KHARTOUM, Sudan — In a crowded hospital ward, 30-year-old Alawiya Zakaria sits clutching her 1-year-old daughter, Sabba, in her arms. The child is painfully thin, her bones and skull protruding under her skin, her feet and stomach swollen from severe malnutrition.
Zakaria said she feared the worst before she undertook a four hour walk to get her daughter to Al Buluk Pediatric Hospital in Omdurman, a city across the White Nile River from Khartoum, the capital city where Zakaria lives.
Back home in Khartoum she and her children were eating a small cup full of lentils once or twice a day.
For a time, volunteer-run community kitchens were her lifeline. But food prices skyrocketed — inflation hit over 150% in April — and vital support dried up, as programs faced cuts from USAID and other organizations. "There were kitchens, then about a year ago, there were none," she said.
Then children in her area gradually began to die. "13 children died of malnutrition in our area," in Zakaria's neighborhood in Khartoum, within the last six months, many with conditions linked to starvation. She was desperate but there were no functioning hospitals in the city or within reach as the Sudanese civil war engulfed the capital.
A health system in ruins
Two years of war in Sudan has caused an unprecedented humanitarian disaster in one of Africa's largest countries and left its health system in ruins.
Before fighting broke out in April 2023, Khartoum had nearly 100 public and private medical facilities, according to the Khartoum State Government. Today, not a single one remains operational.
In March, Khartoum was recaptured by the Sudanese army. The end of the occupation by the paramilitary Rapid Support Forces (RSF) has opened up movement of aid into the city, revealing the full extent of the dire humanitarian toll.
When NPR reported from the capital city in April, every single medical facility had either shut down due to lack of medical supplies or been looted or destroyed during the fighting.
Much of the city has been left in ruins by intense battles between the Sudanese army and the paramilitary Rapid Support Forces. Street after street across swathes of Khartoum have been damaged by gunfire and bombs.
According to the World Food Programme more than 600,000 people are suffering from famine, a figure expected to rise. It's the worst famine anywhere in the world for decades, according to the U.N.
In Sudan hunger is not just a byproduct of war — it's a weapon. Both sides are accused of blocking aid to areas they do not control.
NPR visited Ibn Sina Specialized Hospital in Khartoum — now in ruins. Walls were wrecked by artillery blasts and gunfire. Wards, operating theaters and x-ray rooms were covered in broken glass and concrete, littered with bullet casings and broken syringes — as well as cardboard packages of ammunition manufactured in Serbia.
RSF fighters had occupied the hospital for months. They cooked in hospital wards and dragged patient beds into makeshift encampments. Like many places in Khartoum, electric cables had been ripped from walls and looted for copper, with the plastic remains left behind in heaps on the ground.
In their almost two-year occupation of Khartoum, RSF were accused by several human rights groups of systemic sexual violence and torture, denying or restricting movement in and out of the capital.
In the absence of health care in Khartoum, the sick and the wounded were trapped with nowhere to go for medical attention.
A lifeline from volunteers
With international aid blocked or limited, a network of volunteers stepped in. The Emergency Response Rooms, a Nobel peace prize nominated network of local volunteers across Sudan, were a lifeline in Khartoum. The groups, set up in local areas, provided medical aid, counselling and set up community kitchens funded by local and diaspora donations to distribute food.
Duaa Tariq is a volunteer who stayed in Khartoum during the war. She said the help ERR provided made a difference but often it wasn't enough. Reports were rife of people who died from a lack of basic medical services, including someone she was close to. "Her name was Auntie Magda," she told us.
"We were eating only lentil soup with rice for over a year," she said, because it was cheap to buy but the lack of balance in her diet caused issues with her kidney and she became malnourished. "When I went to see her, I couldn't recognize her. She was just skin and bones." In January Magda passed away.
A hospital buckling under pressure and the threat of drones
With the collapse of health care in Khartoum and other parts of Sudan, people have streamed into cities where the health system has been partially restored, like Omdurman.
Al-Buluk Hospital in Omdurman is supported by the Sudanese American Physicians Association and Doctors Without Borders (MSF). The hospital has been repeatedly struck by artillery throughout the conflict. Patients and medical staff have been injured and killed, but it has stayed open.
Dr. Ahmed Khojeli is the director of Al Buluk and has worked at the hospital throughout the war. He said patient numbers there have surged. "It's getting higher, definitely, because, the daily admissions are [in the] 50s to 60s, but now we've reached 80s and 90s and last Friday it was a hundred," he said in mid-April.
Each ward designed for 25 children now holds two to three times that number, many in need of urgent care. About one in every 25 children brought to the hospital dies, according to Dr. Khojeli most from severe malnutrition.
This week, the Sudanese army said it officially recaptured the entire capital region, after recapturing the capital city, Khartoum at the end of March.
Authorities have begun reviving hospitals shutdown during the war, or repairing facilities damaged by the conflict. But the rebuilding effort is taking place under the cover of increasing RSF drone strikes over the past month.
Al Buluk has been repeatedly struck by artillery during the war. Medical staff and patients have been killed, but it has remained open. Its wards are overflowing with patients, many of whom have traveled miles in search of care, navigating frontlines and shelling, like Zakaria.
She escaped Khartoum before the army recaptured it. The RSF were still in control of her neighborhood when she fled, carrying her baby and walking for hours across the city, as the sound of gunfire and bombing echoed all around her.
She passed through more than a dozen checkpoints mounted across Khartoum by the RSF.
At several checkpoints, she showed them Sabba's condition but was interrogated and abused. "I was slapped, beaten. They robbed my money and my phone, all my things," she said. But eventually she was allowed to pass. And after a month of care, doctors at Al Buluk say 1-year-old Sabba is gaining weight and responding to treatment. It was her mother's courage that saved her.
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