Since President Omar al-Bashir came into power in 1989 after a military coup, his regime has governed Sudan with a strong military presence and limited space for protests or opposition. This approach contributed to the escalation of the war in South Sudan and eventually its seccession in 2011. Following the separation of the south, uprisings in Darfur, South Kordofan, and Blue Nile regions led to killings and violence against civilians by al-Bashir and paramilitary forces associated with him. In 2009 al-Bashir became the first-ever seated president to be indicted by the International Criminal Court for war crimes related to his role in the conflict in Darfur.
In 2018, Sudan experienced significant economic challenges, including an inflation rate ranked second highest in the world after Venezuela. In response, the government ended subsidies for basic goods, prioritizing military and security spending. This has led to a staggering increase in the price of essentials such as bread, fuel, and essential imported medicines.
In reaction to rising prices, citizens organized protests against the government beginning on December 19, 2018. However, what started as demonstrations relating to the economic hardship and lack of opportunity soon expanded to countrywide protests against al-Bashir’s policies and financial mismanagement. Demonstrations by unarmed citizens continued, increasing in frequency through February 2019.
The government of Sudan has met protests with violence, resulting in at least 51 civilian deaths. The government has systematically attacked health care, including violent raids on health facilities, as well as arrests, detainment, and killing of health workers.
Government security forces have entered and raided at least seven hospitals in Sudan since protests began in December. On January 9, security forces raided the emergency and medical wards of the Omdurman Teaching Hospital, firing tear gas and live bullets, and inflicted physical violence on both patients and hospital staff. On January 13, security forces raided Bahri General Teaching Hospital, using tear gas and live ammunition. On January 17, security forces arrested the administrative director as well as the director of staff in Al Feisal Hospital in the capital city of Khartoum. Several other doctors were arrested, and at least one reported being detained and interrogated at the National Intelligence and Security Services offices. Several patients attempted to document the attack and arrests using their mobile devices and as a result the security forces arrested them. Security forces also demanded that footage from the hospital surveillance cameras be erased to minimize the documentation of such violations.
At least 27 health workers have been arrested and detained, both in and out of hospitals. Some of those detained have reported being subjected to isolation and torture. In addition to violence and arrests, security forces have knowingly killed health workers assisting in the care of protesters. In January, security forces shot and killed a 27-year-old doctor, Babiker Salama. The doctor was assisting an injured patient and had requested security officers transport the patient to care.
In addition to attacks on health workers, medical students have also been targeted. For example, on February 25 security forces raided the University of Medical Sciences and Technology in Khartoum and removed students from classrooms. Security forces arrested students and inflicted unprovoked violence on them on the university campus.
The coordinated attacks on hospitals along with violence and arrests of health workers suggests that the government is engaging in systematic attack on health workers. Leaked audio tapes have cited leadership in the Sudanese security forces discussing claims of politicization of health workers and that the doctors largely align with the opposition.
The health care community is responding through organized strikes and participation in the organization of peaceful demonstrations, as part of the Sudanese Professionals Coalition. Additionally, The Sudanese Central Doctors’ Committee announced the withdrawal of doctors from military and police hospitals, as well as some other hospitals in the country.
Sudan has a fragile health system, with recent outbreaks of cholera, Chikungunya, and yellow fever. Violence in the health care setting may influence both the uptake and quality of health services. In the context of a vulnerable health system, further instability may have a profound effect on the ability to address the health care needs and wellbeing of individuals in the country.
In response to protests, President al-Bashir declared a state of emergency on February 22. This declaration suggests resistance by the government to respond peacefully to protests, and has the potential for increased violence. The declaration included imposing prision sentences of up to ten years for participating in unauthorized protests. Despite this decree, citizens have continued to organize protests and security forces have continued to engage in violence against them.
Persistant violations of human rights by national security forces and limited protection of health workers have been documented. Sustained violence and limited protections of health workers threaten the health and wellbeing of the population as well as the stability of the country.
The international community has the responsibility to call attention to citizens in need—including health workers—and under systematic attack before this crisis escalates.