Amidst Sudan’s enduring crisis, Dr. Huzaifa Salim, the Assistant Secretary General of the Sudanese American Physicians Association (SAPA), recently provided insights into the organization’s vital efforts to provide health care amid the ongoing war.

In an exclusive interview with Radio Tamazuj, Dr. Salim says the healthcare system in Sudan was already fragile before the war and the ongoing conflict has now brought it down to its knees. He reveals that SAPA prioritizes healthcare and humanitarian aid, and has been steadfast in addressing the urgent needs of Sudanese communities grappling with conflict, displacement, and health emergencies.

Below are edited highlights from the interview:

Question: Could you tell us more about the Sudan American Physicians Association (SAPA) and its work?

Answer: The Sudanese American Physicians Association is a non-profit professional organization established in 2019 by a group of Sudanese doctors who maintain strong ties to our homeland. Our members include physicians, dentists, pharmacists, and healthcare providers in public health centers and research. We united in 2019 to support our healthcare system amidst ongoing violence, injuries, and diseases related to both medical conditions and the revolution. Our mission continues to focus on empowering Sudanese communities and enhancing capacities within the public healthcare sector.

Q: As a nonprofit organization, where do you receive funding from?

A: Most of our funding comes from our membership, distinguishing us as a member-based organization. Our members form the backbone of our operations, electing our board of directors and contributing directly to our projects and initiatives. Additionally, we receive support from international agencies such as UNICEF and IOM and from our Muslim community partners.

Q: Where is your current area of operation in Sudan?

A: We are actively engaged throughout Sudan, particularly in areas most affected by conflict and displacement. Recently, our focus has been on Khartoum and Madani. In Madani, we constructed one of the largest hospitals in Al Jazeera to serve displaced individuals from other cities.

Currently, we operate in approximately seven states across northern and eastern Sudan. Additionally, we have established an office in Chad to assist refugees in the Eddri camp in western Sudan. Previously, our efforts spanned across every state significantly impacted by the situation. For example, we constructed oxygen tanks in El Geneina and Sinjah in Blue Nile state, aiming to strengthen the healthcare system’s capacity to meet the needs of those requiring medical assistance.

Q: Were you able to operate in some of the rebel-controlled areas before the war started last year like you mentioned Blue Nile and South Kordofan?

A: We managed to carry out some work in Blue Nile, the Darfur Region, and South Kordofan. I need to verify if we currently have any ongoing projects there. However, we aim to extend our reach to as many areas in Sudan as possible.

Q: One year into the war in Sudan, many hospitals and health facilities are not functioning. As SAPA, what are you doing to ensure that operations continue?

A: It is important that you have brought up the dire state of the healthcare sector, which has been systematically devastated. According to the WHO’s latest data from the first week of April, 83 percent of hospitals are either completely non-functional or only partially operational. There is an urgent need for healthcare access, particularly for child vaccinations and maternity care. With an expected 1.4 million births this year, there is a severe lack of capacity in facilities.

Previously, we were operating in Al Jazeera, but since mid-December, the area has witnessed heightened violence, prompting us to relocate to different states. Our approach involves establishing new health centers or supporting existing ones. We provide care to displaced people and refugees, and we also operate mobile clinics.

Currently, we have delivered care to almost 300,000 individuals in northern Sudan, Kasala, and Khartoum, including Omdurman’s Al Buluk Hospital. Through partnerships with organizations like UNICEF, we have been able to fully operate hospitals, ensuring comprehensive care with our local partners and staff on the ground.

Q: You mentioned the use of mobile clinics. Have you been able to set up clinics at border crossings, such as those with South Sudan?

A: Yes, we are currently in the process of setting up operations in South Sudan within the next 4 to 6 weeks. Additionally, we have discussed establishing clinics in eastern Chad and western Darfur. Our priority is to provide healthcare access in border areas, and the logistical preparations are underway.

Q: Doctor Salim, how would you describe the security situation for your teams operating in these areas?

A: The security situation is undoubtedly concerning and challenging. We take all possible measures to ensure the safety of our teams. However, even simple tasks like delivering aid or supplies can be complex due to the realities and logistics of war. Nonetheless, we remain transparent about our activities and objectives, emphasizing our commitment to assisting the Sudanese population. Despite the risks, our team has fared relatively well. However, it is essential to note that more than 50 healthcare providers have been killed or affected by the conflict since its onset, highlighting the severity and complexity of the situation.

Q: How has the loss of colleagues affected your operations?

A: It is truly devastating. Experiencing the loss of colleagues or friends in the line of duty creates a profound sense of trauma. Despite this, we are deeply motivated by our duty and compassion towards our country. We understand that our Sudanese patients deserve the best care possible, so we are determined to persevere. Additionally, we continue to advocate for the safety and protection of healthcare providers. Targeting healthcare facilities is a violation of human rights and constitutes a war crime. It is worth noting that at the onset of the war, these facilities often served as refuges for warring factions.

Q: Have you encountered difficulties accessing areas controlled by either or both of the warring parties?

A: Accessing areas under the control of the Rapid Support Forces (RSF) has indeed been challenging. Previously, we operated a functional healthcare center in Al Jazeera, Madani. However, since the attack in December, we have faced significant obstacles. Our investments, data, and work in that area have been disrupted, and communication has become exceedingly difficult.

Q: Can you estimate the losses incurred, particularly concerning the hospital in Al Jazeera attacked by the RSF?

A: While I do not have precise figures at hand, the healthcare sector was already fragile. The hospital in Al Jazeera had around 80 beds, along with ICU and operating rooms. I would estimate the losses to be in the hundreds of thousands. This loss is particularly impactful given the 6.8 million internally displaced people in Sudan who often lack access to adequate healthcare facilities. Our efforts aimed to bolster the capacity of healthcare systems in these areas.

Q: Regarding the recent Paris Conference on humanitarian issues and pledging for aid, were you involved in lobbying for increased funding for your operations?

A: Yes, we actively participated in advocating for increased funding and support for humanitarian crises. We issued a call to action and held a rally in Washington D.C., where we delivered over 10,000 petitions with our partners, echoing the need for more aid. Our SAPA president attended the Paris Conference to advocate for this cause. A significant focus of our advocacy is the localization of funds. It’s essential to empower local organizations like ours, which have personnel and operations on the ground. By ensuring localized funding, we can deliver culturally sensitive responses that address the specific needs of each community. We are hopeful that the commitments made at the conference will materialize and alleviate some of the burdens faced by our people during this war.

Q: What is SAPA’s plan for ensuring children are vaccinated in the coming period?

A: Our approach is evolving from crisis response to long-term strategic planning aimed at enhancing the health, well-being, and welfare of Sudanese citizens. Specifically, our strategy office has devised plans to ramp up vaccination efforts and distribution, prioritizing reaching areas where newborns can receive vaccinations promptly.

Q: As an association, do you engage with warring parties to advocate for an end to the war?

A: SAPA is a professional, non-political, nonprofit organization focused on healthcare. While we prioritize peacebuilding, our mandate and bylaws prohibit direct involvement in political actions or affiliations with political parties. However, we do advocate for peace-building initiatives and raise awareness about the humanitarian crisis and conflicts between ideologies. Although our focus remains on healthcare and professionalism, we speak out against human rights violations.

Q: Can SAPA provide specific data on the number of psycho-social cases it handles related to trauma?

A: Addressing mental health issues, particularly trauma, is crucial and deserves more attention in the media. Many children in Sudan have been exposed to the sounds of gunfire, bullets, and bombs, leading to long-term effects. As healthcare professionals, we are equipped to address psychiatric and psychological issues.

SAPA has provided mental health services and trauma training to approximately 70,000 individuals. While I cannot provide exact numbers of those suffering from post-traumatic stress disorder or severe mental health deterioration due to conflict circumstances, our focus remains on reaching and supporting those affected.

Gender-based violence (GBV) is another concerning issue in Sudan, particularly targeting women and children. We're scaling up training efforts to address GBV and support those affected by it.

Q: Does SAPA have plans to train perpetrators of human rights and GBV issues?

A: Currently, we do not have specific programs for training perpetrators. Our focus is on supporting victims and increasing awareness about human rights and GBV. While your point is valid, our efforts are directed toward providing assistance and raising awareness to prevent such violations.

Q: How can an ordinary Sudanese citizen access services provided by SAPA?

A: Our main office is located in Port Sudan, with centers established in most states across Sudan. Despite the conflict affecting seven out of eighteen states, we maintain a strong social media presence on various platforms to enhance communication. Additionally, we collaborate with local healthcare administrations and the Ministry of Health to conduct outreach programs, including mobile clinics. These clinics comprise teams of doctors, pharmacists, and lab technicians who visit villages to educate and provide healthcare services. Despite the challenges posed by the conflict, our mobile clinics remain operational.

Q: The Sudanese health ministry has mentioned a need for about $50 million to address healthcare needs nationwide. What are your thoughts on this?

A: While I haven’t seen the specific comment you mentioned, if accurate, $50 million appears to be on the lower end of the scale. The UN estimated the healthcare assistance needs at around $2.7 billion, but only approximately $150 million has been delivered so far, which is merely 5 percent of the required amount. Therefore, I believe $50 million may not be sufficient to significantly increase healthcare capacity to the required level.

Q: What is the total number of SAPA staff involved in healthcare operations across Sudan?

A: Our core operational team consists of approximately 15 to 20 physicians, spread across various locations. Additionally, we collaborate with local partners and organizations, such as Emergency Room Initiatives, Sadakat, and Hadreen, leveraging their expertise. While I cannot provide an exact number, I estimate that between 15 to 20 physicians form the core team on the ground.

Q: Have you documented the number of people who have died due to lack of healthcare since the war began on April 15, 2023?

A: While we maintain rigorous data collection processes, I don’t have the exact number at hand. Over the past year, we have been diligent in compiling data, focusing particularly on the Northern state. While we can estimate the impact, we aim to provide accurate figures as we finalize our compilation efforts. Our association’s data has been recognized and utilized by the United Nations in their reports. In the coming weeks, we hope to present comprehensive figures, including chronic diseases and outbreaks such as cholera and dengue fever, which we closely monitor.

Q: What is currently the primary concern for SAPA regarding Sudan?

A: The ongoing war and conflict in Sudan are deeply distressing for us. Witnessing the suffering of our people, the loss of lives, and the collapse of communities weighs heavily on our hearts. Sudan deserves attention and awareness for the crisis it’s facing, which has persisted for 365 days without clear progress toward resolution.

It is disheartening to see our people enduring such hardships. My main advocacy is for increased humanitarian aid funding, localized to work effectively with local organizations. We must strive for a brighter future for Sudan and ensure that Sudanese citizens receive the healthcare they deserve.

Q: Considering the combination of diseases and hunger in the country, what are your projections for the near future?

A: The hunger crisis in Sudan is currently one of the most severe in the world, and it is expected to worsen. Hunger and healthcare are intricately linked; without proper nutrition, immune systems weaken, making individuals more susceptible to diseases.

In the next month alone, around 200 thousand children are projected to face famine. This isn’t just severe malnutrition; it’s an absolute lack of nutrition leading to fatalities. Without immediate intervention and sufficient resources, we risk losing an entire generation to hunger.

During Ramadan, we were actively involved in addressing the hunger crisis, particularly in Chad’s Eddri camp, where we provide daily meals to approximately 1000 children. However, witnessing the conditions in refugee camps, it is evident that much more needs to be done.

While our focus is primarily on healthcare, we recognize that addressing hunger and nutrition is integral to overall well-being. Over the next five years, our commitment is to continue our efforts to uplift affected generations and communities, striving for a better tomorrow.