War-Torn Sudan’s Medical Training Nightmare

Sudan’s worsening humanitarian crisis has pushed public services beyond the point of collapse. The conflict between the Sudanese Armed Forces and the Rapid Support Forces has also disrupted medical training and licensing, with lasting consequences for the health care workforce.

International agencies and organizations need to join now with Sudanese partners to revitalize medical training in the country.

The war’s devastating impact on medical training takes many forms. The destruction of medical schools and hospitals precludes education in much of the country. Many medical schools and residency programs have been forced to relocate to safer cities in Sudan, while others have transitioned to online instruction. In August 2023, the Sudan Medical Council stopped confirming the completion of medical students’ training, which would have allowed them to officially start their internship. The licensing exam for interns was suspended at the onset of the war and only recommenced this year in mid-August with the support of the Sudanese American Physicians Association. This showcases the solidarity and resilience of the Sudanese medical community.

The sustainability of the health workforce in Sudan is clearly in jeopardy. Faced with a choice between unremitting insecurity and fleeing, many medical students and interns choose to emigrate—worsening the long-standing brain drain of medical professionals. One of us, Mutwakil Ali, MBBS, a medical intern, cared for patients in his community before relocating to the United Arab Emirates. “I had to take on additional responsibilities beyond my experience in a setting with insufficient resources and inadequate supervision,” he recalls. “We had to learn on the job.”

The rapid increase in migration has exhausted the staff who remained and jeopardized the quality of patient care in the conflict zone. The large number of medical trainees who moved to safer zones within Sudan has far exceeded hospitals’ capacity to enroll them, leading to a shortage in training opportunities.

On the first day of the war, co-author and general practitioner Omer Mahgoub, MBBS, witnessed his hospital in the center of Khartoum shut down. “A total systemic failure has hit our health care system,” says Mahgoub. “Right after the war broke out, I went to pharmacies to treat patients since most hospitals and clinics in my neighborhood were out of service.” A few months later, after he and his family were displaced, he joined Médecins sans Frontières (MSF) in Sudan. During his time with MSF, he dedicated himself to training as many interns and students as possible, but many were still left with unanswered questions and self-doubt.

Still, the health care community in Sudan has shown remarkable resilience. Physicians like Mahgoub are training interns and students. Displaced physicians are establishing specialty units in remote hospitals, bringing expertise to regions lacking health services like neurosurgery and orthopedics.

However, disruptions in medical training have compromised the national public health infrastructure, exacerbating the country’s overwhelming health needs. Broken health systems produced by the prolonged armed conflict will continue to undermine public health even after the war ceases.

Nevertheless, medical training must continue even under the direst circumstances. Sudan must act as soon as possible to avoid future physician shortages by facilitating resident transfers to other in-country residency programs with better security and additional capacity. The Sudan Medical Council and the Ministry of Health, in collaboration with the World Medical Association and the World Federation for Medical Education, should coordinate and oversee this process. The appeal for humanitarian aid for Sudan, which seeks $2.7 billion, is only half funded as of early October, according to the UN Office for the Coordination of Humanitarian Affairs. International partners must step up to fill this gap in funding, some of which should be dedicated to upholding medical education and training mechanisms.

During and after the war, Sudanese physicians living in other countries can play a crucial role in rehabilitating the health system through relocation assistance for medical trainees and scholarly exchange.

The WHO and the Sudan Medical Council should make substantial efforts to draw on this community’s capabilities to support the current interns and residents. We urge them to partner with the Sudanese American Physicians Association to conduct research to comprehend how war impacts medical education and training. Developing an evidence base on this subject would mark the starting point of rehabilitating the national medical educational system, maintaining the continuity of medical training, and mitigating the impact of warfare on the health care system.

Habab Iraqi, MBBS, is a Sudanese emergency medicine intern, now based in Saudi Arabia. Current affiliations include SAEM, IFEM, and EUSEM.

Mutwakil Ali, MBBS, is a Sudanese medical intern, now based in the United Arab Emirates.

Omer Mahgoub, MBBS, is a Sudanese general practitioner and a communication officer at the Sudanese American Physicians Association.

Authors’ Note: We wish to thank Charlotte Roy, MD, MPH, for her top-notch and incredibly fast editing assistance.

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