Between hospitals that have reopened after being destroyed and looted, and facilities still struggling with shortages of electricity, equipment, medicines, and staff, two contrasting pictures of Sudan's health system are emerging after more than three years of devastating war. In Khartoum, major referral hospitals have begun gradually resuming operations as residents return and fighting recedes from large parts of the capital. Elsewhere, however, the picture is much bleaker in Darfur, Kordofan, and other areas, where ongoing fighting, funding shortages, and difficulties accessing facilities continue to deny large segments of the population access to healthcare. Data from the World Health Organization indicates that around 37 percent of health facilities in Sudan are not functioning, while around 21 million people need medical services, amid shortages of medicines and rising costs of accessing treatment. At the same time, the organization is monitoring improvements in some states as early recovery efforts and the rehabilitation of facilities begin. This contradiction makes the question more complex: "Has Sudan's health system actually begun to recover, or is what is happening merely a partial restoration of services in areas where the war has receded?" Hospitals Recovering At Omdurman Teaching Hospital, one of the capital's largest referral hospitals, signs of a return to activity are evident. Its Director General, Abdel Moneim Ali Al-Qasim, told Asharq Al-Awsat that the hospital suffered extensive wartime destruction affecting its infrastructure, equipment, electrical networks, cables, and generators. In 2024, rehabilitation began on the emergency department to allow it to receive patients, while other parts of the hospital remained destroyed. With support from the King Salman Humanitarian Aid and Relief Centre and its national partner, Kafaat Organization, the hospital received a 730-kilovolt-ampere generator in July 2025, along with intensive care, emergency, and laboratory equipment. Al-Qasim said the support was worth around $1 million. According to Al-Qasim, the stabilization of the electricity supply had a direct impact on services. The waiting time for laboratory test results fell from four to six hours to around one hour and 15 minutes. Around 500 surgical procedures were performed during the first month of the support, before the number rose to between 1,000 and 1,500 procedures per month, averaging between 40 and 50 procedures a day. The hospital currently receives around 600 patients a day. Eleven of its 15 intensive care beds are now operational, while the remaining four are being prepared for service. The hospital also received an integrated oxygen production unit and opened a prosthetics center with a production capacity of up to 50 prosthetic limbs per month during a single shift. That capacity can be doubled by operating two shifts. But the return of activity does not mean the problems are over. According to its director, the hospital still suffers from a shortage of wards and a need for fuel, in addition to unstable electricity. The return of residents is also increasing pressure on facilities that have resumed operations. Buildings Have Returned... But Shortages Remain The same picture is repeated at Bahri Teaching Hospital, which was rebuilt and reopened after suffering extensive destruction during the war. Its Director General, Ahmed Al-Bashir, told Asharq Al-Awsat that the hospital, with a capacity of 640 beds and 20 operating rooms, still needs intensive care equipment to increase its capacity to handle cases around the clock, as well as a backup power source. The hospital also needs to complete its sewage system and connect it to the public network, or provide tankers to dispose of wastewater. Meanwhile, the administration is seeking to convert the emergency complex into a continuing vocational training center to make up for some of the staff the hospital lost during the war. These details reveal one of the major challenges of rebuilding the health system: repairing a building and reopening its doors does not necessarily mean restoring its full capacity to provide services. A Bleaker Picture Outside Major Hospitals A short distance from the major referral hospitals that have begun to resume operations, the picture can be very different, even within Khartoum State itself. In Fattasha, west of Omdurman, Eman waited for three days while her son suffered from a high fever and worsening cough because the nearest health facility could not provide the services he needed. Eman said in testimony published by the United Nations Children's Fund, UNICEF, in December 2025 that the area's only health center had just one health worker and offered no vaccination, nutrition, medicines, pharmacy, or laboratory services. The mother had no choice but to wait for a UNICEF-supported mobile clinic that visits the area twice a month. Despite the time that has passed since that testimony, the same hardship continues, revealing the wide gap between the return of major hospitals in the heart of the capital and those on the outskirts of the state. The gap becomes even clearer outside Khartoum. At Al-Thawra Health Center in New Halfa locality, Kassala State, Noor, who is pregnant with her eighth child, says she previously had to buy the iron supplements prescribed by doctors during pregnancy. At times, however, she stopped taking them because she could not afford them. In testimony published by UNICEF in July 2025, Noor said that the free provision of medicines had become a major relief for the family after the cost of treatment had prevented her from obtaining the medication. At the same center, Aisha, a mother who received medicines for her children, said that receiving treatment for free represented significant assistance given the economic circumstances facing families. In White Nile State, families face another problem: distance. In January 2026, UNICEF documented the journey of Zahra and her nine-month-old daughter, Amina, to obtain vaccinations. Zahra takes around two hours to reach the nearest health facility from her home. Previously, she had been forced to travel to the city of Al-Jabalain in search of the service. In the same area, another mother named Amina arrived with her two-year-old daughter, Aisha, after the child developed severe diarrhea and vomiting and became so weak that she could no longer walk. After being admitted to a stabilization center and receiving treatment and therapeutic milk, the girl began to regain her strength. El Fasher... Giving Birth Under a Tree The hardship reaches its most severe levels in areas affected by war and displacement. Amani, a displaced mother from North Darfur, recounted how she was forced to move with her family to escape fighting in El Fasher while she was in the final months of pregnancy. In testimony published by UNICEF in August 2025, she said the family went days without food or water or anyone to help them. During their displacement journey between Sharika and Tawila, she went into labor, with no hospital or health workers nearby. Amani gave birth to her daughter by the roadside, under a tree and on a small mat, with the help of her mother and some local residents. She said that during the delivery she did not know whether she would live or die, or what would happen to her children if she died. After giving birth, she was too weak to carry her newborn or continue the journey. She was forced to stop for about a week before she was able to reach Tawila with her family. Her experience represents the exact opposite of the picture presented by hospitals resuming activity in Khartoum. In areas affected by war, the issue is not simply the quality of services or the availability of equipment, but whether a health facility exists at all. Disagreement Over the Definition of "Collapse" These disparities lie at the heart of the disagreement over how to characterize the condition of the sector. Médecins Sans Frontières has warned that cuts to aid funding are pushing more health facilities to close and depriving millions of Sudanese of essential care. The organization says the Sudan Humanitarian Response Plan, which amounts to $2.87 billion, had received only around 41 percent of the required funding as of August 11. Sudanese Health Minister Haitham Mohamed Ibrahim, however, believes the Médecins Sans Frontières report focuses largely on the organization's activities and working conditions. He told Asharq Al-Awsat that it "does not by itself reflect the reality of the health sector in the country." Omdurman Hospital Director Abdel Moneim Al-Qasim likewise rejects describing the system as "on the verge of collapse." He says the sector is indeed suffering from a major shortage of resources, but has begun to recover gradually as a result of efforts by the state and national, regional, and international organizations. Bahri Hospital Director Ahmed Al-Bashir agrees that "the description of collapse is inaccurate," while acknowledging at the same time the need to expand support for referral hospitals and provide specialized equipment and medical specialties. Health workers inside Omdurman Teaching Hospital (Asharq Al-Awsat) Cancer Patient Searches for Medicine For patients, recovery is not measured solely by the number of hospitals that have reopened, but by whether they can find the treatment they need when they reach them. In July 2026, Naela Hamad, who has cervical cancer, was receiving chemotherapy at Khartoum Oncology Hospital, known as "Al-Dhura," while her daughter, Ithar Al-Sir, was searching outside the hospital for a medicine needed alongside the treatment that was not available there. Ithar said in testimony documented by Reuters that the family found the medicine outside the hospital for around 180,000 Sudanese pounds, or about $45 at the time, at the prevailing market price. Her mother needs it with each chemotherapy dose every 21 days. The costs do not end with the medicine. She said she also pays 40,000 pounds for the bed where her mother receives her dose, asking how the family can afford these expenses when there is no work or income. Naela says the family had previously struggled to afford food and is now struggling to obtain both food and medicine, while her home was destroyed and she was forced to stay with neighbors. Reuters quoted Mona Abdel Rahman, head of pharmacy at Khartoum Oncology Hospital, as saying that some patients' doses had been delayed by two weeks or more after the free provision of some medicines stopped because they could not afford to buy them themselves. The economic crisis is also affecting diagnostic services. Medical laboratory specialist Al-Tayeb Youssef told Asharq Al-Awsat that the rise in the price of the dollar has directly affected the sector, given laboratories' reliance on imported reagents and supplies purchased in foreign currency. He added that many laboratory owners who returned to Khartoum had been forced to start "from scratch" after losing their premises and equipment and having to face the costs of maintenance, rent, and purchasing equipment again. The high costs have prompted some laboratory owners to purchase equipment through partnerships and pool it at a single location rather than having each laboratory maintain its own equipment. This is viewed as a temporary solution that helps keep services running. Expensive Medicine and Factories on the Road to Recovery The situation in the pharmaceutical market is not very different. Pharmacist Mahmoud Al-Naeem told Asharq Al-Awsat that rising prices and complaints from citizens have worsened since the war, as a result of the destruction of several local pharmaceutical factories, disruptions to external supply chains, and the reliance on imports requiring foreign currency. He noted that the National Medicines and Poisons Board has begun encouraging the registration of new pharmaceutical products and companies, considering that increased competition could help lower prices. Some factories in Khartoum have begun returning to production, although they are operating below full capacity. This opens the door to gradual relief if local production and supply chains stabilize. Epidemics... A Risk That Has Not Gone Away Alongside destruction, funding shortages, and the high cost of treatment, the health system faces the threat of epidemic diseases. The director of Omdurman Hospital says rates of watery diarrhea, malaria, and dengue fever among the cases treated at the hospital have declined, with epidemic-control campaigns continuing and an isolation center established to handle cases of cholera, dengue fever, and other diseases. The director of Bahri Hospital says malaria, as an endemic disease in Sudan, cannot be tackled by hospitals alone. It requires coordination among the federal health system, states, localities, and communities, from awareness, prevention, and vector control to diagnosis and treatment. These risks remain more severe in areas affected by displacement and fighting, where disease and malnutrition coincide with weak water and sanitation services and difficulties accessing health facilities. Thus, the current picture may not show a sector that has completely collapsed, but neither does it show a health system that has overcome the effects of the war. In Khartoum, hospitals have returned to service, surgeries and intensive care and laboratory services have resumed, and rehabilitation and oxygen production projects have begun. In Kassala and White Nile, there are examples of facilities that have regained their ability to provide free services or services closer to local populations. But Eman is still waiting for the mobile clinic to treat her son, Zahra still travels two hours to reach a health center, Amani gave birth to her daughter under a tree while fleeing the war, and Naela reached one of the capital's largest cancer treatment centers only to find that the medicine she needed was unavailable.
