
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