Summary
- Since April of 2023, over 150 000 people have been killed and nearly 14 million have been displaced due to renewed fighting in Sudan.
- Mortality estimates are obscured by access and reporting challenges, but indirect deaths in Darfur alone may exceed 75 000.
- Health systems have collapsed, with 80% of facilities nonfunctional, and vaccination rates dropping from 79.9% to 46.4% in 2 years.
- 825 000 children face severe acute malnutrition.
A war without witnesses or international interest
These challenges are starkly evident in Sudan, where the war that began on 15 April 2023, after the breakdown of negotiations over military reform between the Sudanese Armed Forces and the Rapid Support Forces. It has now become one of the most devastating humanitarian crises in recent memory. Both factions had jointly deposed Omar al-Bashir in 2021, but unresolved power-sharing, disputes and interference from remnants of his regime reignited old rivalries with catastrophic consequences.
Reports now describe mass killings, forced disappearances, deliberate obstruction of aid and targeted attacks on civilians. In El Geneina, ethnically motivated massacres are believed to have killed around 12 000 people. By mid-2024, famine had been declared in West Darfur, where thousands of children face imminent starvation. As one of the world’s poorest nations, Sudan has endured catastrophic losses—an estimated 150 000 deaths as reported in early December 2025. Nearly 14 million people have been displaced, and mortality rates among the displaced have reached as much as 20 times baseline levels.
In such an environment, quantifying death is an important demographic/statistical exercise. But it is also a moral act. Mortality data record more than numbers; they bear witness to injustice and violence to whole communities. Reliable death estimates give visibility to victims of war, inform humanitarian priorities and provide an evidence base for policy and prevention. Above all, credible mortality figures protect suffering populations from statistical invisibility and in fine help establish some accountability after the fact…. Beyond direct killings, the indirect effects of war—famine, disease, impaired mental health and the collapse of essential services—are far deadlier.
Respected and proven initiatives run by local groups such as the Sudan Emergency Response Rooms, shortlisted for the Nobel Peace Prize by the Norwegian Peace Research Institute of Oslo, could be actively supported. The Small Arms Survey estimates four indirect deaths for every direct one. Applied to Sudan, reported ACLED’s current figure of 18 916 direct deaths8 implies more than 75 000 indirect deaths in Darfur alone since April 2023.
Patterns of mortality vary with the nature of warfare. Unlike conflicts dominated by aerial bombardment, such as Yemen or Syria, Sudan’s war is marked by close-range violence, sexual assault and deliberate starvation. Combined with the widespread destruction of health facilities, including those in Khartoum, the indirect toll is almost certainly higher—and continues to rise.
Children bear the brunt. The convergence of malnutrition and infectious disease is especially lethal: respiratory infections, diarrhoeal diseases, measles and malaria account for up to 70% of deaths in conflict zones, mostly among children under five. Médecins Sans Frontières reports 13 child deaths per day in Zamzam camp, largely from severe malnutrition…
Nearly 825 000 children were projected to experience severe acute malnutrition in 2026, which is 25% above pre-conflict value, a condition both difficult to treat and often fatal. Malnutrition amplifies vulnerability to infection, creating a vicious cycle of hunger and disease. In July 2026, the cholera outbreak in West Kordofan, Darfur, resulted in 833 reported admissions, including 84 officially recorded deaths. However, deaths occurring at home or in the community are rarely captured by official surveillance systems, and these tolls substantially underestimate the true toll. Vaccination coverage has collapsed—from 79.9% in 2022 to 46.4% in 2024, despite rising to 68.4% in 2025, levels remain far below pre-war value—threatening to reverse decades of progress. Yet many deaths remain preventable through basic interventions: immunisation, nutritional support and diarrhoeal disease control. These simple, rapid measures can save lives now and rebuild resilience for the future.
Assault on healthcare
The deliberate targeting of healthcare has magnified the catastrophe. Nearly 80% of medical facilities in conflict-affected areas—including Kordofan, Darfur, Al Jazirah and Khartoum—are now inoperable. In Khartoum alone, 39 of 59 hospitals were reported to have closed because of shelling, with at least 58 doctors killed. These figures illustrate the broader collapse of Sudan’s health system: by March 2026, 37% of health facilities nationwide were non-functional, while up to 80% of hospitals in conflict-affected areas were reportedly out of service. Health facilities, ambulances, patients and health workers have been repeatedly attacked, with 735 incidents of violence against or obstruction of healthcare documented since the conflict began in April 2023 and at least 195 health workers killed. Diplomatic efforts have so far faltered. Ceasefire talks led by the USA and Saudi Arabia collapsed in August 2024, even as famine spread. Restoring peace will require not only renewed negotiations but sustained investment in Sudan’s recovery—economic, social and institutional. In the interim, immediate protection for health services and unhindered humanitarian access are essential to prevent further loss of life.
Beyond numbers
Sudan’s tragedy is not solely the product of war; it reflects decades of neglect, deprivation and political manipulation. Few regions illustrate this more starkly than Darfur, where chronic marginalisation has left communities dangerously exposed to today’s violence and hunger.
The genocidal attacks on Sudanese civilians are an affront to universal values and a warning for future conflicts. Attacks on civilians, health workers and humanitarian staff must be met with more than words. As public health professionals, we are called not only to measure and report but to bear witness, support our Sudanese colleagues and demand accountability. Sustainable peace demands accountability not only in Sudan but also by Russia in its war against Ukraine and by both Israel and Hamas in Gaza and by aggressors in other conflict theatres.
Editor’s Note: In a lengthy, detailed article in which a large number of deaths of children are reported, it is notable that there is not a word about deaths of women, or mothers.
SOURCE: BMJ Global Health, by Debarati Guha-Sapir, Thomas Jideofor Ogbu. Commentary, 2 November 2026. https://doi.org/10.1136/bmjgh-2025-022673. Open access.
Further information can be found at: South Sudan: Briefing and Consultations, What’s In Blue, Security Council Report, 6 November 2026.
PHOTOS: Sudan current photos – Search. UN now expects 1.8 million people to flee Sudan by year end. And: U.S. Says Sudan’s R.S.F. Committed Genocide and Sanctions Its Leader – The New York Times.
