Sudan is going through a catastrophic situation that can only be solved by a massive and rapid increase in global humanitarian aid

The Emergency Coordinator for Doctors Without Borders (MSF) in Sudan, Esperanza Santos Suárez, analysed the cholera outbreak that has caused dozens of deaths and more than 2,700 hospitalisations in the Sudanese country on the Onda Madrid programme ‘De cara al mundo’. Addressing the complicated situation that the African nation is going through.

In addition, she considered the importance of humanitarian aid.

Regarding the professional profile of Esperanza Santos Suárez, it should be noted that she is a nurse, she began her professional career at the Hospital La Princesa, and, since 2015, at the Hospital Gregorio Marañón.

Since 2006 she has alternated working in hospitals in Madrid with missions for Médecins Sans Frontières in different countries where the organisation is working. During this time, she has worked in 20 different countries, most of the time in response to emergencies of various kinds: armed conflicts, epidemics, natural disasters or nutritional crises, among others. Some examples: conflict in Syria, Yemen and Ethiopia; cholera epidemics in South Sudan and Haiti; Ebola in Sierra Leone and Congo; a nutritional crisis in Yemen; and the response to Hurricane Haydan in Mozambique.

She started out as a nurse, and then went on to carry out different tasks within the medical department and in the coordination of emergencies and projects with MSF. She has alternated her work with MSF with her post on the oncohaematology ward at the Gregorio Marañón Hospital.

In 2022 and 2023, she spent a year as general coordinator of MSF in South Sudan. Since June 2024, Esperanza has been emergency coordinator in Sudan, a country from which she has recently returned.

What is the general context of MSF in Sudan?

The first humanitarian response of Doctors Without Borders in Sudan was in 1979. Before the war our teams were working in 10 states in Sudan. When the war broke out in April 2023, many activities were interrupted or changed to respond to new needs and emergencies throughout the country, although some continued, especially in Darfur and Blue Nile, thanks to the efforts of our locally hired MSF staff.

MSF currently supports 22 hospitals, 42 primary care centres and mobile clinics, and 15 community case management centres. It is also implementing programmes for vaccination, treatment of malnutrition, and response to disease outbreaks. Despite these efforts, government restrictions and the inadequacy of the international response make aid difficult.

In recent months, MSF has supported mobile clinics in Bahri, distributed food in South Darfur and carried out measles vaccination campaigns. However, some activities, such as in Bashair and Al Saudi hospitals, were suspended for security reasons, although work is continuing on waste management in these centres. 

What are the priority issues for MSF?

Firstly, the chronic nature of the emergency, which will worsen with the arrival of the rainy season. This is an operational challenge for our teams as the medical and humanitarian needs of the population are extreme and multiplying, the presence of humanitarian actors providing a response is limited and the funding from the international community is clearly insufficient. Action must be taken now.

Also, the attacks on the medical mission and against the civilian population: deliberate attacks are being carried out against civilians, healthcare personnel and medical infrastructures supported by MSF, which has left many health centres out of service. Between 70 and 80% of these centres are inoperative due to insecurity, staff shortages and looting. MSF has recorded at least 60 incidents of violence against its staff, vehicles and buildings. The war in Sudan has become a direct attack on the civilian population, and both the staff and the health facilities must be respected and protected at all times by all parties to the conflict.

The needs in the country are catastrophic and can only be met by a massive and rapid increase in global humanitarian aid.

On the other hand, there is malnutrition: the food crisis in Sudan, exacerbated by the conflict that has interrupted the food supply and left the population unemployed, has caused widespread chronic malnutrition.

Half the population (24.6 million people) face high levels of acute food insecurity and almost two out of ten (18.3%, equivalent to 8.5 million people) are in an emergency situation or close to famine. This situation is expected to worsen in the coming months. The lack of access to food, added to alarming rates of malnutrition and a collapsed healthcare system, further aggravates the situation. In addition, more than 12 million people have been displaced, increasing the urgency of humanitarian intervention.

We can also talk about humanitarian criminalisation: restrictions on access to humanitarian aid affect some 25 million people who need it. The Government of Sudan has repeatedly obstructed the delivery of aid, especially in areas outside the control of the SAF. This obstruction has caused a serious shortage of medical supplies, making it difficult to meet vital needs. In the midst of the violence, millions of Sudanese lack access to basic medical care, which aggravates the high rates of maternal and infant mortality and disease outbreaks. The humanitarian response remains severely underfunded and urgently needs to be expanded to meet the needs of the population.

Since June 2024, Esperanza has been the Emergency Coordinator in Sudan for Médecins Sans Frontières, a country from which she has recently returned. Esperanza, we highlight the sadly most recent, the cholera outbreak in White Nile State. Yet another tragedy, isn't it, because this country has been suffering for far too long.

Yes, a tragedy added to the tragedy that the country has been experiencing in recent years. We have been working in White Nile since June 2023 and we have been responding to the cholera epidemic in several areas of White Nile since October. In other words, this is not something new, but just when it seemed to be under control again, on 20th February we had a new outbreak of cholera in Kosti, where we admitted 800 patients in a single day at the Kosti cholera treatment centre. And this is unmanageable. It is related to the lack of water, and to the fact that civilian infrastructure is being attacked.

Three days before this new peak in the epidemic, an electrical substation had been bombed, leaving the whole city of Kosti and the whole region without electricity and water. 

Esperanza is a nurse, she has worked in several hospitals here in Spain and has travelled around many tragedies in the world for many years. Why Esperanza? 

It has always called to me, it always called to me and I think I have been lucky. I always say it is a stroke of luck because I really like my job as a nurse and I also really like combining it with missions for Médecins Sans Frontières, attending to emergencies. 

You have been to lots of places.

Yes, in many countries. And, in fact, we are talking about Sudan and Sudan was the first place I went with Doctors Without Borders in 2006. Not just many places, but I keep going back. I always say that, after Spain, the place where I have spent the most time in my whole life has been Sudan.

You have been there for more than 15 years now. Why Sudan? It's a country I'm particularly fond of because we were there in 2005 doing a special for the magazine Atalayar. Why is this happening in Sudan? It's all about political and economic interests. Sudan was already divided with South Sudan over the issue of oil, but then there was war, now there is war again, in Darfur. What is happening in Sudan?

I think there are many factors, of course, but I think it's a power struggle. It has always been a struggle for power and a struggle for power and the economy. It has never been a place of conflict.

It is true that, in 2018, 2019, 2020 there was even a little hope for democracy when Omar Al-Bashir's regime fell, but then we saw how in 2021 there was another coup d'état that destabilised the country and the two generals who were the architects of this coup d'état are the ones who started the conflict in 2023 with fighting between these two armed groups, which are the two main armed groups in the country.

It is these two generals, who had already carried out a coup d'état in the past, who have caused a humanitarian catastrophe in the country because this conflict really started in the capital and has spread to most of Sudan's cities. So, other conflicts had affected different regions, but now what we see is a conflict that is completely affecting the whole country. 

The fear, I remember, was the construction of the Grand Ethiopian Renaissance Dam. There were certain tensions between Ethiopia and Sudan because it was affecting the course of the Nile and Egypt. Fortunately, however, that tension did not escalate between those countries. Are there regional strategic interests or interests of Islamists and/or other forces? Because Sudan, within North Africa, is a strategic country.

Yes, it is clear that it is a very turbulent region and there are interests not only at a regional level but also at an international level. I am not going to talk about politics and I am not an expert in telling you about international interests, but it is clear that otherwise this conflict could not have been sustained for two years with local resources and local weaponry.

Money and weapons from outside continue to flow into both sides of the conflict. What interests us most is the impact on the population. Of the country's 50 million inhabitants, 12 million have already left their homes and 2 million have crossed the borders. One in four inhabitants is displaced right now.

What resources does Doctors Without Borders need to be able to continue its aid and work in this country?

The dimensions of this conflict are so great that I believe that all means are few. What we are doing is a lot. We are in 11 of the 18 states. We are in more than 22 hospitals, 40 health centres, but it doesn't matter, this is a drop in the ocean. I believe that there has been a failure on the part of the international community and on a humanitarian level to reach the level of what Sudan needs right now.

Because Sudan is not on the front pages of newspapers or on television. Why? Does there have to be a big massacre for us journalists to become aware of it? Or are there other interests right now? Is Trump grabbing everything?

Yes, it's true. I think there are more journalists who can say why not. Because I don't understand it. Because there are massacres. It's a war that's being waged against civilians.

There are massacres, there are mass rapes, and there are deliberate attacks on certain communities and populations. And there are deliberate blockades to prevent aid from getting through to some places. There are cities that have been under siege for months.

I don't understand why we don't talk about Sudan because it seems to me that it is the biggest humanitarian catastrophe at the moment.

I remember when I came back from Bosnia, for example, or from the Gulf, feeling powerless, frustrated, even angry, because there was no interest in these kinds of issues. We were more concerned with internal political issues, with stupid things. A person like you, who is risking their life, who is doing a service to others, who is caring for a lot of people, what do you feel? Or do you already have a defence mechanism that allows you to carry on, assuming that, unfortunately, things are the way they are, but that the work you are doing is very necessary?

I think it's a bit of both. I think it's necessary to feel that you're having an impact. It's true that you're not going to change the global situation. And I think that in the humanitarian world we always say that. It's the impact you can have on the life of a person, of a specific person. We don't change big situations, we don't change the situation of a State, but we do alleviate the suffering of certain people. And this is what invites you to continue on a day-to-day basis. Because it's true that the frustration is also very great and it's one of the first things, I think, that you learn to live with frustration.

Also being a nurse, I think that this, the humanitarian aspect and the person-to-person aspect, helps you. So I think that's why in the end you keep going day by day. It's trying to see day by day, thinking about the person, not the situation.

What message would you send out to everyone?

Well, to be grateful for this attention and for people talking about Sudan. I really understand that it's a human issue that affects you more when it affects you more closely. But really, in the end, Sudan is a population of 50 million people who are suffering a crisis that is beyond words. So I think that people should remember Sudan and that we should get out of our own little circle a bit. 

Sudan is North Africa. North Africa, to put it plainly, is our backyard and its stability and security is the stability and security of Spain and Europe. So, we have to understand that too, right?

Yes, of course. And in the end, in a global world, everything affects us. But, well, it's true that in the end it seems that people are more affected by something that is happening close to Europe or migration.

Well, yes, it's clear that Sudan is the origin of many of the migrants who cross and die in the Mediterranean trying to escape this dramatic situation. So, of course it is. But well, often the human condition limits us to seeing a very small circle of our environment and a few kilometres around. And maybe we see what happens in the Mediterranean, but we don't see what happens on the other side of the Mediterranean.