Sudan war

Hasanat al-Rashid, 48, has lived with diabetes for 15 years, and the three-and-a-half-year civil war between Sudan’s military and the Rapid Support Forces paramilitary group has worsened her situation. Finding the treatment she needs has become a daily struggle.

When the war broke out in April 2023, she was forced to flee south from her home in Haj Yousif in Khartoum North to Umm Daw Ban in Khartoum State.

During her displacement, she went for days without medication and was forced to eat foods unsuitable for her condition, such as asida, a traditional Sudanese porridge.

She underwent operations on her foot twice when she developed complications of diabetes, including a severe infection.

She moved between hospitals in Gezira State south of Khartoum, seeking treatment in Rufaa, Wad Madani and Al-Hasahisa. When fighting spread to these areas in December 2023, she fled again, arriving in Port Sudan, a city on the Red Sea that was less affected by the war.

Her condition has worsened to the point that she now has to use insulin every day and with this comes added costs, something that forces diabetes sufferers in Sudan to choose between medicine and other essentials, such as food.

“The doses vary depending on whether my blood sugar is high or low,” she told Al Jazeera.

The war has pushed income levels in Sudan back to those last seen in the 1990s, according to the United Nations Development Programme. This means Hasanat and other diabetes sufferers are struggling to afford the medicine they need to treat the condition.

Hasanat’s doctor recommended she use an insulin pen, a device used to inject insulin under the skin. She would need one or two of the devices a month, but the cost at 70,000 Sudanese pounds ($8) is more than she can afford up front, so she opts for a vial of insulin.

This is cheaper at 17,000 Sudanese pounds ($1.80), but there is the additional cost of buying ice every day to keep the insulin cool. She spends 180,000 pounds ($20) a month on ice to preserve the medicine. But she is able to spread these costs out through the month, making the vials her only viable option even if the overall costs are higher than an insulin pen.

“It may last a month or less, but the challenge is that I don’t have a refrigerator, so I struggle to store the insulin properly,” she said.

She also needs painkillers and vitamins on a regular basis to manage complications caused by the diabetes.

The rising cost of treatment

Fatima Adam, 75, is among the patients at Port Sudan Hospital struggling to afford the medicines she needs to manage her hypertension and a thyroid condition.

She was admitted to the hospital with complications caused by high blood pressure, which has started to impact her heart. Too unwell to speak to Al Jazeera herself, her daughter, Aisha, described how the rising cost of treatment has affected her whole family.

Before the war, Fatima received medicine through the National Health Insurance Fund. She paid a quarter of the cost while the fund covered the rest. But when the war started and the economy collapsed, the medicines she needed were no longer covered by the scheme.

“My mother takes six different medicines because hypertension has affected her heart in addition to her thyroid medication. The war has made things harder because the prices of these medicines have gone up,” Aisha told Al Jazeera.

The responsibility for paying for Fatima’s treatment and supporting her and her daughter falls on her son, who works as a casual worker. With no fixed income, he goes to the market every day in search of work but sometimes returns home empty without any luck.

“Sometimes, when my brother finds work, we buy enough medicine to last a month. Other times, we have to buy smaller quantities and take the medicines intermittently,” Aisha said.

She bought a month’s supply of her mother’s medication a few days ago for 160,000 Sudanese pounds ($17.80), a substantial expense for a family whose income depends on day labour but essential to treating Fatima’s condition.

War damage

The war has caused an estimated $500m in losses to medicine stocks, infrastructure and transport fleets, dealing a major blow to Sudan’s pharmaceutical supply system, the National Medical Supplies Fund told Al Jazeera.

The National Medicines and Poisons Board estimated that only eight of the 30 pharmaceutical factories in Khartoum that shut down during the conflict have resumed operations despite the security situation in the capital recently improving.

This has increased Sudan’s reliance on imported medicines, but the subsequent depreciation of the Sudanese pound has driven up the costs of pharmaceutical procurement and production.

Hossam al-Naeem, who works as a pharmacist in Port Sudan, said customers with diabetes and hypertension require regular painkillers and vitamins to help their overall condition.

“I feel deeply saddened when I see the expressions on some patients’ faces as they ask about the prices of medicines and discover how much they have increased because of the depreciation of the Sudanese pound,” Hossam told Al Jazeera.

The currency’s collapse has created added challenges for pharmacists. Before the war, a dollar traded for roughly 600 Sudanese pounds. Now black-market currency traders are quoting rates of 9,300 pounds to the dollar, meaning higher costs for most goods in Sudan.

Sometimes Hossam incurs losses himself when he finds that the prices of drugs have risen sharply, and keeping essential medicines stocked is becoming difficult.

“I used to sell a strip of cold and flu tablets for 6,000 Sudanese pounds [70 cents]. But when I went to buy new stock, I found that the supplier’s price was also 6,000 pounds per strip. That means I made no profit, not even enough to cover the pharmacy’s operating costs,” he said.

The struggle to afford heart medication

Huda Mahmoud, 58, lives in el-Obeid, the capital of North Kordofan state in south-central Sudan, where drone attacks and other violence remain a problem while the military is making advances towards the city.

Huda has lived with heart problems for more than 12 years and described the impacts of the war as being physical, financial and emotional.

“I take five different medicines. There was a time when they weren’t available, and I suffered a lot. Sometimes, I had to ask people in Wad Madani, Sennar or Port Sudan to send them to me,” she told Al Jazeera. “The medicines were extremely expensive, costing me 300,000 Sudanese pounds [$33.30] a month.”

Taking medication has become a carefully managed routine with each pill tied to a specific time of day.

“I’ve become tied to my pills: this one before eating, that one afterwards. If I forget one, my heart starts beating very fast,” she added.

In March, Huda was forced to travel from el-Obeid to Omdurman. Following her strict treatment regimen has become increasingly difficult during repeated periods of upheaval.

She has now returned home to el-Obeid, where her regular medicine is priced at 151,000 Sudanese pounds ($16.80) a month, something she can barely afford.

Her greatest fear is running out of medicine or being unable to afford her next supply, which would put her at risk of a blood clot.

“I’m afraid of becoming incapacitated. I used to be responsible for the whole household, but now I need help. I feel like I’ve become a burden on my family,” she said.

At least 10 civilians were killed in West Kordofan and 5,500 displaced in Blue Nile as clashes widened on Tuesday.

Sudan’s military chief, Abdel Fattah al-Burhan, has promised to seize “every inch” of territory under the control of the paramilitary Rapid Support Forces (RSF), rejecting negotiations to end three and a half years of war.

Al-Burhan made the comments on Tuesday while addressing a gathering in Village 5, located in the northern Sudanese locality of Merowe, according to the Sudan News Agency.

He said the “military option” would continue until the RSF was removed from Sudan.

The Sudanese army and the RSF have been fighting since April 2023 after leaders of the groups fell out over plans to integrate the paramilitary force into Sudan’s army. The conflict has killed tens of thousands of people and displaced around 13 million, according to UN and international estimates.

Al-Burhan’s pledge to continue fighting came as 10 civilians were killed and several others were wounded in an attack by the RSF in Sudan’s West Kordofan state, according to a local charity group.

In a statement, the Dar Hamar Emergency Committee accused the RSF of multiple violations against civilians in Abu Ajal village in the southeastern countryside of En Nahud.

The RSF has been massing in West Kordofan as Sudan’s army advances towards the cities of En Nahud and Al Khuway after gains in neighbouring North Kordofan.

In Sudan’s Blue Nile state, more than 5,500 people were displaced from villages over three days amid deteriorating security, the International Organization for Migration (IOM) said on Tuesday.

Meanwhile, an envoy of US President Donald Trump said Sudanese parties must take the lead in talks to end the war.

In a post on X on Monday, Massad Boulos, the US senior adviser for Arab and African affairs, said peace could be achieved “through an inclusive Sudanese-owned and Sudanese-led national dialogue, transition toward a civilian-led government”.

The US State Department said last month that neither the Sudanese Armed Forces, the RSF, nor their respective leaders “represent legitimate, constitutional governance for Sudan”.

Fighting in Sudan’s Kordofan region has intensified since late 2025, turning it into one of the main battlegrounds in the war between the Sudanese Armed Forces (SAF) and the paramilitary Rapid Support Forces (RSF), now in its fourth year.

The vast region, which comprises North, West and South Kordofan states, lies where the two sides’ areas of control meet, between the army-held central region and the RSF-controlled Darfur in the West. In recent months, the SAF has pushed the RSF out of much of North Kordofan.

The battle is increasingly being fought from the air. Drone strikes on towns in North Kordofan are growing more frequent and deadly, and civilian infrastructure has been hit across the region.

Since the war began in April 2023, one in five recorded attacks in Sudan has taken place in Kordofan.

Al Jazeera maps where the fighting is concentrated in Kordofan and across Sudan, and the displacement that has followed.

Who controls what on the ground?

Sudan is broadly divided between the two sides. The SAF controls the capital, Khartoum, and most of the north, east and centre, while the RSF controls the west, including almost all of Darfur and parts of Kordofan. Smaller armed groups, including the RSF-allied Sudan People’s Liberation Movement-North (SPLM-N), hold pockets of territory in the south.

The army has the upper hand in the north, the RSF in the west, and South Kordofan remains contested.

Where have most attacks occurred?

According to an Al Jazeera analysis of data from the Armed Conflict Location and Event Data (ACLED), an independent conflict monitor, there were 14,648 recorded attacks between the start of the war on April 15, 2023, and September 19, 2026.

The four most affected states include:

• Khartoum: The capital region has seen the most, with 5,719 attacks, or 39 percent of the total, almost three times as many as North Darfur, the second-highest
• North Darfur has witnessed 1,999 attacks (13.7 percent)
• Gezira state has seen 1,435 attacks (9.8 percent)
• Kordofan emerged as a major centre for fighting. North, South and West Kordofan together recorded 2,876 attacks, or about 19.7 percent of all recorded attacks, putting the region behind only Khartoum when considered collectively.

Who has carried out the most attacks?

The SAF is associated with the largest share of recorded attacks between April 15, 2023 and September 19, 2026, accounting for just over half (52 percent), compared with just over a third (34.7 percent) for the RSF and 13.3 percent for other actors.

The balance of attacks has shifted over time. The SAF was associated with more recorded attacks than the RSF in the first year and a half of the war, before the RSF overtook it in number of attacks from late 2024 to mid-2025.

Since August 2025, the two sides’ monthly attack counts have been closer, with the SAF generally recording slightly more, even as the overall number of attacks has fallen sharply.

Where have attacks in Kordofan occurred?

After the fall of el-Fasher, the last major Darfur city held by the army and its allies, in October 2025, attention shifted to Kordofan. The region sits between RSF-held Darfur and the army-held centre, north and east, forming a corridor between the two sides’ heartlands.

Kordofan’s three states recorded 2,717 attacks: North Kordofan had 1,205 (44 percent), South Kordofan 789 and West Kordofan 723. Adding Abyei, a disputed oil-rich area on the Sudan-South Sudan border that was historically part of Kordofan, brings the total to 2,878.

The concentration of attacks differs from state to state. In North Kordofan, Sheikan locality alone accounted for 497 attacks, or 41 percent of the state’s total. Sheikan is home to the state capital, el-Obeid, a commercial and administrative hub linking central Sudan with the west. Taking the city would open a route east towards Khartoum for the RSF.

On September 9, a drone strike on a college in el-Obeid tore the roof off the building and killed a security guard, the college’s dean, Abdel Aziz al-Sheikh, told Reuters.

“As you can see, the entire faculty is destroyed and we feel that our dreams are destroyed, ⁠our future is destroyed,” Omnia Aboul Gassim, a student who had sat her exams at the el-Obeid college just one day before the attack, told Reuters.

In South Kordofan, Dilling locality was the main hotspot, with 242 attacks (31 percent), followed by Kadugli with 107 (14 percent) and Al Quoz with 94 (12 percent).

Attacks in West Kordofan were spread more evenly across localities. Babnusa recorded the most, with 142, followed by En Nuhud (119), Al Khiwai (112) and Abu Zabad (111).

ACLED has recorded at least 12,314 reported fatalities in Kordofan since April 2023.

The SAF was associated with 1,323 attacks (46 percent) across all three states in Kordofan, compared with 920 (32 percent) for the RSF and 633 (22 percent) for other actors.

How many people are displaced?

About 8.6 million people remain internally displaced across Sudan, according to the latest United Nations figures, down from a peak of 11.6 million in January 2025 as millions returned home to areas retaken by the army. New displacement continues in Kordofan, Darfur and Blue Nile.

Darfur hosts the largest concentrations of internally displaced people (IDPs), particularly South and North Darfur.

Returns have steadily increased since 2025, reaching about 5.1 million by August 2026. Khartoum has seen a major return of displaced people, with about 2.7 million returnees.

Despite the decline, millions remain displaced more than three years into the war. The International Organization for Migration (IOM) says the number of people newly displaced in Kordofan since fighting escalated in October 2025 has risen 65 percent in four months, from more than 132,000 in February to at least 219,000 by late June.

The agency has warned that el-Obeid, which shelters about 500,000 people, including more than 83,000 displaced, faces a looming threat of a full-scale invasion.

“The warning signs are impossible to ignore,” said IOM Director General Amy Pope earlier this month. “Across Sudan, families are fleeing violence, losing access to water, electricity and healthcare, and now facing the added burden of destructive floods.”

As renewed fighting spreads across northern Ethiopia, the government has accused Eritrea, Sudan and Egypt of backing armed opposition groups, raising fears that the conflict could draw in regional powers.

Over the weekend, Ethiopian army chief Birhanu Jula attributed his country’s unrest to those he called Ethiopia’s “historical and contemporary adversaries”.

Birhanu accused Eritrea of being the go-between linking these external powers – including Sudan and Egypt, which he explicitly named – with armed groups inside Ethiopia.

Eritrea, Sudan and Egypt have all rejected the accusations. Speaking to Al Jazeera, Egyptian Foreign Ministry spokesperson Nader Zaki said that Egypt’s foreign policy was founded on “full respect for the sovereignty, unity and territorial integrity of states, and noninterference in the internal affairs of other countries”.

Zaki added that Egypt “is fully committed to the rules of international law and the Charter of the United Nations, and rejects any practices that would undermine regional security and stability”.

Major-General Samir Farag, the former head of the Egyptian Armed Forces’ Morale Affairs Department, also told Al Jazeera that the accusations against Egypt were false. “It has not been Egypt’s policy to interfere in the internal affairs of any state in the region,” he said.

Sudan’s military also dismissed the accusations as “baseless” and levelled its own charge of destabilising behaviour at Ethiopia, accusing it of supporting the paramilitary Rapid Support Forces (RSF), which has been fighting the Sudanese Armed Forces since 2023. Ethiopia has denied those allegations.

Troubled relations

Ethiopia’s relations with the countries it has accused have already been strained by other disputes that predate the latest fighting.

Relations between Cairo and Addis Ababa have remained tense as a longstanding dispute over the Grand Ethiopian Renaissance Dam (GERD) remains unresolved. Competition between the two has increasingly extended to regional security, the Red Sea and the Horn of Africa.

Sudan’s relations with Ethiopia are similarly troubled. Since the outbreak of the Sudanese civil war, Khartoum has accused Addis Ababa of providing training, supplies and the use of Ethiopian territory to the RSF.

Eritrea had fought alongside Ethiopia against rebel groups in the latter’s Tigray region during a war between 2020 and 2022, but relations between the two neighbours have since soured, with Eritrea alarmed by Ethiopia’s attempts to gain access to the Red Sea.

Against that background, some analysts and Ethiopian opposition figures say that Addis Ababa is pointing the finger at foreign conspiracies in a bid to rally support behind its national army.

Mohamed Selim, deputy chair of the Egyptian parliament’s African Affairs Committee, told Al Jazeera that he believes the accusations were an attempt to shift attention from Ethiopia’s domestic problems by creating an external enemy and seeking to unify the internal front.

Amani al-Tawil, director of the Africa Programme at the Al-Ahram Centre for Political and Strategic Studies, similarly described the accusations as “an understandable attempt to escape from internal crises”.

She questioned why Egypt would choose this moment to intervene militarily in Ethiopia, given the two have been in dispute over GERD since 2011.

Al-Tawil said the breadth of the new opposition alliance in Ethiopia – seven groups representing disparate ethnic groups and regions announced the coalition last week – presented a challenge to Addis Ababa.

Spillover concerns

The renewed fighting in Ethiopia has spread across Tigray and into neighbouring Amhara and Afar.

Mohammed Hussein, the chairman of the Prosperity Party Afar Region Branch Office – the ruling party in Ethiopia’s Afar region – told Al Jazeera that the three regions together have a population of more than 38 million, according to his estimate, and include areas near the borders with Djibouti and Eritrea, raising fears of a regional war.

Ammar Arki, a writer focusing on Horn of Africa affairs, told Al Jazeera that Ethiopia had, at various stages, blamed Sudan, Egypt and Eritrea for contributing to instability inside Ethiopia.

He said the latest accusations could be interpreted as an attempt to redirect some domestic attention towards an external threat and build support around the federal government.

But Arki warned that the longer Addis Ababa continued to explain its internal crisis in terms of an “external conspiracy”, particularly if neighbouring states responded in the same way, the greater the risk that Ethiopia’s conflict could move beyond Ethiopia’s borders and become regional.

Sudan’s collective memory has long carried stories of famine-induced tragedies. Now, as war pushes the country deeper into a catastrophic food crisis, historians and humanitarian activists fear that some of those horrors are being repeated.

The ongoing war between the Sudanese army and the paramilitary Rapid Support Forces, which erupted in April 2023, has plunged the country into one of its worst modern food crises, with conditions deteriorating sharply since 2024.

Sudan has endured severe famines before, often triggered or made worse by drought and other environmental shocks. However, the current hunger crisis, which has triggered famines in Sudan in 2024 and 2025, has been brought on by a man-made factor: war.

Past starvation

One of the earliest recorded major food crises in what is now Sudan occurred in 1684, during the Funj Sultanate. The crisis, which lasted several years, brought severe grain shortages across central Sudan. Historical accounts describe people driven to desperation, and in some cases forced to eat dog meat. The hunger triggered mass displacement, as well as a deadly smallpox outbreak.

Similar climate-driven crises were recorded in 1750 and again between 1835 and 1838 during a period of Ottoman-Egyptian rule, exacerbated by severe drought and low water levels in the River Nile.

The famine most deeply embedded in Sudanese popular memory occurred between 1888 and 1889, during the rule of Khalifa Abdullahi al-Taashi.

Drought, locust infestations and conflict combined to cause widespread hunger and death. Some historical estimates put the death toll at more than one million people, although precise figures from the period are difficult to establish. The crisis was reported to have been so severe that some families shut themselves inside their homes to die rather than going out to beg for food.

Sudan experienced more periods of food shortages during the 20th century. Droughts and poor harvests during the colonial period of the first half of the century forced the authorities at times to import grain from abroad.

Then, in 1984, during the rule of President Jaafar Nimeiri, a devastating drought hit western Sudan, including Darfur and Kordofan, where there were widespread crop and livestock losses, displacing hundreds of thousands of people from rural areas to the capital, Khartoum.

Man-made catastrophe

Unlike many of those historical crises, the current famine is distinctly man-made.

War has disrupted agricultural production and trade, forced farmers to leave their land, and made it difficult to move food and humanitarian aid across the country.

Abdullah al-Tijani, a social historian and humanitarian activist, noted the unprecedented scale of the current disaster.

“Most previous famines were often confined to specific regions, as happened in 1984, or areas in southern Sudan before its secession in [2011], while the capital and major cities continued to have the necessities of life and services,” al-Tijani told Al Jazeera.

This time, he said, hunger and the collapse of basic services have spread across the entire country.

“A comprehensive food crisis has struck the heart of major urban and agricultural centres in the states of Khartoum, Gezira, Sennar, Darfur, and Kordofan, causing millions of citizens to be displaced inside and outside the country,” al-Tijani added.

He pointed to what he described as the “systematic destruction of infrastructure, disruption of large agricultural projects, and targeting of markets, bakeries, and crops, along with disrupting the banking system and communication networks, which isolated entire regions”.

Al-Tijani also cited the “restrictions on humanitarian access and delays in granting transit permits for relief workers”. He accused the warring parties of using control over food supplies as a tool of war, while warning that international funding has fallen short of the size of the crisis.

Lost agricultural potential

The scale of the crisis is stark because of Sudan’s agricultural potential. The country has immense resources, including roughly 200 million acres (81 million hectares) of arable land, abundant water from the Nile, and extensive livestock resources, but Sudan’s potential as a global breadbasket remains unfulfilled.

Mohammed Abdul Rahman, an economic researcher, explained that the current food security crisis reflects a clear development gap, and a longstanding weakness in Sudan’s agricultural sector compounded by war.

“Wars and armed conflicts are among the most influential factors on food production,” Abdul Rahman said, “along with the displacement of farmers from their lands, the absence of political stability and agricultural policies, weak funding and government guarantees, and reliance on traditional farming methods.”

A gold mine collapse in northern Sudan has killed at least 10 people and injured 21, according to survivors, bringing renewed attention to the dangers facing workers in one of the country’s most important and least regulated industries.

The collapse took place on Sunday at the Awny mining area near Sudan’s border with Egypt. Miners told the AFP news agency they had recovered 10 bodies and pulled 21 injured workers from the site, while the search continued for people believed to be trapped beneath the rubble. It is unclear how many people are trapped in the collapsed mine.

The disaster comes just days after another deadly accident at a gold mine in West Kordofan State. A collapse at the al-Zaraa mine near en-Nahud, a town in central Sudan, left at least 82 people dead.

Sudan is one of Africa’s top gold producers, recording 70 tonnes of production last year, according to the Sudanese government.

Since fighting broke out in April 2023 between Sudan’s army and the paramilitary Rapid Support Forces (RSF), businesses have been devastated, agriculture has been disrupted, millions of people have been displaced, and Sudan’s formal economy has weakened. In that environment, gold has remained one of the country’s most valuable sources of income.

In July 2025, it was reported by local agencies that Sudan’s gold production rose sharply despite the ongoing conflict, reaching 64 tonnes in 2024, 53 percent higher than the 41.8 tonnes recorded in 2022, and generating $1.57bn in legal export revenues.

However, the gold trade has also become a point of international scrutiny. Most of the gold exports end up in the UAE. In March 2025, Sudan went to the International Court of Justice (ICJ), accusing the UAE of supporting and funding the RSF using gold. The UAE has denied accusations that it supplies weapons to the RSF.

Sudan’s gold deposits are spread across the country, with the majority in the northeast. Port Sudan, the country’s main port, is home to most of the deposits and has been largely controlled by the Sudanese Army since the war began. However, areas controlled by the RSF are also populated by gold deposits.

At the moment, “much of Sudan’s gold is taken out of the country through smuggling or illicit networks instead of passing through government channels that could directly contribute to public revenue,” said Joseph Tucker, senior analyst on the Horn of Africa at the International Crisis Group.

But amid that diplomatic battle and the accusations surrounding gold, the mining deaths in northern Sudan have also raised larger questions over how the country manages the sector, analysts say.

“This disaster is yet another example of the deadly hazards facing those working in Sudan’s gold mines,” Tucker told Al Jazeera. “Most of these (gold mines) are informal, artisanal mines in remote areas that are unregulated and lack modern mining technology, adequate infrastructure, and specialised safety equipment.”

This year, Sudanese Prime Minister Kamil Idris met with the minister of minerals and spoke on the policies for regulating traditional mining and the management and control of various mineral markets. According to French-based Sudanese media, Sudanese authorities called for swift action to address the environmental damage and public health hazards caused by mining activities across the country.

Yet, despite the dangers, Tucker said the state of the Sudanese economy made gold mining appear lucrative to many Sudanese.

During the war, the Sudanese currency’s value has crashed. Before the outbreak of fighting in 2023, about 570 Sudanese pounds could buy a US dollar. By April 2026, the currency had slid to a sixth of that value: It cost 3,500 pounds or more to afford a dollar. That has led to sharp food inflation and a surge in the costs of transport and fuel.

According to estimates by the United Nations Development Programme, Sudan lost $6.4bn of its gross domestic product (GDP) in 2023 alone: That’s a quarter of the country’s $26bn GDP that year. In August, the UN agency reported that 90 percent of the agrarian nation’s farmers had seen yields drop over the previous year.

That economic crisis, Tucker said, “fuels the demand for gold and willingness of miners to work in poor conditions” – even if it proves deadly.

In this episode of On the Record, Al Jazeera’s James Bays sits down with United Nations Secretary-General Antonio Guterres, ahead of his final UN General Assembly before stepping down in December 2026. They discuss the situation in the Middle East and its global consequences, whether the UN is still relevant in addressing today’s challenges and why Guterres believes the UN Security Council must be reformed.