The Last Healers: Guardians of the City’s Sole Hospital

Dr Mustafa Ali Abdulrahman Ibo along with his team courageously conducts surgery amidst escalating bombardment in the last operational hospital in el-Fasher, a city besieged for the past nine months in Sudan’s western Darfur region.

In the previous month, the medical facility recorded 28 fatalities and over 50 injuries involving both staff and patients due to the relentless shelling. This marks the greatest casualty count logged in a single month since the siege commenced.

“Recent ongoing assaults on Saudi Hospital have ramped up significantly; it has almost become part of our everyday existence,” Dr Ibo, a Darfuri resident of el-Fasher since 2011, reported to the BBC.

He recounted an especially terrifying day when a group of medics was in the midst of performing an emergency caesarean when the shelling started—a near-fatal situation for them all.

”The first explosion struck the hospital’s boundary wall… [then] another shell impacted the maternity operating room, scattering debris that damaged the electrical generator, severing power and casting us into complete darkness,” he explained.

The surgical team had no choice but to rely on the flashlights from their mobile devices to complete the two-hour procedure.

Parts of the building had crumbled, and the room was filled with dust and shrapnel strewn everywhere.

Dr Khatab Mohammed, who was overseeing the surgery, illustrated the hazards involved.

“The circumstances were critical; the environment was no longer sanitary,” the 29-year-old physician relayed to the BBC.

“After confirming both our safety and the patient’s protection from debris, we sanitized her and replaced our surgical gowns since our attire was coated with dust, continuing the operation,” he stated, noting that the patient was at risk of dying from complications.

After successfully delivering the infant, the medical professionals transferred both mother and newborn to a separate area for recovery, subsequently convening for a group photograph.

It served as a symbol of their endurance; however, Dr Mohammed remarked: “I feared it might be our final photograph, thinking that another shell could strike the same area and take our lives.”

They proceeded to carry out two additional life-saving emergency procedures that same day.

These physicians—most of whom are alumni of the University of el-Fasher—have remained in place since the eruption of Sudan’s civil war in April 2023.

The conflict pits the army against the paramilitary Rapid Support Forces (RSF) and has sparked the globe’s most significant humanitarian crisis, displacing over 12 million individuals from their residences.

The two factions were previously partners—seizing power together during a coup—but fell into discord over an internationally supported initiative aimed at transitioning to civilian governance.

One year into the strife, the siege of el-Fasher commenced. It remains the only city still under army leadership in Darfur, where the RSF is accused of executing ethnic cleansing against non-Arab populations.

The RSF initiated attacks on el-Fasher from three angles and severed supply routes. In a report released last month, the UN Human Rights Office noted that the conflict had resulted in over 780 civilian deaths and more than 1,140 injuries—many stemming from crossfire.

The fighting has forced every other medical facility in el-Fasher to close.

South Hospital, once supported by the medical charity Médecins Sans Frontières (MSF), was the principal health center in the city addressing war injuries.

Located near the frontline, it was stormed by RSF forces in June, who also plundered medical supplies and equipment and assaulted personnel.

Saudi Hospital, operated by the Ministry of Health and supported by NGOs, the UN, and MSF, focuses on obstetrics and gynecology but is now delivering all types of medical services – it stands as the sole facility in North Darfur state equipped for surgical procedures.

In light of shortages in medical supplies, apparatus, and personnel, Saudi Hospital is contending with ”a devastating scenario that transgresses all humanitarian and international laws and principles”, stated its medical director, 28-year-old Mudathir Ibrahim Suleiman, in an interview with the BBC.

He recounted the fear experienced during recent bombings: “Pregnant women, children, and staff were in a state of shock and paralysis, with some individuals injured needing to be extracted from the debris.

“All the circumstances compel us to think about halting our efforts, yet women and children have no alternative place to protect their lives except this hospital,” he remarked.

“The personnel at the hospital are achieving the improbable to preserve lives.”

Every ordinary facet of life has vanished from el-Fasher, particularly in the northern and eastern regions. The university, for instance, conducts classes online, with examination centers set up in safer cities like Kassala in eastern Sudan.

With rampant hunger and instability, the city has also been deserted. Approximately half of the population has fled to the nearby Zamzam camp, where an estimated 500,000 individuals currently live in conditions of famine.

Saudi Hospital additionally caters to the camp, with MSF operating ambulances to transport emergency situations.

However, these ambulances have also recently come under fire, including a recent event wherein a gunman targeted a “clearly labeled ambulance with the MSF emblem and flag”.

“We are appalled by this lethal assault on a humanitarian team executing life-saving medical endeavors where they are critically required,” stated MSF’s Michel Olivier Lacharité in an announcement.

Dr Ibo acknowledged that it was his colleagues – comprising 35 doctors and 60 nurses at Saudi Hospital – who motivated him to persist.

”We lose individuals daily, and offices and rooms are devastated, but owing to the resolve of the young personnel, we continue to push forward.

”We derive our resilience from the inhabitants of el-Fasher – we are its own and graduates of the University of el-Fasher.”

Relief organizations are cautioning that one of the most severe maternal and child health crises is unfolding in Darfur, where some regions are also enduring aerial assaults from the military.

The World Health Organization (WHO) has advocated for a cessation of attacks on medical facilities and compliance with international humanitarian regulations.

“The integrity of health must be honored even during wartime,” WHO Sudan communications officer Loza Mesfin Tesfaye expressed to the BBC.

Dr Mohammed, originally from Sudan’s White Nile State but who relocated to el-Fasher in 2014 to pursue medical studies, also pays tribute to his team, who have declined numerous chances to escape.

“Our spirits would not allow us to abandon the individuals of this city – particularly in light of the dire conditions we observe daily.”

All the medics, who communicated through chats and voice messages on WhatsApp, appeared resolute.

”We are resolute in our commitment to continue preserving lives, from any location we can, even underground or beneath the shade of a tree, we pray for the conclusion of the war and for peace to prevail,” Dr Ibo stated.

Supplementary reporting by Sudanese journalist Mohammed Zakaria