Sudan

On a modest bed inside his war-battered home in the Khartoum North neighbourhood of the Sudanese capital, Khartoum, Murtada Mohieddin, a diabetic patient in his early 50s, carefully counts his remaining doses of insulin. His search for medicine has transformed into a harrowing battle – not just to find the treatment he needs to survive his diabetes, but to ensure the medicine is not expired or ruined.

“Sometimes the insulin is spoiled,” Mohieddin tells Al Jazeera, inspecting his limited supply. “You wouldn’t know if it is ruined or expired. You can check the expiration date, but it could still be damaged from poor storage.”

More than three years of civil war have crippled Sudan’s healthcare infrastructure: hospitals, health centres and pharmaceutical factories have been shut and vital medical supply chains and storage across the country have been disrupted.

The war, which erupted as a power struggle between Sudanese Armed Forces (SAF) and the paramilitary Rapid Support Forces (RSF), has killed more than 50,000 people and displaced 14 million – nearly a quarter of the country’s population.

The devastating conflict has paralysed domestic pharmaceutical production and collapsed vital supply chains across the country.

According to a World Health Organization (WHO) news release dated April 14, 2026, Sudan represents the world’s largest humanitarian crisis, with 21 million people lacking basic healthcare services out of 34 million needing aid.

In the void left by the closure of pharmaceutical companies, smuggling networks have flourished, flooding the market with unregulated drugs locally known as “Boko” medicines.

These include critical intravenous malaria medications smuggled across borders. Because they completely bypass strict temperature controls and quality checks during transit, these drugs are frequently spoiled, rendering them either totally ineffective or lethally toxic to patients.

A double threat

Inside local pharmacies in Omdurman, located on the outskirts of Khartoum, the crisis is not just limited to scarcity. Patients now face the double threat of exorbitant costs and life-threatening quality issues, as these illicit medicines are often severely spoiled due to a lack of proper storage and refrigeration.

Mutawakil Hamza, a pharmacist based in Omdurman, said the reliance on unregulated channels is putting lives at immediate risk.

“Most malaria medicines are now brought in through smuggling,” Hamza said. “These are ultimately injections for intravenous use, and this is highly dangerous to a patient’s health.”

Because intravenous treatments bypass the body’s natural defences and require absolute sterility, administering improperly stored or degraded smuggled injections can rapidly cause severe bloodstream infections, systemic shock, or death.

The war has effectively dismantled local manufacturing, reversing years of medical self-reliance. Yasser Ahmed Youssef, a pharmaceutical industry expert whose factory is located in Khartoum, noted the stark contrast to the pre-war era, when local factories managed to produce “very large quantities of life-saving medicines, including drugs for blood pressure, diabetes, colds, and paediatric care”.

Now, the majority of those production lines are silent, leaving the population dependent on a shattered healthcare system. According to the October 2025 Health Resources and Services Availability Monitoring System (HeRAMS) report cited in a WHO Public Health Situation Analysis from January 6, 2026, 40 percent of health facilities nationwide are entirely nonoperational.

The situation is even more drastic regionally, with 87 percent of facilities shut down in Khartoum and 85 percent closed in North Kordofan, whose control is contested between the rival sides.

In active conflict zones such as Gezira, Khartoum, Darfur and the Kordofan regions, the shortages are particularly dire.

A United Nations Population Fund (UNFPA) emergency report from August 2025 highlighted that the only functioning maternity hospital in the besieged city of el-Fasher faces critical medicine shortages and risks imminent closure.

El-Fasher, the last SAF stronghold in the western region of Darfur, was taken over by the RSF in late October 2025, trapping approximately 700,000 civilians – mostly women and children. People have been cut off entirely from food and medicine and subjected to attacks.

Collapsed warehouses and supply lines

In the government-funded public sector, the National Medical Supplies Fund maintains that it is working to secure essential medicines despite the fighting, claiming to have achieved 75 percent availability for cancer medications and fully secured supplies for kidney patients.

However, officials admit the overarching infrastructure is in ruins, with the local health ecosystem almost destroyed.

“We have been massively affected by the ongoing war inside Sudan,” said Abubakar Salouha, a department director at the fund. “The medical supplies have been severely impacted; there has been a collapse at the level of the main warehouses at the headquarters.”

International aid deliveries from neighbouring countries also face enormous logistical hurdles.

The WHO’s January 6 situation analysis detailed that cross-border transit times for medical commodities can take up to 90 days to reach remote regions like Darfur from the Cameroonian city of Douala via Chad. Compounding these suffocating delays, armed groups have repeatedly targeted medical infrastructure, looting pharmacies and stripping remaining hospitals of their vital medical supplies.

Recent attacks highlight this systematic destruction by rival sides. On March 20, 2026, a drone attack on Al-Daein Teaching Hospital in East Darfur state killed at least 64 people, including medical personnel, and injured 89 others. Sudanese rights group the Emergency Lawyers reported that the army was behind the attack.

On April 2, another drone attack struck Al-Jabalain Hospital in White Nile state, killing 10 staff members, including the hospital’s director while he was performing surgery. That same day, the Family Hospital in el-Daein was looted, and patients and health workers were assaulted and expelled. Similarly, a hospital in Kurmuk, Blue Nile state, was looted on March 25, its equipment destroyed, and patients forced out. The RSF was blamed for these attacks.

“Sudan is confronting one of the gravest humanitarian and public health emergencies in the world today. The ongoing conflict has pushed the health system to the edge of complete collapse,” warned WHO Director-General Tedros Adhanom Ghebreyesus on April 4.

“These incidents are stark reminders of the urgent need for renewed international solidarity and decisive political and humanitarian action. Sudan cannot endure this crisis alone.”

Sudan has recalled its ambassador to Addis Ababa, accusing Ethiopia of being behind attacks on Khartoum’s airport. International Crisis Group’s Alan Boswell says the escalation risks making the countries’ internal challenges worse.

The security landscape along the border between the Democratic Republic of Congo (DRC) and South Sudan is deteriorating amid a series of alarming attacks attributed to armed men believed to be South Sudanese soldiers. The Kakwa chiefdom, particularly the Roumou tribal group and the village of Agoroba in Aru territory, Ituri province, has been severely affected by these incursions. 

Local sources said the suspected South Sudanese soldiers looted cattle and money, and abducted Congolese civilians.

“These armed men coming from South Sudan have looted from the population, taking away cows, goats, money, and even abducting young men, whom they continue to hold in the bushes. This situation does not date today. It has been several months since these armed men have been crossing the border to attack our villages,” a local chief told HumAngle.

Dieudonne Tabani, a national parliamentarian,  has raised concerns about the worsening security situation along the border between the DRC and South Sudan in the Aru territory of Ituri province. He condemned how the repeated incursions in several localities of Kakwa chiefdom are characterised by the looting of belongings as well as the abduction of civilians.

“The number of our soldiers along the border with South Sudan is very minimal. When these armed men enter, they are not faced by a rigorous response. We call on the provincial authorities, under the state of siege, to urgently reinforce the military presence in the zone,” a local in the Ituri province told HumAngle. “The central government must also get involved in diplomatic overtures with a view to clearly demarcating the boundary, most times given as a reason for the incursions into our territory.”

Amid this troubling situation, Ituri provincial authorities have called on the population to remain calm, assuring that the authorities in Kinshasa have already been briefed and that measures will eventually be taken to secure the zone.

In January, DRC and South Sudan completed a major prisoner exchange following a diplomatic meeting. The border town of the Aru territory in the DRC serves as a haven for numerous South Sudanese refugees escaping the civil conflict in their homeland.

The attack, the second in a week, follows months of relative calm in the city after government forces regained control last year.

A drone strike carried out by the paramilitary Rapid Support Forces (RSF) has killed five civilians in Khartoum, according to an NGO.

The attack, which Emergency Lawyers, an independent legal group supporting victims of human rights violations in Sudan, reported on Saturday, is the second to take place in the capital within a week. It follows months of relative calm in the city after government forces regained control last year.

The NGO said it holds the RSF fully responsible for the strike, accusing the group of breaching international humanitarian law.

Emergency Lawyers said the incident forms part of an ongoing pattern of attacks on civilians. Nearly 700 civilians were killed in drone strikes in the first three months of this year, according to UN figures.

‘Completely free’

On Tuesday, a drone struck a hospital in the Jebel Awliya area, around 40 kilometres (25 miles) south of central Khartoum, a security source and eyewitnesses told the AFP news agency. It was the first such attack in the area in months.

The Sudanese army, which now enjoys a solid grip in the north and east, launched a rapid counteroffensive last year that pushed the paramilitary forces out of the capital.

Following intense fighting around the capital last year, Sudan’s military government declared the Khartoum region “completely free” of RSF.

Since then, the RSF has largely concentrated on expanding its control in its stronghold in the western Darfur region and pushing into neighbouring areas, capturing valuable oil-producing assets.

Violence has also spread to southeastern Blue Nile state near the border with Ethiopia, raising fears of a more prolonged and fragmented conflict.

The RSF carried out a series of drone strikes on Khartoum last year, largely targeting military sites, power stations and water infrastructure.

In recent months, however, the capital has seen relative calm. More than 1.8 million displaced residents have returned, and the airport has resumed domestic flights. That said, much of the city remains without electricity or basic services.

The conflict between the Sudanese government and the RSF – a former ally – began in April 2023. Since then, around 14 million people have been displaced and two-thirds of the population are in urgent need of humanitarian support, according to the United Nations.

Emergency Relief Coordinator Tom Fletcher told the UN Security Council that South Sudan is at risk of slipping into ‘full-scale famine and collapse’ as fighting intensifies and the UN peacekeeping mission is cut back.