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Sudan’s Healthcare on Brink Amid Fighting & Targeted Attacks on Medical Workers, Hospitals Worldwide

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Fighting between rival military factions in Sudan targeting medical facilities has left the country’s healthcare system on the verge of collapse. With a limited amount of power, water and medical supplies, and doctors fleeing the country for safety, less than a third of hospitals in the country’s conflict zones remain open. Calling this situation a calamity, Dr. Khidir Dalouk, advocacy director of the Sudanese American Physicians Association, joins the show to share the perspective of healthcare workers in the country. “We, as physicians, have sworn an oath to treat and take care of civilians and military, whether it’s in peace or it’s in war.”

Meanwhile, a new report shows 2022 was the most severe year of attacks against healthcare facilities and personnel worldwide in the last decade, with over half of the documented attacks in Ukraine and Burma. Attacks on medical facilities are a widespread and common problem in conflict when military leaders ignore international rules protecting healthcare, according to Christina Wille, director of Insecurity Insight, which contributed to the new report, “Ignoring Red Lines: Violence Against Health Care in Conflict.”

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This is a rush transcript. Copy may not be in its final form.

AMY GOODMAN: We begin today’s show with the humanitarian crisis unfolding in Sudan as the healthcare system there is collapsing after two months of fighting across Sudan between the army and the Rapid Support Forces. Volunteers and aid workers are struggling to keep critical healthcare running, but the Sudan Doctors Trade Union says less than a third of hospitals in Sudan’s conflict zones are still open. Many have been targeted by fighters. Those that continue to operate face cuts to power and water and a lack of staff, medicine and dialysis supplies. Reports also show, since the outbreak of the conflict in April, rape survivors are struggling to access emergency contraception and abortion medication because a warehouse with nearly 50,000 post-rape medical kits has been cut off.

This comes as a new report from the Safeguarding Health in Conflict Coalition concluded 2022 was the worst year for attacks against healthcare facilities and personnel worldwide in the last decade. The report found a 45% increase in reported incidents of violence against or obstruction of healthcare in conflict zones as compared to 2021, including in Sudan. Over half the documented attacks were in two countries: Ukraine and Burma.

For more, we’re joined in Geneva by Christina Wille, director of Insecurity Insight, which contributed to the new report, “Ignoring Red Lines: Violence Against Health Care in Conflict.” And we begin in Houston with Dr. Khidir Dalouk, advocacy director of the Sudanese American Physicians Association, which is providing support to Sudan’s healthcare facilities and services during the crisis.

We welcome you both to Democracy Now!, but we begin with the Sudanese doctor. Dr. Dalouk, can you talk about the situation in Sudan today? Today marks the two months where these rival military forces have been attacking each other. Of course, the collateral damage, as they say, the horror is the number of civilians who have died or are also at this point seeking healthcare in places where — that many hospitals don’t even exist anymore.

DR. KHIDIR DALOUK: Good morning to you, to Christina and to your audience and viewers.

As you report and you correctly mentioned, what is happening in Sudan is a calamity. It’s almost a nightmare that is getting worse every day. And our concern, if this continues and the conflict, you know, spreads to neighboring states, this might break into civil war pretty soon.

What is happening in Darfur is a total disaster, especially in El Geneina, where hospitals are completely shut down, and civilians are between death and, you know, caught in the armed conflict. They’re not even able to flee to neighboring Chad.

As you mentioned, in Khartoum, two-thirds of the hospitals are out of service, evacuated or forced to close. My colleagues who are working on the ground, they’re working in very difficult situations. It’s not even comprehendible. They’re working with very little, if no, supplies. The major concern we have is their safety. You know, healthcare professionals and providers are facing gunfire every day to reach to work and to their houses. They’re completely burned out. They’re not able to provide to their families, because they have not had any salaries for months now. So, it’s not comprehendible, the way they’re working. And their safety is our biggest concern. They have been deliberately targeted. Since the conflict, hospitals have been targeted. Almost 21 of our healthcare colleagues have lost their lives. A few days ago, one of our colleagues — he’s a neurosurgeon — he lost his life while he was on duty serving in a hospital called best hospital in Khartoum.

You know, we, as physicians, have sworn an oath to treat and take care of civilians and military, whether it’s in peace or it’s in war. Me and my colleagues on the ground, they are doing their best to abide to this oath. Maybe the generals and those who are fighting have forgotten, you know, their oaths to defend the country and to defend civilians. And this is a reminder and a call to them that they should at least leave us do our duty.

NERMEEN SHAIKH: And, Dr. Dalouk, Dr. Dalouk, if you could speak specifically about what we mentioned in our introduction, namely, the difficulties for women in accessing emergency abortion and reproductive rights medicine, because these rape kits, post-rape kits, tens of thousands of them, are inaccessible? And this is in a moment in this conflict where there have been widespread reports of sexual violence and rape. And, of course, in Sudan, abortion is illegal.

DR. KHIDIR DALOUK: Well, it’s very unfortunate that, you know, violence against women and rape is used as a weapon in this war. And this is not new. This has been the case in Darfur in the genocide that happened and the attacks back — going back to 2003. So, it’s very unfortunate. You know, we are totally against rape and using women’s body in this war.

I think, you know, there are no supplies, period, to any civilians, including women, including children for the last two months that are, you know, infants who have been born. And there are totally no vaccinations. And we are going to see an emergence of infectious diseases that have almost — you know, have been eradicated, that they’re going to emerge because there are no vaccinations that are happening to those children. And as you correctly said, there are no kits to provide to those rape victims. It’s very unfortunate.

You know, the internally displaced is another group of people who are facing a lot of problems. You know, we are trying to support four different hospitals in Madani, which is a neighboring state. We are, as Sudanese American Physicians Association, operating — or, funding the operation of a hospital in Halfa and, as well, in Nyala — as well, in Nyala, Nyala Hospital. But, unfortunately, because of the blockage of the borders in Egypt, as well as in Ethiopia, as well as — you know, other countries are closing up their visa access to Sudanese. There is a lot of people who are in the borders. Halfa Hospital, for example, you know, is facing a huge number of patients that are people dying because, you know, we are not able to operate like a government. We are an organization. We are doing our best, but this is not enough. I think if we don’t act —

AMY GOODMAN: Let me ask you something.


AMY GOODMAN: Do you think the military forces are targeting hospitals and other healthcare facilities? You’ve stated that so far 11 ambulances have been attacked by strikes, that the Rapid Support Forces have commandeered ambulances, cars from the Ministry of Health. The significance of this, as we begin to wrap up?

DR. KHIDIR DALOUK: Well, you know, as I said, hospitals and healthcare professionals have been deliberately targeted. And it’s very unfortunate that hospitals are used in this war, you know, as areas where the conflict is going. These two generals are not abiding to any international law, not to any Geneva Conventions. And I think what it is important is safety of my colleagues on the ground, the impartiality of hospitals. Both parties are trying to force healthcare professionals to, you know, say that we are siding with this party or that party. That is not what we do. Our oath is to all civilians. And, you know, at times of war, this is not what we do. Our oath is towards those civilians and towards those who are injured. And, you know, this is what we do, and we want to abide to that. Me and my colleagues call for the international community to act now, not even tomorrow. You know, they have to do it now.

NERMEEN SHAIKH: I’d like to bring in Christina Wille into the conversation. If you could talk about what’s happening in Sudan in the context of the report that your organization has put out, “Ignoring Red Lines: Violence Against Health Care in Conflict”? Talk about what this report concludes.

CHRISTINA WILLE: Yeah. Thanks so much. And most of all, thank you for putting this really important topic of violence against healthcare for discussion into your show, because it is always terrible when political conflict turns violent, and we’ve seen that in Sudan in past years during demonstrations, and particularly now, but it is heartbreaking to see the personal consequences for people when they can’t access healthcare in such situations.

And I think you’ve already evoked several of these issues. You know, imagine a woman going into labor or needing emergency care after experiencing sexual violence, and then you have security forces using roadblocks to prevent access, and people seeking treatment when the hospitals are bombed or occupied and raided by security forces. And we’ve documented at numerous times for Sudan of military, security forces going into hospitals, beating health workers there, arresting them in front of patients. And this increases the suffering for the civilians in conflict to incredible extent. And so much of these consequences could really be prevented, if only healthcare would be properly protected in conflict. And that’s such an important topic the international community needs to address more seriously.

NERMEEN SHAIKH: And can you speak, Christina, about where these attacks are most prevalent, and also whether these attacks are mostly deliberate?

CHRISTINA WILLE: So, our report for the last year identified Ukraine and Myanmar as two countries where the whole health system is under an incredible attack. In Ukraine, some 11% of the health infrastructure has been damaged. And in Myanmar, the devastation is in so many areas, through so many different ways, from arresting health workers, from the coup government bombing its own civilians. It is really, really close to unimaginable for people who live in more secure places, the extent of the violence that occurs. And these are the two countries where most events have been documented. But in total, we covered 42 countries, and it is so widespread and such a common problem in conflict.

AMY GOODMAN: Christina Wille, if you could talk about the best practices — though it’s horrible to think in, you know, conflict regions what are the best rules of war — but also the effect on healthcare workers specifically? And use specific examples.

CHRISTINA WILLE: There is a law of war, and that is very clear, that healthcare should be protected, and healthcare needs to be provided to all sides in conflict. And this is really something that the humanitarian community tries to do, to not ask who the person who needs care is, but to offer it to everyone. But the real problem is that in conflicts like Sudan, but so many others, it is the conflict parties that do not respect these rules, and that they go on deliberate attacks on the health systems in many places and also the health workers, because they’re just so important in preventing further consequences to civilians.

And it is so — there are practical things that humanitarian agencies can and are doing, but one of the big concerns is that there’s just no — there’s no impunity for this. So, we have these laws, but there’s never any consequences. And there, unfortunately, we have very few examples of any attempts being made to actually address that this rules of law are just not respected.

NERMEEN SHAIKH: Christina Wille, very quickly, before we wrap up, you’ve said that Russia’s attacks on Ukraine are not without precedent; they’re just different in terms of scale and intensity. The World Health Organization also found earlier this year that the number of attacks on healthcare facilities and personnel in Ukraine was the highest ever recorded in any humanitarian crisis. So, what do you mean when you say they’re not without precedent?

CHRISTINA WILLE: We’ve seen it in Syria, hospitals being deliberately bombed. We’ve seen it as far back as in Chechnya in 1996, when Russian forces attacked an ICRC-run hospital. So, it definitely is nothing — unfortunately, nothing new. But we’re also seeing it in many other countries. And it may also be worth to note that the Wagner forces in Africa have also been attacking health systems in the Central African Republic, for example.

AMY GOODMAN: Christina Wille, we want to thank you for being with us, director of Insecurity Insight. We’ll link to your new report, “Ignoring Red Lines: Violence Against Health Care in Conflict.” And Dr. Khidir Dalouk, advocacy director of the Sudanese American Physicians Association, speaking to us from Houston.

Coming up, as Russia transfers tactical nuclear weapons to Belarus, we’ll speak to professor Gilbert Achcar, author of The New Cold War: The United States, Russia, and China from Kosovo to Ukraine. Stay with us.

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