Young Man Wisdom

Sudan at a Crossroads: Two Years of Civil War and an Uncertain Future

2025-05-03T14:33:00.005+02:00

This April the 15th, 2025 marks the second anniversary of Sudan’s devastating civil war, a conflict that has ravaged the nation, displaced millions, and left thousands dead (1). Initially triggered by a power struggle between the Sudanese Armed Forces (SAF) and the paramilitary Rapid Support Forces (RSF), the war has since escalated into a prolonged and deeply destructive confrontation with far-reaching implications for Sudan and the wider region. The conflict has also opened the door to increasing foreign interference, with regional and international actors vying for influence in Sudan’s future(2).

As the war rages on, the prospects for a ceasefire—and even more so for a lasting peace—remain remote. The humanitarian crisis deepens daily, while the political and territorial integrity of Sudan hangs in the balance (3).

Origins of the Conflict: A Broken Transition

Sudan’s descent into conflict began with the peaceful uprising of 2019, which led to the overthrow of longtime autocrat Omar al-Bashir. In the wake of his removal, a transitional power-sharing arrangement was brokered between civilian leaders and the military, designed to guide Sudan toward democratic governance. However, this fragile arrangement collapsed in October 2021 when the SAF and RSF—under the leadership of General Abdel Fattah al-Burhan and General Mohamed Hamdan Dagalo (Hemedti), respectively—staged a coup, effectively dismantling civilian authority (1).

The political rift between the SAF and RSF widened as both factions competed for control over Sudan’s security apparatus. Tensions further escalated over disagreements on security sector reform, the integration of the RSF into the national army, and allegations that the SAF was working to reinstate figures from Bashir’s former regime(4). By April 15, 2023, these disputes erupted into full-scale war, beginning in Khartoum and rapidly spreading across the country.

A Nation in Ruins

The toll of the war has been catastrophic. Major cities such as Khartoum and Wad Madani have been transformed into battlegrounds. Indiscriminate shelling, airstrikes, and street-to-street combat have led to significant civilian casualties. Infrastructure vital to Sudan’s economy and social stability—including hospitals, schools, power plants, and water stations—has been severely damaged or destroyed, exacerbating the suffering of the population(5).

The humanitarian crisis has reached unprecedented levels. Over 8 million people have been displaced, marking Sudan as the site of the world’s largest displacement crisis. Thousands have fled to neighbouring countries, including Chad, South Sudan, and Egypt, while those who remain are subjected to acute shortages of food, clean water, and medical care(3,6). Reports from human rights organizations have documented widespread atrocities, including mass killings, sexual violence, and the forced recruitment of child soldiers(7–9).

The Collapse of Humanitarian and Economic Structures

Sudan’s healthcare system has collapsed. More than 80% of hospitals in conflict-affected areas have ceased to function, leading to uncontrolled outbreaks of cholera, severe malnutrition, and other preventable diseases. Medical supplies are critically scarce, leaving the sick and injured with little to no access to treatment. Women and children, particularly those in displaced communities, are disproportionately affected, facing rising levels of gender-based violence and exploitation(10).

Economically, Sudan is in freefall. The war has devastated key sectors, including agriculture and oil production, leading to skyrocketing inflation and the widespread unavailability of basic goods. The formal banking sector has all but collapsed, forcing much of the population to rely on informal markets where prices are exorbitantly high. Meanwhile, a war economy has emerged, with the RSF seizing control of gold mines and trade routes, while the SAF maintains dominance over state resources. This economic division has not only prolonged the conflict but has also entrenched the suffering of ordinary Sudanese citizen(11,12).

International Response: Diplomatic Failures and Foreign Meddling

Despite multiple attempts by regional and international actors to broker a ceasefire, efforts have largely failed. Mediation initiatives by the African Union (AU), the United Nations (UN), and the Intergovernmental Authority on Development (IGAD) have been rendered ineffective due to the unwillingness of both factions to negotiate in good faith. While Western nations—including the United States and the European Union—have imposed targeted sanctions on individuals and entities fuelling the war, these measures have had minimal impact in curbing the violence (13).

Meanwhile, foreign powers have taken advantage of the chaos to exert their influence. The United Arab Emirates, Russia, Turkey, and Egypt have been accused of supplying weapons and logistical support to different factions, thereby complicating peace efforts and further entrenching the conflict. The presence of Russia’s Wagner Group in Sudan’s lucrative gold trade has also raised concerns about the country becoming a hub for illicit global networks (2).

Humanitarian assistance remains grossly inadequate. Funding for relief efforts falls well below required levels, and aid workers continue to face severe access restrictions and security threats. The international community’s failure to effectively respond to Sudan’s crisis reflects both a lack of political will and a strategic prioritization of other global conflicts(14).

The Looming Threat of Fragmentation

Perhaps the most alarming development in Sudan’s civil war is the increasing likelihood of territorial fragmentation. A recent political realignment saw the RSF and several political factions withdraw from the civilian coalition Taqadum to form a parallel government in the areas under RSF control. This move has significantly weakened Sudan’s pro-democracy movement and raised fears that the country is on the verge of a formal split(15).

While this self-declared government has not received official recognition from any international body, it underscores the growing divide between the warring factions. If left unchecked, Sudan could follow the path of Libya or Yemen, where prolonged internal conflicts have led to the fragmentation of state authority and the rise of multiple, competing governments(16).

A War Without a Victor

Sudan’s history of conflict suggests that no clear winner will emerge from this war. The SAF appears intent on consolidating control over the central, northern, and eastern regions of the country, focusing on governance rather than reclaiming lost territory. Meanwhile, the RSF and its political allies face the monumental task of establishing a functioning administration in their areas—an endeavor for which they have little governance experience or institutional capacity.

The SAF faces significant internal challenges, including the need to maintain cohesion among various allied militias while addressing persistent civilian demands for democracy and reform. The RSF, for its part, must navigate the complex ethnic landscape of Darfur, where long-standing rivalries could ignite further conflicts. Additionally, the RSF’s reputation for lawlessness, looting, and human rights abuses complicates its ability to build a legitimate governing structure.

The Future of Sudan: A Warlord State?

If the war continues on its current trajectory, Sudan risks descending into a fragmented warlord state, where rival militias exert control over separate territories, plunging the country into perpetual violence and lawlessness. The combination of weak state institutions, economic collapse, and unchecked foreign interference could make Sudan an enduring epicentre of instability in the Horn of Africa(17).

Despite the dire situation, global attention remains minimal, as other international crises dominate political and media discourse. However, ignoring Sudan’s crisis will have far-reaching consequences, not just for the region but for global security as well.

Conclusion: A Crossroads of Destiny

Sudan stands at a crossroads. One path leads toward continued fragmentation, suffering, and lawlessness. The other demands an urgent and coordinated international effort to bring about a negotiated settlement and an inclusive political process that addresses the underlying grievances that fuelled this war.

The stakes could not be higher. Without decisive intervention, Sudan’s future will be one of prolonged conflict, deepening humanitarian suffering, and a fractured nation struggling to reclaim its sovereignty. The world cannot afford to look away.

Reference:

1.Savage R, team reporting. Sudan’s civil war: how did it begin, what is the human cost, and what is happening now? The Guardian [Internet]. 2024 Oct 21 [cited 2025 Feb 19]; Available from: https://www.theguardian.com/global-development/2024/mar/22/what-caused-the-civil-war-in-sudan-and-how-has-it-become-one-of-the-worlds-worst-humanitarian-crises

2.Conflict in Sudan: A Map of Regional and International Actors | Wilson Center [Internet]. 2024 [cited 2025 Apr 6]. Available from: https://www.wilsoncenter.org/article/conflict-sudan-map-regional-and-international-actors

3.Sudan, ‘the most devastating humanitarian and displacement crisis in the world’ | UN News [Internet]. 2025 [cited 2025 Apr 6]. Available from: https://news.un.org/en/story/2025/02/1160161

4.A critical juncture for Sudan’s democratic transition | Chatham House – International Affairs Think Tank [Internet]. 2023 [cited 2025 Feb 19]. Available from: https://www.chathamhouse.org/2023/03/critical-juncture-sudans-democratic-transition

5.Crisis in Sudan: What is happening and how to help | International Rescue Committee (IRC) [Internet]. 2025 [cited 2025 Mar 19]. Available from: https://www.rescue.org/article/crisis-sudan-what-happening-and-how-help

6.AP News [Internet]. 2025 [cited 2025 Mar 19]. Nearly 100 people died of cholera in less than a month in Sudan’s White Nile State. Available from: https://apnews.com/article/sudan-cholera-white-nile-c76a78916a744b0a632b077ff226ae02

7.Sudan: UN rights chief ‘alarmed’ by summary executions, attacks on civilians | UN News [Internet]. 2025 [cited 2025 Feb 7]. Available from: https://news.un.org/en/story/2025/01/1159666

8.AMB. UN Human Rights Commissioner ‘alarmed by 18+ summary executions in Khartoum North’ [Internet]. Dabanga Radio TV Online. 2025 [cited 2025 Feb 19]. Available from: https://www.dabangasudan.org/en/all-news/article/un-human-rights-commissioner-alarmed-by-18-summary-executions-in-khartoum-north

9.BBC News [Internet]. 2025 [cited 2025 Feb 19]. Sudan civil war: RSF kills 200 civilians in White Nile state, say activists. Available from: https://www.bbc.com/news/articles/c0rzw8wqn8vo

10.Elamin A, Abdullah S, ElAbbadi A, Abdellah A, Hakim A, Wagiallah N, et al. Sudan: from a forgotten war to an abandoned healthcare system. BMJ Glob Health [Internet]. 2024 Oct 30 [cited 2025 Apr 6];9(10). Available from: https://gh.bmj.com/content/9/10/e016406

11.ISS Africa [Internet]. [cited 2025 Apr 6]. Sudan’s civil war fuels a new regional conflict economy. Available from: https://issafrica.org/iss-today/sudan-s-civil-war-fuels-a-new-regional-conflict-economy

12.AfricaNews. Africanews. 2024 [cited 2025 Apr 6]. Sudan’s economy contracts 40% as war rages. Available from: https://www.africanews.com/2024/02/28/sudans-economy-contracts-40-as-war-rages/

13.Sudan’s Calamitous War: Finding a Path toward Peace | Crisis Group [Internet]. 2025 [cited 2025 Apr 6]. Available from: https://www.crisisgroup.org/africa/horn-africa/sudan/b204-sudans-calamitous-war-finding-path-toward-peace

14.Sudan Humanitarian Needs and Response Plan 2025 - Executive Summary (December 2024) [EN/AR] | OCHA [Internet]. 2024 [cited 2025 Apr 6]. Available from: https://www.unocha.org/publications/report/sudan/sudan-humanitarian-needs-and-response-plan-2025-executive-summary-december-2024-enar

15.Sudan’s RSF and allies formalise vision for parallel government. Reuters [Internet]. 2025 Mar 5 [cited 2025 Apr 6]; Available from: https://www.reuters.com/world/africa/sudans-rsf-allies-formalise-vision-parallel-government-2025-03-04/

16.Hudson C. Avoiding the ‘Libya Scenario’ in Sudan. 2023 Nov 14 [cited 2025 Apr 6]; Available from: https://www.csis.org/analysis/avoiding-libya-scenario-sudan

17.Battle for Khartoum Marks a Crossroads in Sudan’s Civil War | Crisis Group [Internet]. 2025 [cited 2025 Apr 6]. Available from: https://www.crisisgroup.org/africa/horn-africa/sudan/battle-khartoum-marks-crossroads-sudans-civil-war

Parallels and Contrasts: Examining Support for SAF in Sudan and Assad in Syria

2024-12-21T17:47:00.005+02:00

The comparison between supporters of the Sudanese Armed Forces (SAF) in Sudan and those who supported Bashar al-Assad in Syria has some parallels but also important differences. Both situations involve complex conflicts driven by a mix of local, regional, and international factors, and the motivations of supporters in each case vary significantly.

Similarities:

1. State vs. Insurgent Dynamics:

Supporters of both SAF and Assad often frame their stance as supporting the legitimate government or state apparatus against what they perceive as insurgents, rebels, or illegitimate actors (RSF in Sudan and various rebel groups in Syria).

2. Desire for Stability:

Many supporters in both cases prioritise stability over political reforms or revolutionary change. They may fear that the fall of the state would lead to prolonged chaos, as seen in post-Gaddafi Libya or Iraq after the US invasion.

3. Regional and International Alliances:

Both SAF and Assad regimes have relied on international allies to sustain their positions. SAF is supported by regional powers like Egypt and sometimes Saudi Arabia, while Assad had backing from Russia, Iran, and Hezbollah. Supporters often align with these international alliances as a justification for their stance.

4. Anti-Western Narratives:

In both cases, supporters often highlight the role of perceived Western interference, portraying the opposition as tools of foreign powers seeking to destabilise the region.

Differences:

1. Nature of the Conflicts:

The Syrian Civil War is rooted in a broader Arab Spring uprising against authoritarian rule, which Assad responded to with extreme violence. The Sudan conflict is primarily a power struggle between two military factions (SAF and RSF) following a coup and the collapse of a fragile democratic transition.

2. Support Base Composition:

Assad’s supporters include a significant sectarian element, particularly from the Alawite community, alongside other minorities and secular groups who fear Islamist dominance. SAF’s support base is more rooted in traditional military loyalists and those opposed to the RSF’s rise to power.

3. Humanitarian Perceptions:

Assad’s regime has been widely accused of atrocities, including chemical weapons use, which alienated much of the international community. SAF’s actions, while also involving violence against civilians, have not reached the same global notoriety (though this could change as the conflict evolves).

4. Framing of the Opponent:

In Syria, Assad’s regime portrayed opposition groups as a mix of Islamists and foreign-backed terrorists. In Sudan, SAF frames the RSF as a rogue militia attempting to seize power illegally.

While both groups’ supporters may share some ideological or pragmatic rationales, the contexts and details of the conflicts differ significantly. SAF supporters are primarily backing a military institution in a domestic power struggle, while Assad’s supporters were defending an entrenched authoritarian regime against a revolutionary uprising. Both stances reflect fears of instability but are shaped by distinct local, regional, and historical circumstances.

A talk form the the previous minister of finance, Sudan (Arabic)

2020-09-12T12:32:00.001+02:00

Test, test, test!

2020-09-06T00:43:00.002+02:00

#COVID19 ? What COVID-19 ?!

2020-08-22T13:45:00.002+02:00

As of August 18th, the total numbers of COVID-19 cases in Sudan reached 12,582 (28 cases per 100,000 population) and with a death rate of 6.5% (812). If you look at the number of the daily positive cases and the positivity rate you will think that Sudan is driving the virus under control as you can see both indicators are trending down.

But as we said previously, Sudan is not testing enough. You will notice from the second graph that the rate of daily testing is not stable and ranges from 1000 to less than 200 tests per day. For Sudan to truly be able to know the real size of infection rate, Sudan needs to do more than testing suspect cases. 

And to add insult to injury, due to the political instability, Sudan had many protests and crowd gatherings, which without doubt accelerated the spread of the virus. Furthermore, the government started to relax some measures that helped, to some extent, in confiding the virus to the state of Khartoum. Recently the government allowed bus travel lines to resume between Khartoum the rest of the states. It also gave the green light for internal flights to resume.  And recently the Federal Ministry of Health warned the public of a possible second wave of COVID-19! The strange thing is Sudan never came out of the first wave to get a second one. While it is true that the number of cases in Khartoum and Gazer state is stabilizing, the virus is spreading rapidly in other states such as Nile River, Northern, Red Sea, and Kassala. 

These states have less capacity to test and samples are sent all the way to Khartoum for testing and results are only available after a couple of days which make contact tracing almost impossible. Moreover, the medical capacity of the mentioned states is modest in comparison to Khartoum. 

The Ministry of Health needs to be transparent and frank with the public. It needs to explain that it has no real picture of the virus spread and the data are limited because testing is limited. Also, it needs to take social distancing measures seriously and not pick and choose when to call for them and when to turn a blind eye. 

#Sudan #healthcare #FMOH_Sudan #coronavirus

Further reading:

[تاكيداً لما انفردت به (السوداني): استئناف عمل البصات السفرية  للولايات السبت المُقبل – صحيفة السوداني](https://www.alsudaninews.com/ar/?p=84611)

[تقرير لوزارة الصحة يحذر من احتمالات تصاعد حالات الاصابة بكورونا](https://suna-sd.net/ar/single?id=688602

TEST, TEST, & TEST

2020-08-07T23:46:00.002+02:00

Since the being of the Pandemic, The WHO could not have stressed the importance of Testing as the core strategy to fight the spread of the disease. “We have a simple message for all countries, test, test, test,” Said the WHO Director Dr Tedros Adhanom Ghebreyesus. But why testing is important?

Testing is important for diagnosis so treatment can begin, also for isolating the infected persons to stop the spread of the disease and to do contact tracing and isolate exposed persons. The objective from Lockdown is/was to control the spread so hospitals have time to deal with the influx of patients while at the same time health authorities can have the time to invest in building testing capacity and contact tracing and isolation facilities. As no one knows exactly the number of people who are infected, testing plays a crucial part in providing a window on how the virus is spreading and where. This information is vital to the response, otherwise, you will be acting blindly and resources will be misplaced.

Countries that were able to increase there testing capacity early were able to get hold of the virus spread such as South Korea and Germany and countries that did not are still struggling to control the virus spread such as the USA.

Regardless of the resources available to each country, you won’t be able to test everyone but it is important to test enough to be able to monitor the outbreak. But how you will be able to say if a country is testing enough? The positive rate is the percentage of positive sample out from the total tests performed. If you want to know if a country is testing enough you need to look at its positivity rate. If the positive rate is high this indicates that there is a lot of cases out there in the community and out of a few tests you will find one positive. By increasing testing, the positive rate starts to fall which mean you are testing enough but also the spread fo the virus is slowing down. E.g. look at the trends of the positivity rate between the USA, Germany, and South Korea. You will notice after the USA ramped up its testing capacity the positive rate fell sharply between April and June but then the positive rate started to increase again which indicating that the country lost control over the virus. Also, from the graph, you will notice that South Korea was ready for the virus as its positive rate never went beyond 5%, while Germany faced difficulty in testing at first but was able to catch up. The WHO has suggested a positive rate of around 3–12% as a general benchmark of adequate testing. So how Sudan is holding when it comes to testing?

As of (August 5th, 2020) the total number of tests performed in Sudan is around 28051 and the total number of confirmed cases is 11878 which give you a positive rate of 42.3%. We made great progress going from 100% all the way to 42% but we are still not testing enough to get a window on the virus spread in the community. Is it because Sudan lacks the resources to do so? One way to know is to compare Sudan with a similar country like Ethiopia. Both, Sudan and Ethiopia, had their first COVID-19 patient on the same day. The maximum positive rate for Ethiopia was 6% on July 13th. But is Sudan and Ethiopia are performing the same number of tests? Sadly Sudan is doing far less than Ethiopia as you can see from the graph

While Sudan testing rate has improved but it never passed 0.02 test per 1000 population. With this level of testing, controlling the Pandemic is going to be hard and we will not get a good picture of how bad the situation is in the community. It is hard to make a good sound policy when you are in the dark. Authorities Must increase test capacity and look into other methods such as pool testing to cover more areas while it is building its capacity. If the virus is not under control the human and the economic cost will be unbearable.

Reference:

[Coronavirus (COVID-19) Testing - Statistics and Research - Our World in Data](https://ourworldindata.org/coronavirus-testing)

#Sudan Healthcare Workers

2020-07-29T14:43:00.005+02:00

Podcast

2020-07-25T03:16:00.001+02:00

Health Workforce Density in Sudan

2020-07-18T02:04:00.008+02:00

Health Workforce Density

In the last post, we discussed the health unit density comparing the different states and that sometimes the numbers can be misleading. Today we are going to talk about another important aspect of the healthcare system delivery, Healthcare workers distribution.

As per the World Health Organization (WHO), 4.45 of Doctors, nurses, and midwives per 1,000 population is the minimum ratio needed to meet the Sustainable development goals. In General, Sudan has 0.22 doctor and 0.69 nursing and midwifery personnel per 1000 population.

But look at how these numbers are distributed, and you will notice that none of the states of Sudan has the desired ratio of the workforce. Also, some states are worse than others.

You will observe the Blue Nile state has the highest health care worker ratio followed by West Darfur and the Northern States. These numbers most likely include NGOs local and international staff, which are temporary as these states are conflict zones. But the ratio of Northern state is likely to be correct due to the low population density (estimated 833K in 2006).

River Nile, Gazera, Sennar, and White Nile all have a ratio between 1 to 1.5 per 1000 population. Compare this to Red Sea, Kassala, Gedaref, Khartoum, and North Kordofan where there are fewer health workers 0.5 - 1 HCW per 1000 population. And the worst states are North, South, and East Darfur, and West and South Kordofan.

Now, compare the staff ratio numbers to the health units density numbers that we covered earlier on and you will conclude that many units are staffless. Also, you will notice that some states have a high density of units to the population but lack staff to provide the services required at these units. Training and retaining medical staff at all levels is one of the major obstacles that face Sudan and the developing countries. Building units or donating equipment is easy and takes less time and efforts compared to training medical staff.

It is worth to go in-depth into these numbers to examine the distribution of each medical staff grade by itself. i.e. studying the distribution of doctors per state per se and so on as the current measurement provides only the sum which might mask the real disparities between the states.

How to tackle these disparities is the real question but I will leave it for another post

Welcome!

2020-07-10T20:28:00.000+02:00

Access to Health

2020-07-08T13:42:00.002+02:00

One of the great issues that occupied the imagination of health care workers, health policymakers, and as well as a politician is equal access to health. This means wherever you are, ideally, you should have the same access to at least the basic health care. What is basic healthcare? That is a discussion for another time. However, we should not mix accessibility with affordability as these are two different concepts. There are different metrics to measure access to health but today I want to discuss two metrics in particular.

The first one is the health facility density by state. It measures the number of health facilities per 100,000 population. It is a crude way to measure and compare the availability of care facilities in a certain geographical location. This includes all type of facilities private or publicly owned.

Source: OCHA Sudan

As you can see from the graph, the Northern state has the most Basic health units and Hospitals compared to its population despite that quarter of basic health units are closed. When you look at the Health centres, The River Nile State takes the first spot with more than 15 hospitals per 100,000 population. Khartoum has only more than 5 for 100,000 population. However, I would regard these numbers with caution as I do not know on average, how long does it take to reach a health facility.

Al-Jazirah State has the highest number of basic health units in total (480 units, ratio 10 - 15/100,000) while East Darfur has only 32 Basic Health Unit (ratio 1.8 - 5/100,000).

In Summary, when it comes to access to health care facilities, The northern region of Sudan seems like have it all if you are just looking at the numbers. Also, from just looking at the numbers, Khartoum state and East Darfur have the same ratio of Basic Health Units. If you believe in equal health access, how these numbers are going to affect the health policy you won't pursue to achieve equal access?

Next, let’s have a look at the distribution of health care worker distribution between Sudan’s States.

Resources:

[Number and distribution of health facilities per 10,000 population — MEASURE Evaluation](https://www.measureevaluation.org/prh/rh_indicators/health-systems/hss/number-and-distribution-of-health-facilities-per)

[Sudan | Situation Reports](https://reports.unocha.org/en/country/sudan)

2000 Cases

2020-05-21T19:10:00.000+02:00

The last time I talked about the number of cases was on May 9th. on that date, Sudan reached 1000 cases. And I was planning to write another piece when Sudan reached 2000 cases but due to the rapid increase in numbers of cases, I was not able to catch up. Now, The number of confirmed cases is 3138 and of those 121 expired (3.9%). The mortality rate has declined which I hope indicates more testing. 

The number of cases is doubling every five days. As I said before it is not a surprise considering the lack of social distancing. However, for some reason, the situation in Sudan is worst when compared to other countries in East Africa in terms of mortality and the number of cases. Considering that some of these countries did not go all the way with the lockdown policy as Sudan did. 

I hope the number of new cases will stabilise over the next few days but with Eid coming and current lack of political stability, it is unlikely that this will happen. 

The role of the federal ministry of health in Sudan

2020-05-13T16:09:00.001+02:00

The health system in Sudan is messed up!

Sudan governing system is federal. This means the provision of health services is the responsibility of each state. This includes dealing with the workforce from medical to supporting staff. Each state should run it according to its health priorities and budget. Health priorities of Khartoum are different from Gadarif. Hence different spending priorities.

The question that we need to answer is what is the role of the federal ministry of health is going to be as federalism is here to stay.

Firstly, the role of the federal health ministry should be limited to a certain aspect of the health system. The FHM role should be the provision of a road map to improve public health in general. The emphasis should be on prevention as it is the most effective and rewarding. However, the states need to run these programs, and the federal ministry should provide technical support and training.

Secondly:

The federal ministry should be responsible for establishing, running, and maintaining surveillance systems that cover all of Sudan for early detection and intervention. Dealing with outbreaks and “Pandemics” should be a federal responsibility. This also should include data collection regarding communicable and non-communicable diseases from the states.

Thirdly:

Curative medicine should be the responsibility of the states. This should include running hospitals, health centres, etc. The role of the FMH should be limited. The FMH should run a few federal hospitals to serve a certain purpose. For e.g. tertiary hospitals where it is more cost-effective to treat by increasing the caseload and the expertise to deal with certain conditions such as Cancer, Cardiac surgery and so on. Not every state needs these centres, but there should be clear criteria and area of coverage for such services. With the provision of such services, there will be a need for federal transport services between the states and these specialized centres.

Fourthly:

Training & Research! The FMH should use the specialized medical centres to train medical and nursing professionals and to conduct research that helps improve the health service in Sudan.

Fifth:

Work Force! Logically, most doctors should be hired by the states rather than the Federal Ministry of Health. So most industrial disputes should be between the local unions and the state ministry of health rather than with the federal ministry of health. Although, the Federal ministry should have its employees and should deal with their representative bodies.

Six:

Finance! Each state should be responsible for its own health budget! The federal government should provide financial assistance to less developed states. State such as Khartoum should not receive any federal funding for curative purposes. However, if Khartoum treats other states residents shouldn't Khartoum get compensation by other states and vice versa? Point for debate because the state health budget should come from local taxes.

Despite federalism is the governing system in Sudan the health system is controlled from the centre. Running a federal health system means increase running cost and fragmentation of services. Having a small but effective federal ministry of health will help reduce the fragmentation and improve coordination between the states and lead to an efficient health system. Federalism is a political choice and not a medical one.

1000

2020-05-09T01:21:00.000+02:00

Today Sudan reached a milestone in this pandemic by confirming more than 1,000 cases of COVID-19. Khartoum state remains the epicentre of the virus but recently the number of cases in other states started to increase.

It is not a surprise we reached this milestone, it was expected considering the continuous lack of effective social distancing and political instability. Despite the introduction of lock measures more than four weeks ago, the number of new cases continues to increase daily. And the logarithmic curve has not flattened yet. If this rate of daily new cases continues as it is, Sudan should brace itself for a big jump in cases are more likely more fatalities.

The current pandemic demonstrated how fragile the health system is. The infrastructure for health surveillance, early detection, contact tracing and isolation almost not existing or it is not effective. 

By next week if the curve does not show any signs of slowing down Sudan should get ready for a crisis that Sudan has not seen before and not ready for it. 

FLATTING THE CURVE VS SHIFTING THE CURVE

2020-05-04T02:38:00.002+02:00

I always had an interest in Public health because it showed me the big picture. As, doctors, we always get consumed with what in front of us and the daily routine, but we do not stop and ask ourselves where all these diseases come from and what we can do about it.

During this pandemic, the public suddenly became aware of many new vocabularies. Terms such as ventilators, N95 masks, and flatting the curve became a meme. However, when it comes to curves, there are different types of dealing with them.

In this public health intervention, by asking the public to practice social distancing, we aim to spread the cases over a longer period so as the health services can deal with the increased caseload and demand in intensive-care beds. Without social distancing, the rise in the number of cases will be sharp, but the health service will not be able to cope with the flooded of cases which will lead to doctors have to make the hard decision on who gets intensive care and who does not. Believe me, it is not a decision you want to make and explain it to someone’s family.

The other form of public health intervention is described as moving the curve. So basically, you try to move the whole curve of exposure in a good direction. E.g. let examine the relationship between the diagram below.

The red curve represents the number of a population where at a certain level of risk an “X” disease will develop. To reduce the number of people who will go on and develop the disease we can try and shift the whole curve “population” to the left. This will reduce the risk to the whole population and eventually will lead to fewer people developing the disease.

An example is the advice given to the whole population regarding coronary heart disease. This can range from exercise, a balanced diet, to the cessation of smoking. This is easier said than done but the reward is huge and in the number of prevented incidence of the disease and cost to health service.

As this Pandemic continues, more public health topic and intervention will become the mainstream. What I hope will increase the interest in Public health and will encourage more doctors and others into the field.

What do you think?

Sources:

1. [Flattening the curve: OUWB experts explain how novel coronavirus can be stopped](https://oakland.edu/medicine/news/auto-list-news/2020/Flattening-the-curve-OUWB-experts-explain-how-novel-coronavirus-can-be-stopped)

2. Geoffrey Rose, Sick individuals and sick populations, International Journal of Epidemiology, Volume 30, Issue 3, June 2001, Pages 427–432, https://doi.org/10.1093/ije/30.3.427

Sudanese Parties election programs

2020-04-30T01:08:00.001+02:00

Sudan vs Others

2020-04-27T14:53:00.001+02:00

As the situation of COVID-19 continues to develop, it is important to keep what is happening in Sudan within the perspective and context of Sudan’s regional circumstances rather than comparing Sudan to the gulf or European countries.

Sudan situation is similar to other countries like Ethiopia or Rwanda. But it is important to consider and not to forget the political instability in Sudan currently and its impact on Sudan’s ability to respond to the pandemic.

Ethiopia

Population 93.88

% GDP on public health 2.2%

Doctor:Population 0.03/1000 people

Hospital beds 0.24/1000 people

First case March 13, 2020

Declared state of emergency but did not impose the same level of restrictions as sounding countries

Deaths 3

Sudan

Population 34.85

% GDP on public health 1.3 %

Doctor:Population 0.22/1000 people

Hospital beds 0.7/1000 people

First case March 13, 2020

Partial lockdown since March 26

Deaths 21

Rwanda

Population 12.01

% GDP on public health 4.85%

Doctor:Population 0.05/1000 people

Beds: Population 1.65/1000 people

First case March 14th, 2020

National lockdown March 21, 2020

Deaths 0

There is a population difference between all of them but Sudan the country with the least spending on public health compared to Ethiopia and Rwanda despite having more doctors in comparison. Also, Sudan death numbers are higher compared to Rwanda (0) and Ethiopia (3).

It is too early to draw a conclusion or make judgments at present but as time goes, it is interesting to watch the three countries diverge in terms of statistics.

What do you think?

Do you think the comparison is fair?

Sources:

1. [Ethiopia Health Stats: NationMaster.com](https://www.nationmaster.com/country-info/profiles/Ethiopia/Health)

2. [Top stats for Sudan: Country profile](https://www.nationmaster.com/country-info/profiles/Sudan)

3. [Rwanda Health Stats: NationMaster.com](https://www.nationmaster.com/country-info/profiles/Rwanda/Health)

4. [Ethiopia declares state of emergency to fight coronavirus | Ethiopia News | Al Jazeera](https://www.aljazeera.com/news/2020/04/ethiopia-declares-state-emergency-fight-covid-19-200408142519485.html)

5. [Coronavirus in Africa tracker - BBC News](https://www.bbc.co.uk/news/resources/idt-4a11d568-2716-41cf-a15e-7d15079548bc)

Charlie, Who?

2014-09-19T02:14:00.000+03:00

My five year old girl started school this July for the first time. I have to say I was more existed about her starting school than her. I still remember my first day going to school, I was so upset that I am leaving my pre-school class and moving to a place where I know no one. I even cried and refused to go, but after the first day everything went fine. This is why I was so interested to see my little girl reaction to leaving her pre-school and moving to a real school.

I picked up her up the first day, teacher did not have anything to report, my kid was not crying, so I assumed everything went fine. I was so wrong. The second day the picture was different, she was not crying but she was upset, the usual smile on her face was not there. When I asked her what is wrong? she said she was sent to the cloud!!! I did not understand what she was referring to, and whether this is good or bad thing? she also kept saying that a boy has been mean to her, he would not let Charlie go home with her! Charlie? who is Charlie? My daughter speaks so fast that I sometime do not understand what is she saying!

When I picked her up on the third day of her first week in school she was again upset. The teacher explained to me that she is upset because she would not take Charlie with her home. I could not pretend anymore that I know who's the hell is Charlie! so asked the teacher, "Who is Charlie? she was upset the other day and kept blaming herself for Charlie not going home with her, Who is Charlie?"

The teacher finally explain it to me. Charlie is a teddy bear which goes home with kid who behaved the most in class and have a sleep over. The thing has a diary where parents write down how the sleep over was and pass it from one kid to another. And if you misbehave in the class not only you would not be taking Charlie for sleep over, you get to spent time under the clouds in the class, which is a spot where teacher send naughty kids. I picked her up on the fourth day of her first week, I became obsessed with Charlie, looking out if my kid will come out carrying Charlie or not. unfortunately she came out empty handed, and upset as usual, I told her that she is a good girl and one day she will bring Charlie home for a sleep over.

On Friday, her last day of her first week, I did not pick her up, my wife did. My daughter was so good today so she get to bring Charlie home and keeping for the whole weekend. She was so happy, taking him with her everywhere including the toilet. I took the following picture so we can write in Charlie's diary book.

Since that week, whenever she return from school, I ask her was she sent to the clouds today? she tells me she is good girl, but that kid was sent today because he was talking during class, or that girl was sent gain to the cloud because she drew on the class walls. I kept asking her about the cloud daily, I even started to predict who is being naughty today. Kids and their little adventures.

Iraq

2014-06-16T10:47:00.001+03:00

While how things evolved in Iraq took many people by surprise few observers were expecting it. Do not take me wrong, what ISIS managed to achieve militarially is astonishing but make no mistake it has to do with the support they found from Sunni population they came across or at least their apathy toward the central government.

Since Malaki appeared on the political scene in Iraq he made his intentions quite known. He did not reserve any effort to put Shiat interest on top of all Iraqies but made it his priority. Putting loyal army officers and public servants in every important joint in the government is one example. He manages alienate the Sunni tribes and the Kurds, this why his solider left their posts and ran away. Most of them were Shiat but did not have the backing of people they supposed to protect and secondly they were not certain of their government backing.

The Thoughts of ISIS having state in Iraq and Syria is scary and it can not be good to the region or to the international community. However bombing them without inclusive political process is waste of money, time, and lives. It is president Obama chance to exert some leverage on the Shitt in general and Malaki in particular to start sharing power with Sunni.

Overall, the situation is grim. A lot of efforts needed to stabilise the situation, not only in Iraq but also Syria. It the time for the USA to get involved rather stand by.

Miriam Ibrahim

2014-06-02T03:03:00.000+03:00

While I was away, the last few months were quite busy for Sudan. A lot of things happened and still happing. Sudan is going over a very critical phase at present, and while some thought that the current government went through the separation of South Sudan with no major draw back locally I believe the worse is still to come. Sudan is still unstable, bankrupted, and in deep troubles with its neighbours. Nonetheless, I will focus on two events that to dominated the news about Sudan in the last few weeks.

The arrest and sentencing of Miriam Ibrahim to death for changing her believes was very sad and depressing. Sudan is a country well known for the diversity of its people from culture, skin colour, and religion. I grew up in a neighbourhood where there was two churches within a diameter of less than 1 kilometre. Hence the recent news about Miriam was a shock to me and to many other Sudanese. In my opinion I think Bashir is trying to get attention after feeling neglected by the west and the Obama’s administration. He is trying to get back into the spot light in a strange way. I believe he is trying to open communication channels with the west and mainly the USA. In recent months his health deteriorated quite badly and his ability to access good health service outside Sudan has become so limited. May be he is trying to arrange for his exist. however it is more likely that a group of his inner circle or his party is arranging for his departure.

Miriam Ibrahim case is nothing but an invitation for the west to negotiate terms of Bashir surrender in hope of a good deal. Despite the rhetoric in the local media they would not go through with the ruling and she will walk free with her children unharmed. it is just another tactic but a stupid one. Will discuss the other issue next week

Speakers Corners

2014-02-03T18:49:00.002+03:00

I have recently had a heated discussion with a friend who was once one of those who are engaged with one of the traditional Sudanese parties. He accustomed to speak every now and then in the Faculty of Medicine main road in fashion similar to speakers corner in Hyde Park! It is among the older traditions of the University of Khartoum. Even under the most suppressive regimes students of the university were successful in maintaining their freedom of speech for most of the time, of course it landed them in deep trouble and in some cases jail or even dismissal from college.

From an outsider point of view you will admire their courage to take part, but if you took a close look at what actually been said you will be surprised!

First, these students were representing their own party agenda rather than interest of the university students which I felt personally they could not be careless about. Second, most of the these events and the exchange were personal attacks rather anything else and cheap shots at each party. They were prepared to scarify the interest of their fellow students for the benefit of their political movement. Nonetheless, what was more upsetting and disturbing is the way they looked upon those who do not participate in political activity in the campus are less patriotic than them. I was among those who were labelled as "Standbys" But I am no less patriotic than any of them. Those elites brought nothing but destruction to Sudan and the fabric of its society with no exception. No one of them has the moral ground from which he or she can judge us. We were more active in civic activities inside the university and outside in the heart of our community. We represent the majority of the Sudanese people who just fed up with them and decided to ignore them all.

If they are Sudan's only hope then, I guess there is not any hope.

Egypt crisis impact on Sudan

2013-07-05T03:20:00.000+03:00

Despite the fact that I did not like President Mursi at all I thought it would a good chance to expose the Brotherhood for the people to see but what happened in Egypt has no description but a military coup! I know Mursi abused the power of his office specially when there was no legislative power to oppose him or keep him in check and even if there was one most likely it will be dominated by his own party!

what happened in Egypt is short term gain for long term loss. I have always been an advocate for letting Political Islamist to reach power via election and let them role and experience the burdens of governing people, that is the best way to expose their empty promises and their hypocrisy. In addition it prevent them from taking the violent rout to reach power when they see it is a fair game and the people are the ones who decided who is staying in power and who is leaving.

I hope the leadership of the Muslim brotherhood are wise enough to control their membership and accept defeat and go back to the drawing board and evaluate what went wrong. Do not write them off yet, most likely they will win a reasonable quota of any coming parliament as long as it is free and fair.

This impact Sudan quite significant! NCP and Bashir saw in Mursi a window of hope and an ally for them against ICC and a way out of their isolation. They were quite cautious in commenting about events in Egypt but you can feel the disappointment in their faces. This is not a good thing for Sudan. many commentator on the Sudan and in fact some Islamists did refer to Egypt Muslim Brotherhood experiment as an example of how if you are patient and invested at the level of the grass root and in Democracy you will eventually reach your goal but I am sure now they will stick to their guns and be more aggressive dealing with civil society! they will say no benefit in going the deåmocracy rout becuse it never pays out and you will be forced out by force.

I hope things in Egypt seatle down quickly in terms of an elected civilian government as soon as possible.

I am Sudanese and I have the DNA to prove it!!!

2013-06-22T05:15:00.000+03:00

People keep asking me why I did it? I did it for one reason, Knowledge. In Sudan we always ask the question of who we are and where did we come from?! So I did send my Saliva for DNA testing. The service provide you information in regard to your health and ancestry. The service is called 23andme.com, you can check the website if you are looking for more information or explanation of what am about to say, they have nice videos. You will notice from the graph the DNA analysis concluded I am half north african and the rest, or most of it, is Sub- Saharan African.

I have no doubt this represent most of North Sudanese with different percentages for each one. It basically showed that my Y chromosome did come from North aftrica, you get your Y chromosome from your father who in turn got it from my Grandfather and so on. My my Mitochondria, which the organism that provide energy to most cells int he body, was handed to me from from my mother, and she in turn got it from her mother and so on. That DNA line showed it originated in the West of aftrica before it migrate to East of africa.

The conclusion here is the affirmation that Sudan is the land of immigrants who came from Middle East and North Africa and mixed with the local population in East Africa and created the people who we come to know as Sudanese.

Image via CrunchBase

LEARNING THE HARD WAY!

2012-12-09T22:16:00.000+03:00

The recent event in Egypt showed how inexperienced the Muslim Brotherhood in matter of governing under a democratic system. Despite what ever Egypt has is far away from being described as democracy still there is a good amount of freedom of expression which is the underpinning of any healthy democracy. The Muslim brothers thought post Mubarak era will be a walk in the park. they thought there is no one but them and the other parties are so weak to oppose. they were proved wrong.

English: (Islam_Is_The_Solution.jpg) arabic logo to muslim brotherhood organization (Photo credit: Wikipedia)

Like most Islamists they did not think it through. They only think of taking power and control but they have no idea about governing. they have quite vague mottoes like "Islam is the solution" but they never told us how Islam is going to solve the unemployment problem, or housing, or improve education and health status of Egyptians! the problem these mottoes are for the illiterate and their base. I do not think the brotherhood has major support in big cities but it base is mainly concentrated in rural areas.

Ramadan! What did you miss?

2012-08-25T14:52:00.000+03:00

English: Khartoum downtown view at night (Photo credit: Wikipedia)

Ramadan in Sudan like all other arabic/islamic countries is a month where everything slow down. Public services start late, you will lucky if you found anyone in office in the first place, and if you did most likely they will say to you they are in the mosque doing Quran reciting or praying and you have to come back some other day!

SudanRevolt is no difference! once Ramadan announced the number of demonstrations against NCP declined sharply. There may have been one here and one there but nothing promising, some tried to promote night demonstrations but this did not work too. Even the Nyala incident was not enough to mobilise the street in Khartoum during Ramadan. Is it Just Ramadan or is it the disconnect between Khartoum resident and rest of the country? a question for another day.

The Umma party still trying to be on both sides at the same time, with and against the government, Turabi still bitter and willing to say anything against his nemesis Bashir, at least he is consistant not like Sadiq Al Mahadi.

Economical hardship continues with the hope when south Sudan resume oil production NCP will have more hard currency to spend but I expect the black market to flourish because the agreed transportation fee was not as hoped by NCP. They rolled back electricity cost increase for now but for how long?

Bashir still can only fly to few countries and one of them is Ethiopia, but with the death of its prime minster and the surface of new leadership will the situation change? south Sudan went a little bit over the top when it declared three days to mourn him, it is true he played vital role in mediating talks between the two nations but three days and brining the flag down? come on, will Paulino Matip (it is pronounced Faulino by the way) the second in command for South Sudan Army receive same treatment? let us not forget he fought with Bashir against SPLA later in the civil war.

The only good news the fact that most of political detainees were released for Eid but still some of them remain in custody and their where about is unknown. During Eid another airplane crash claimed the lives of some low profile NCP officials. Civil aviation authority chief resigned claiming his responsibility of the short coming of his administration and you think Bashir will be happy that someone is taking the blame but NO. Bashir refuses to accept his resignation and ask him to resume his duty with no investigation at all, they are blaming the Russian pilot for his incompetence (who allowed him to fly then?).

Now that Ramadan is over, Eid Mubarak everyone, and let's see if it was a matter of hunger that slowed down SudanRevolt phenomena.

Young Man Wisdom

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Parallels and Contrasts: Examining Support for SAF in Sudan and Assad in Syria

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Test, test, test!

#COVID19 ? What COVID-19 ?!

TEST, TEST, & TEST

#Sudan Healthcare Workers

Podcast

Health Workforce Density in Sudan

Welcome!

Access to Health

2000 Cases

The role of the federal ministry of health in Sudan

1000

FLATTING THE CURVE VS SHIFTING THE CURVE

Sudanese Parties election programs

Sudan vs Others

Charlie, Who?

Iraq

Miriam Ibrahim

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Speakers Corners

Egypt crisis impact on Sudan

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I am Sudanese and I have the DNA to prove it!!!

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