Sudanese doctors should not have to risk their own lives to save lives

On the afternoon of April 24, Dr. Attia Abdullah, a general medicine doctor and secretary general of the Sudan Doctors Trade Union, got a call: An airstrike had hit the Al-Kalakla neighborhood of Khartoum and civilian casualties were pouring in. He set off immediately for the hospital.

The route to the hospital was peppered with military checkpoints. Groups of soldiers roamed the streets carrying machine guns. Abdullah did not dare wear his medical scrubs or carry his professional badge. He also dared not drive. If he were stopped by the soldiers at one of the checkpoints, his driver's license would reveal he was a medical doctor. Like other doctors in Sudan, he had received many cryptic calls and text messages that made him fear for his life.

So he walked. Twelve miles, in his jalabiya, the floor-length billowy white robe traditionally worn by men in Sudan. By the time he arrived at Al-Kalakla Turkish Hospital three hours later, its hems were dusty with sand.

The waiting room of the hospital was crowded with patients and their caretakers. Many patients were actively bleeding. Some had gunshot wounds. Others bore crush injuries from the concrete rubble of bombed buildings. "We were not prepared for the casualties we saw," Abdullah recalls. Still, he and his few medical staff began systematically triaging and treating the many patients.

Taking aim at hospitals

The conflict in Sudan erupted on April 15, as two generals went to war over absolute power. Overnight, the generals turned Sudan's capital, Khartoum, into a playground for urban warfare, trapping millions of civilians in the crossfire. In shopping districts and residential areas across the city, soldiers exchange machine gun fire in open streets. Fighter jets have boomed overhead, raining down artillery shells that glimmer like meteoric orbs before plummeting down, destroying homes, schools and factories.

On May 22, a week-long ceasefire took effect to pause the fierce fighting and establish safe routes for the delivery of international aid. The product of weeks of negotiation, it was heralded as a breakthrough. However, within hours of taking effect, gunfire and explosions were heard throughout the capital of Sudan and the hope of humanitarian aid dwindled.

The conflict in Sudan has so far resulted in over 860 deaths, thousands of injured and over one million displaced civilians. Sudanese doctors are among the few organized groups attending to the humanitarian crisis on the ground in Khartoum — but the health system is teetering on the brink of collapse.

Hospitals under siege

Hospitals have been explicit targets in the conflict. They've been stormed by fighters with machine guns drawn, who hijack the buildings to establish strategic bases for their urban warfare, – and they've been targeted with aerial bombing.

According to the Sudan Doctors Trade Union, which is tracking hospital capacity across the country, barely a third of hospitals in all of the country's clash sites remain open. And even those facilities are operating at reduced capacity. In Geneina, Darfur, a town of over 250,000 in the western border where fighting has been especially severe, all health facilities are out of service.

In the hospitals still able to function, water is scarce and electricity is unreliable, as is the case in many sectors of the city. Our Sudanese colleagues tell us that surgeons are sometimes operating under the glow of cellphone lights, relying on basic surgical tools like steel scalpels. Resources like oxygen and dialysis supplies, anesthetics and other medications have completely run out in some hospitals. Supply chains that bring food and medicines to Khartoum by air and land have been severed by violence and looting.

Sudanese doctors are suffering the moral agony of making impossible medical decisions in these extreme circumstances. Dr. Abdullah and his colleagues ran out of blood while treating the flood of casualties at Al-Kalakla Turkish Hospital. The medical team also lacked the supplies needed to properly collect and store blood donations. Their only option was to perform direct blood transfusion, a risky medical practice wherein blood is passed directly from the arm of a willing family member into the arm of their injured relative through an intravenous tube connecting them. The blood types of the donor and patient are briefly checked for very broad compatibility using a blood typing card. However, because the blood is not tested for communicable diseases and may not be an exact match, the procedure carries the risk of infection and severe allergic blood reaction.

Aided by volunteers, Sudanese doctors are improvising to provide life-saving medical care. They pool what little medications are in stock, distributing them to the neediest patients. In addition, they have set up medical triage networks — including hotlines and websites that civilians can use to request help. They also organized mobile teams of community volunteers that can be dispatched to patients' homes to render first aid and identify those in most need of hospital transport.

Doctors are known as 'Soldiers in White'

As Sudanese-American doctors practicing in the United States, we are inspired by our Sudanese counterparts. They are exemplars of the ideals of our profession. They've not just managed to provide care in unimaginable circumstances; they've done so while facing enormous risks to their safety. They have long been called "Soldiers in White" for their dedication to their profession in periods of conflict — never more so than in this violent time.

Among the most sinister threats Sudanese doctors have faced are the direct personal threats to their lives. Sudanese doctors have maintained neutrality and abided by their professional oaths to treat all victims, including soldiers from both sides. However, the warring armed forces have indiscriminately trampled on the human rights guaranteed for medical staff under the Geneva Convention, accusing them of supporting the opposing side and sending staff death threats through both private telephone communication and public social media posts.

Despite escalating threats to their lives, the Sudan Doctors Trade Union released a statement on May 6 asserting that they "remained committed to the values of the medical profession, and the duty to provide care to injured and wounded amidst armed conflict."

Not only that, they have refused to stay silent – documenting the number of deaths and injuries, speaking out against human rights abuses and appealing for support from the international community. A joint statement with partner organizations abroad – including the Sudan Doctors Union-Canada, Sudanese American Physicians Association, Physicians for Human Rights and others – implores that the "international community and international organizations must also act swiftly to secure safe passage for civilians fleeing the war and prepare shelter, food, and medical services for internally displaced people and refugees."

The apparent failure of the May 22 ceasefire means this support won't arrive.

A doctor's dream

This is not the first ceasefire to fail in this conflict. The United States and many regional nations have attempted to broker multiple ceasefires. Their diplomatic strategy has been to negotiate just with the two warring generals. Civilian groups have been excluded. Attempted ceasefires have been broken, and both warring sides have thrown human rights principles to the wayside.

Other diplomatic strategies are needed. We have seen the remarkable capability of the United States and the global community to act when tyrants unlawfully threaten the rights of peoples. In supporting Ukrainian citizens from Russian aggression, the State Department committed to protecting the human rights of Ukrainians by "ensuring that perpetrators, human rights violators and war criminals are brought to justice." They have used a number of policy levers to do so, sanctioning Russian government officials, wealthy elites and entities that are financially fueling the violent conflict against Ukrainians and empowering Ukrainian civilian experts as "domestic authorities" to investigate human rights abuses.

For their herculean efforts to provide humanitarian relief against all odds, Sudanese doctors, nurses and civilian volunteers deserve the same full-weighted diplomatic efforts. It is time that the United States and other powerful nations give civilian groups a seat at the negotiating table. Aid organizations, including the U.N., should commit to localization and partner directly with local civilian organizations, rather than the armed forces, to distribute and manage aid. Lastly, the United States should proceed with sanctions against the generals who have committed clear human rights abuses and other entities fueling the conflict.

And what does Dr. Abdullah want from the international community? He told us: "If only one request, I would ask the international diplomatic specialists to stop this war immediately and unconditionally. This is my first request. This is my dream."

Hazar Khidir is a Sudanese-American emergency physician at Yale. Dalia Owda is is a Sudanese-American emergency physician at Yale. Hana Khidir is a Sudanese-American internal medicine physician at Olive View-UCLA Medical Center.