Charged Affairs

By Nikia Crollard | Rising Expert on Public Health | November 12, 2025 | Photo Credit: AA.Com

Nearly three years into Sudan’s devastating civil war, the need for humanitarian action is an understatement: over 150,000 people have died, and one-third of Sudan’s population are displaced inside and outside of the country. The United Nations has labeled this the world’s worst humanitarian crisis, yet as we witness another year of relentless conflict, international attention to the systematic destruction of Sudan’s healthcare system and its devastating consequences for women remain inadequate.

Civil war erupted on April 15, 2023, with violent clashes between two rival military factions: the Sudanese Armed Forces (SAF), led by General Abdel Fattah al-Burhan, and the paramilitary Rapid Support Forces (RSF), commanded by Mohamed Hamdan Dagalo. Recently, the war’s escalation has brought increasingly brutal tactics, including weaponizing humanitarian relief, deliberately targeted healthcare facilities, and launching attacks on heavily populated civilian areas.

An attack on Al-Mujlad Hospital in West Kordofan State in the center of the country exemplifies the violent attacks on Sudanese healthcare structures and systems. On June 21, more than 40 people, including six children and five health workers, were killed in a deadly attack on one of the only functioning healthcare facilities in the area. Such indiscriminate acts, which are not directed at specific military targets, constitute war crimes under international law. The number of attacks on healthcare facilities in Sudan since the onset of the armed conflict totals 108 World Health Organization (WHO)-verified incidents since mid-September. Attacks on healthcare structures are direct attacks on Sudanese citizens.

The Sudan conflict has destroyed livelihoods unilaterally, with Sudanese women and girls bearing the heaviest burden. Pre-existing disparities, amplified by armed conflict, are reinforced by patriarchal social norms and a legal framework that provides lacks domestic violence legislation, and fails to criminalize marital rape. Discriminatory social norms, poor governance, male-dominated decision-making, economic instability, and conflict are combined root factors that create devastating outcomes for women and girls.

Targeting health care facilities and healthcare workers: implications for women

The systematic targeting of healthcare infrastructure has created a medical crisis that disproportionately affects women and girls. 1.63 million women of reproductive age remain without adequate health care services as warring parties continue to target hospitals, health workers, and block the flow of aid.  As cases of violence against women and conflict-related sexual violence soar and Sudan’s healthcare system rapidly deteriorates, many survivors are left without medical treatment.

There are reports of women and girls who have been raped being unable to access treatment services, including one 15-year-old rape survivor who died before family members were able to find medical care. Due to Sudan’s instability, only 25% of GBV service providers are able to work, the majority of which are operational outside of conflict-afflicted areas and are inaccessible to survivors most in need. This leaves women and girls without access to services such as contraception, abortion medication, and post-exposure prophylaxis treatment.

In Khartoum alone, around 219,000 pregnant women are at risk of being unable to access maternal services. Critical supplies for life-saving obstetric and neonatal interventions are running dangerously low, if even available. Reports of increases in unsafe home deliveries have been well-documented, where those who give birth at home are without specialized care and resources.

Additional health access challenges are present for internally displaced people (IDPs) who reside in displacement shelters. Approximately 3.8 million people have been displaced internally in Sudan. Women make up 69% of IDPs. Compared to displaced men, these women face greater challenges accessing health services due to the physical distance between functioning health services and displacement shelters. Transportation costs can be prohibitive for women who are economically dependent on family, widowed, or disabled with limited incomes. Additionally, as war constrains financial resources, cultural norms further compound healthcare access challenges: non-pregnant women are given less priority for health care or medication. Men largely determine a woman’s access to medical care, making women more likely to seek the counsel of traditional healers, who may not be able to provide her with biomedical interventions.

Agents of change and the world’s silence

Sudanese women and girls will not be reduced to caricatures as “victims of war.” Woven into the fabric of Sudan’s revolution is the leadership of women, with 70% of protestors being women in 2018. In response to the current conflict, grassroots women’s organizations are actively monitoring violations by armed forces, documenting abuses, and providing essential services like medical care and shelter to displaced communities.

The systematic targeting of the provision of health, specifically women and girls’ health, demands larger international accountability. Yet the world’s attention remains elsewhere, leaving Sudanese women and girls forgotten. The international community is implored to:

• Ensure accountability for attacks on healthcare facilities by holding perpetrators accountable in international courts, including the International Criminal Court, and strengthening sanctions against them.
• Increase visibility and funding for women-led Sudanese organizations by providing opportunities to keep sharing their stories at international fora, including the UN General Assembly (UNGA).
• Meaningfully include women in all peace and decision-making processes, particularly women of ethnic or religious minorities, and ensure that funding is provided to enable financially vulnerable women to pay for transport, childcare, or health needs while participating in the aforementioned processes.
• Address structural drivers of violence against women vulnerability: long-term stability requires addressing root causes that perpetuate women’s marginalization, including legal frameworks, limited economic opportunities, and inadequate representation in governance structures.

 Nikia Crollard, MPH, MSW, is YPFP’s Rising Expert on Public Health. She is a global health professional focused on advancing sexual and reproductive health and rights. Her work spans international development, public health research, and community-based initiatives aimed at improving health systems.

Text of Disclaimer: Nikia Crollard contributed to this article in her personal capacity. The views expressed are her own and do not necessarily represent the views of the Department of Health & Human Services (HHS) or the United States Government.