"Right now, our presence here is critical for cardiac patients in need of treatment and…
On the morning of 15 April 2023, armed clashes between the Sudanese army and the Rapid Support Forces (RSF) began in the streets of Sudan’s capital, Khartoum. Fighting has since spread throughout the country.
EMERGENCY immediately reshaped its activities in Sudan, where it is present with the Salam Centre for Cardiac Surgery and a new Centre for Emergency and Trauma Surgery in Khartoum, and with Paediatric Centres in Mayo (Khartoum), Nyala (South Darfur) and Port Sudan, where it offers free treatment to children under the age of 14.
In Khartoum, the activities of the Salam Centre continue, albeit at a limited capacity, while the new surgical hospital provides emergency care to the war-wounded and civilian trauma cases. In Port Sudan, the Paediatric Centre remains open. However, the Paediatric Centres in Nyala and Mayo are closed for security reasons.
From Our Hospitals And Clinics Across the Country
Update from our Satellite Cardiology Clinics
For heart patients operated on at the Salam Centre for Cardiac Surgery in Khartoum, receiving the medication, therapies and tests they need after surgery is crucial.
After more than seven months of fighting, many of our patients have fled Khartoum or struggle to reach the capital because of deteriorating security conditions.
That’s why we have set up a network of Satellite Cardiology Clinics throughout the country, in places that are easier and safer to reach: to guarantee access to care to our heart patients, even in the midst of conflict.
Restoring the Nyala Paediatric Centre
Our Sudanese colleagues are working to restore the Nyala Paediatric Centre in South Darfur after it was vandalised and looted.
They want to re-open as soon as possible because mothers, children and cardiac patients need a place to receive care, especially at this time.
We don’t know when we will be able to resume operations: we lack medicines – the ones we had were stolen and scattered in the looting – and currently there is no safe way to get new ones to Nyala; we have to replace the equipment that was stolen; and, above all, we have to be able to ensure the safety of our patients and our staff.
A hospital is a place of care. It must not be violated.
Nyala Staff Released, Activities Suspended
Our colleagues who were arrested last week at the Paediatric Centre in Nyala, South Darfur, have all been released with apologies from the Rapid Support Forces. They are shaken, but all are well.
The Paediatric Centre, however, was looted, so we are forced to suspend activities until further notice.
Our colleagues were the first to ask us to keep the Paediatric Centre open to ensure the continuity of health activities. They see first-hand the impact their work has on their communities every day, and so their commitment has never wavered. However, we will not be able to reopen the hospital without assurances of the safety of our staff, our patients and the ability to work autonomously.
In Khartoum, too, the management of our facilities is becoming increasingly difficult. The city has been torn apart by over six months of continuous fighting, and most hospitals have closed.
There is massive need. Even in our cardiac surgery and emergency surgery centres, there is a shortage of drugs, consumables, and fuel for the generators. Many Sudanese colleagues have fled the escalating fighting, while the issuing of visas to our international staff is very slow; they have been waiting for months to enter the country and relieve colleagues who have been operating the projects since the beginning of the conflict.
Even in war, the right to care must be guaranteed. We demand respect for patients, staff and health facilities so that we can continue our work providing free, high-quality care in Sudan.
Staff Taken from Nyala Paediatric Centre
On Tuesday 25 October, a number of Sudanese staff members at EMERGENCY’s Paediatric Centre in Nyala, South Darfur, were taken from the hospital and arrested by the Rapid Support Forces. It seems they are still being held.
EMERGENCY has been present in Nyala since 2020, providing free medical care to mothers, children and cardiac patients. Since the outbreak of war on 15 April, the Centre has continued its work to guarantee essential assistance to a population heavily affected by the conflict. In the last three weeks the hospital has remained open with great difficulty due to the increasing intensity of fighting. However, EMERGENCY managed to stay in touch with the staff until last Tuesday, when the situation seemed to be improving.
At the moment we have not received any communication from the RSF and we have lost contact with the remaining staff members, which since the beginning of the war has only been possible via satellite phone. We therefore have no certainty as to the number of the colleagues arrested or their identities, except for what we have learned from a video circulating on social media.
EMERGENCY asks for the safety of its staff to be ensured, for them to be released immediately, and for the Paediatric Centre to be respected so that it can continue its activities in support of the local population.
Update from President Rossella Miccio
Six months ago, war broke out in Sudan
Six months ago, war broke out in Sudan. Since 15 April, the conflict has claimed over 9,500 lives, while more than 5.5 million people have fled their homes because of the fighting.
In August, we opened a new surgical Centre in Khartoum to provide urgent care to those who cannot receive it in other facilities. Here we receive people burned by explosions, wounded by bullets and mines, but also patients injured in accidents or by civilian trauma.
Since opening the Centre, we have treated more than 500 people.
We continue cardiac surgery and cardiology at the Salam Centre even though it is becoming increasingly difficult for patients to travel. In general, it is difficult to get supplies of even essential goods, fuel and medicines; every day there is a new difficulty, in addition to deteriorating security conditions.
This war attracts few headlines, but it has already triggered a massive humanitarian crisis.
We will remain here. We are not abandoning Sudan.
Juma is Another Civilian Victim of War
Juma is just 11 years old, but he has already lost an eye and a hand to a grenade.
When he came to our hospital in Khartoum, he was screaming in fear. A piece of chocolate was the only thing that could calm him down.
Juma’s parents are missing, most likely from the ongoing conflict in the country.
Now, he is doing better. His other eye – which had also been hit – is safe. “Juma is lively again,” Gina, Medical Coordinator, tells us. “He even went out to the garden yesterday to eat.”
Within a city engulfed in fighting, our Centre for Emergency and Trauma Surgery provides care for civilian victims of the war.
We are not abandoning Sudan.
Update from the Salam Centre on World Heart Day
Patients continue to arrive at the Salam Centre for Cardiac Surgeryin Sudan despite the war. The fighting makes travel difficult for many, but the care they receive at the Centre – surgery, follow-up exams, lifelong therapy – is essential. Our perfusionist Elisabetta gives an update this World Heart Day.
“We have performed about 100 operations since 15 April. Patients slowly keep coming in. We get both pre-op and post-op patients for regular follow-ups and INR treatment.
INR is a parameter that quantifies the time it takes for a clot to form and a key analysis for monitoring patients on oral anticoagulant therapy. In fact, most of our patients undergo valve replacement that requires lifelong anticoagulant therapy.
We have noticed an increase in the number of patients who, because of the war, are unable to reach the Salam Centre for INR therapy and the consequence is a blocked valve.”
“Mariam is a 32-year-old woman we admitted a few days ago. She presented with both valves blocked, mitral and aortic.
She came with her 7-year-old son whom she managed to entrust to relatives.
She was admitted for treatment here, which was fortunately successful without the need for an operation. Now both valves are unblocked. Mariam is already on the ward and doing well.”
“It seems to be never-ending.”
“The fighting in Sudan is appalling. In Khartoum, we continue to receive injured people,” reports Gina, Medical Coordinator of the Centre for Emergency and Trauma Surgery in Khartoum.
“Recently, a 10-year-old boy named Woul arrived at our hospital. His mother told us that a bullet hit him while he was sleeping. Unfortunately it had lodged in his brain; there was nothing we could do.”
“We are also seeing injuries from looting incidents. There are elderly women who end up with bullets in their abdomens and in need of urgent surgery, perhaps for a ruptured spleen.”
“The situation is really heavy. It seems to be never-ending.”
Fighting Continues in Khartoum
“The fighting continues,” reports Gina, EMERGENCY Medical Coordinator in Khartoum. “We often hear explosions, sometimes quite close together. We have received burn patients from the explosions, including a woman, as well as a child who unfortunately did not survive.”
In the new Centre for Emergency and Trauma Surgery, we have already received more than 250 patients amid the deteriorating healthcare infrastructure and safety in the country.
“Colleagues at the Salam Centre for Cardiac Surgery are continuing to operate,” Gina continues. “Our two new satellite cardiology clinics are working at full capacity: on average they receive ten patients per day for anti-coagulation therapy and pre-surgery health monitoring. Many travel from significant distances to receive the medical assistance they need at our clinics.”
“Other hospitals we collaborate with sometimes transfer the patients that they cannot manage to us,” Gina concludes. “The healthcare situation in Sudan is catastrophic.”
Second Satellite Cardiology Clinic Open
In Atbara, the second of our new satellite cardiology clinics is open.
Here, as in Wad Madani, we will ensure the necessary check-ups and therapies for patients we have operated on in Khartoum at the Salam Centre for Cardiac Surgery, as well as preoperative care for those awaiting surgery.
The network of cardiology clinics we are opening in different parts of the country is our way of ensuring the necessary care for our patients in a context of war, where movement is limited or impossible for many, even for essential reasons like treatment.
Rocket lands in garden of Nyala Paediatric Centre
In recent days, conflict has resumed in Nyala, South Darfur, with some fighting taking place near our Paediatric Centre. On the morning of 22 August 2023, a rocket landed in the compound’s garden: fortunately there were no injuries, but the safety of our staff and patients is at its highest risk since the beginning of the war.
🔴 #Sudan: Following renewed fighting in Nyala, South #Darfur, this morning a rocket landed in the garden of EMERGENCY’s Paediatric Centre.
Fortunately there were no injuries, but the safety of our staff and patients is at its highest risk since the beginning of the war. (1/3)
— EMERGENCY NGO (@emergency_ngo) August 22, 2023
EMERGENCY opens Centre for emergency and trauma surgery in Khartoum
At EMERGENCY’s Salam Centre complex in Khartoum, already home to a cardiac surgery hospital, the NGO has opened an emergency and trauma surgery hospital to treat people in a context where few other medical facilities are available because of the war that began in Sudan on 15 April 2023.
“We know Sudan well, having worked here for 20 years. When the country became the scene of a new conflict in April, we decided to stay, although we had to reshape our activities, so as not to abandon our patients,” comments Rossella Miccio, President of EMERGENCY. “As the war has continued, needs have increased, and that is why we decided to expand our activities: in addition to supporting various hospitals with medical supplies, we have refitted a part of our existing cardiac hospital where we used to host patients from other African countries, to create an emergency surgery centre. Here we treat war-wounded, civilian trauma cases and surgical emergencies.”
Within the Guest House, which usually houses 40 patients from the Regional Programme for Cardiac Surgery, are now two operating theatres, an observation ward, an emergency room (up to 7 beds), a sub-intensive care unit (8 beds), dedicated locker rooms, storage rooms for sterile and clean material, and a decontamination space for material that needs to be sterilised. A 30-bed ward has been created in another building.
“So far we have received 77 patients, of whom 44 had war wounds and 2 were dead on arrival,” says Gina Portella, Medical Coordinator at the Salam Centre. “27 have been admitted, and the rest have been managed in the outpatient clinic.”
100 Days of Fighting in Sudan
Today, we mark the 100th day of fighting in Sudan since conflict broke out on 15 April.
The UN reports about 2.6 million people have been internally displaced. 24.7 million are in need of humanitarian assistance.
The conflict is disappearing in the international media, but on the streets it can still be seen and heard. Many report stories of abuse, looting, occupied hospitals. The national health system is collapsing.
We continue to treat cardiac patients at EMERGENCY’s Salam Centre for Cardiac Surgery in Khartoum, albeit at a slower pace. Our Paediatric Centres in Port Sudan and Nyala are also open, mainly providing anticoagulant therapy for former cardiac patients and vaccinations, while in Mayo we remain closed.
Hunger and malnutrition were already at record levels before the conflict broke out. Now, instability and the skyrocketing cost of food have led to an estimated 3 million malnourished children, and cardiac patients who have previously received surgery at the Salam Centre are at risk of adverse health effects.
At our Paediatric Centre in Port Sudan, about 120 children a day queue for triage and vaccinations in the corridors. Although the city is not experiencing direct clashes, it is the main destination of those trying to escape the country. Many people are sleeping in the streets around the port and living in a perpetual state of waiting, suffering the logistical, sanitary and social consequences of overcrowding.
It is clear that EMERGENCY remains a key health provider for the population, made possible by the dedication of our colleagues in the country. They have spent hundreds of hours on the wards and in the operating theatres, continuing to treat patients despite the obstacles of war.
Three Months of Fighting in Sudan
“From the Salam Centre we still hear the sounds of fighting. There has been heavy gunfire and we have seen columns of smoke rising.” Three months after the start of armed clashes in Sudan, Franco – Medical Coordinator of our Salam Centre for Cardiac Surgery – tells us about the situation in Khartoum.
The Salam Centre’s activities continue, albeit at a reduced pace. We continue operating on and admitting patients, conducting follow-up examinations and providing anticoagulant therapy, but “many patients cannot get there, transport is difficult if not impossible” in such an insecure context.
For every patient who manages to reach the Salam Centre, many more are stranded by the war, waiting for the treatment they need.
Even some of our colleagues, who used to travel for an hour to commute to the hospital, now face a six-hour journey.
“A health catastrophe. The country will pay the consequences for a long time.”
3 July 2023
The Situation in Port Sudan
“Since the conflict broke out in Sudan, thousands of displaced people have reached Port Sudan, hoping to escape to countries like Egypt or Saudi Arabia.” Mutasim, our Medical Coordinator in Port Sudan, updates us on the situation in the city and the activities of our Paediatric Clinic.
“The number of patients arriving at the Paediatric Centre has doubled compared to a year ago: around 60 children a day, on Sundays often more than 100. Most of them suffer from sickle cell anaemia or respiratory diseases, made even more acute by the heat: temperatures here have reached 40 degrees.”
“The war has drained all economic resources,” Mutasim continues. “Many have lost their jobs and have nothing left. Their children need treatment and vaccinations: only EMERGENCY is providing these completely free of charge.”
14 June 2023
World Blood Donor Day
When fighting erupted in Sudan two months ago, one of the first concerns of our colleagues at the Salam Centre for Cardiac Surgery in Khartoum was the supply of blood and blood components, which are crucial in a facility like ours.
They are usually donated by the relatives of hospitalised patients and the local population but in war context, we feared that the difficulties and dangers of travel would discourage donors.
Instead, “Not even the war stopped them,” says Elena, our anaesthetist. In recent weeks, many have contributed: colleagues, residents of Soba, people who despite the war – and the scorching heat – have come to the Salam Centre to donate. At such a critical time for the country, even these small but vital gestures have made a difference.
17 May 2023
Ongoing Activities in Nyala, South Darfur
“We are one of the few centres still open where parents can get their children vaccinated,” says Laura, Medical Coordinator at EMERGENCY’s Paediatric Centre in Nyala. “In just three days since we resumed immunisation activities, we have administered more than 400 doses.”
The Centre is located in the capital of South Darfur, Sudan.
“Our activities in Nyala have never stopped, even on days when the fighting was most intense. Parents and children continue to arrive, as well as patients from Darfur who have undergone heart surgery at the Salam Centre for Cardiac Surgery in Khartoum and who come to us for check-ups and to receive medications, about 20 every day.”
15 May 2023
Thank You to Our Colleagues in Sudan
Without the incredible efforts of our Sudanese colleagues, we would not be able to continue operations or caring for existing patients. Thank you for all that you continue to do!
9 May 2023
We Are Still Operating at the Salam Centre
On Sunday, our surgical team in Khartoum performed an urgent operation on H., an 18-year-old woman suffering from severe valvular insufficiency.
She had been admitted to our hospital and awaiting surgery, but when the fighting started we discharged her for safety reasons.
She was waiting to return to the hospital when her condition suddenly deteriorated overnight. The surgery could not wait any longer.
She is now recovering in intensive care, constantly monitored by our team.
5 May 2023
Surgery Updates from Khartoum
“Of the 40 people we were hosting in the guest house in mid-April – patients, relatives and translators from various African countries – we have managed in recent days to repatriate most of those coming from Uganda and Burundi, and soon we will also evacuate those from Chad,” says Franco Masini, Medical Coordinator at the Salam Centre for Cardiac Surgery.
Today there are just over 20 patients in the hospital who cannot be moved because of their health conditions. Some have already been operated on, while others are awaiting surgery.
And, despite the insecurity in the country, even during this difficult time, critical patients have arrived for emergency surgery: remaining in Sudan has made it possible for EMERGENCY to provide these people with life-saving care to which they would otherwise not have had access.
Among the admitted patients is K., 15 years old, who arrived from Uganda prior to the fighting thanks to our Regional Programme.
Suffering from an advanced heart problem due to severe valvular dysfunction, it was immediately apparent that his condition was serious.
We operated on K. the day after fighting began. His path has not been easy: he first went into kidney failure, which required us to put him on dialysis, and then developed a serious infection and gastrointestinal bleeding.
Today, K. is fully awake, although his condition remains serious. Next to him sits his sister, who accompanied him on the long journey from Uganda; she visits every day and squeezes his hand to give him strength.
28 April 2023
We continue to provide continuity of care through our Anticoagulant Therapy Outpatient Clinic
“Although the situation in Sudan is difficult, we continue to provide continuity of care through our Anticoagulant Therapy Outpatient Clinic,” reports Nicoletta Erba, Haemotologist at the Salam Centre for Cardiac Surgery in Khartoum. “Patients, albeit in smaller numbers, come to the Salam Centre to perform necessary tests and receive their medication. Those who live far away are sending blood tests from external laboratories so that we can fill their prescriptions.”
“Providing this treatment is critical: after cardiac surgery, patients require anticoagulant therapy for life. Our Outpatient Clinic is a fundamental part of the Salam Centre’s cardiac programme, giving our patients the security of receiving prescriptions and medications.”
We are receiving only half the number of patients as we did before the fighting started: our thoughts are also with those who cannot reach the Centre in these days.
26 April 2023
Thanks to the great work of our Sudanese colleagues
In Khartoum, the Salam Centre for Cardiac Surgery is still open.
We have several in-patients who need our care and medical attention, our colleagues tell us.
It is thanks to the great work of our Sudanese colleagues, who are at the hospital 24 hours a day, that the Intensive Care Unit and the Anticoagulant Therapy Outpatient Clinic are currently open. “They are the beating heart of this hospital,” Elena writes to us from Khartoum.
In recent days we have discharged, when possible, all patients who were fit to leave the hospital. Having done this – and with the hospital’s activities reduced as a result of the situation in the country – a second group of international staff has now evacuated.
The remaining international medical staff members are working with their Sudanese colleagues to provide treatment in the Intensive Care Unit and the Anticoagulant Therapy Outpatient Clinic, both of which are critical for patients who have undergone heart surgery.
24 April 2023
EMERGENCY Calls on Warring Parties to Respect for Health Facilities
EMERGENCY calls on all parties to the conflict to respect our health facilities and recognise hospitals as safe zones.
23 April 2023
Khartoum, Nyala, and Port Sudan Continue their Work
Over the weekend, seven EMERGENCY workers returned to Italy with an evacuation convoy, three of whom had already planned to return but had been stranded in the country since the outbreak of fighting. Another 46 international workers have remained, and continue their crucial work.
Colleagues at the Salam Centre for Cardiac Surgery are caring for the 81 patients that were admitted before fighting began. Many of our Sudanese colleagues are unable to travel home because of security reasons and are sleeping at the hospital in the meantime.
The Paediatric Clinic in Nyala is once again accepting patients, as is the clinic in Port Sudan, where the situation has remained more stable and our services have gone uninterrupted. The clinic in Mayo remains closed, until we can guarantee safety for both staff and patients.
19 April 2023
Our Facilities Around the Country Continue at a Reduced Capacity.
Across Sudan, many of our colleagues are unable to reach EMERGENCY’s clinics because of unsafe travel routes. They report a lack of food, water and electricity as the situation becomes increasingly difficult.
At the Salam Centre for Cardiac Surgery, in the south-eastern part of Khartoum, ongoing clashes and fighting have limited our work. Muhameda, Country Director in Sudan, tells us: “Here in Salam Centre, we are still working and taking care of our patients, but we are not performing surgeries anymore because we do not have the necessary blood for ventral transfusions.”
Our colleagues continue to manage patients in our ICU and wards, including 57 from the Regional Programme, from countries like Chad, Uganda and Ethiopia, who have been referred to the Salam Centre through our cardiac screening missions.
Our Paediatric Clinic in Mayo, on the outskirts of Khartoum, remains closed.
Nyala, in South Darfur, has experienced heavy clashes from the beginning of the conflict. At our Paediatric Clinic, our staff and patients had to shelter in the basement because of nearby fighting. As of this morning, we are once again receiving paediatric patients.
In Port Sudan, Red Sea State, the situation is more stable. Our Paediatric Clinic there continues to operate.
18 April 2023
“We have a smaller number of staff that is present with us since the 15th of April.”
EMERGENCY NGO’s Country Director in Sudan, Muhameda Tulumovic, provides an update on the organisation’s activities following several days of fighting across the country.
16 April 2023
EMERGENCY’s Country Director in Sudan, Muhameda Tulomovic, joined CNN to discuss the impact of the ongoing fighting on EMERGENCY’s facilities and programmes across the country.
15 April 2023
Armed clashes between the Sudanese army and the paramilitary Rapid Support Forces (RSF) began this morning on the streets of the capital Khartoum after fighting in recent weeks erupted into violence and conflict across the country.
“At the moment we have reduced activities at our healthcare facilities across the country,” explains Muhameda Tulumovic, EMERGENCY’s Country Director in Sudan. “At the Salam Centre for Cardiac Surgery in Khartoum, many Sudanese colleagues cannot go home for security reasons and will stay here. We closed the Paediatric Centre in Mayo, on the outskirts of the capital, evacuating our staff.”
“In the other cities where we operate two paediatric centres, the news we are receiving at the moment is that police, army and military tanks are on the road in Port Sudan, ready to intervene in case the clashes spread, even if at the moment the situation is still under control. In Nyala, the airport and shops are closed, and armed forces just outside the city.”
According to reports from the country, RSF paramilitaries have taken control of the Khartoum airport and the presidential palace in the city centre, while the army has bombed facilities used by the RSF. Explosions and shootings continue in the capital and other parts of the country, while aircraft are reportedly hitting targets in Khartoum.
EMERGENCY is present across Sudan with the Salam Centre for Cardiac Surgery in Khartoum, and Paediatric Centres in Mayo (Khartoum), Nyala (South Darfur) and Port Sudan, where it offers free medical treatment to children under the age of 14.