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“The ongoing conflict is also contributing to this outbreak, constraining the capacities of medical actors to both prevent and respond to outbreaks of contagious diseases,” adds Dr Cecilia Greco, MSF Medical coordinator for Central Darfur. “Mass population displacement has made the illness spread even faster across the region, further complicating the situation.”  

Since the war broke out, constant administrative impediments and regular blockades of key supply roads have caused vaccine shortages throughout Darfur. This led to disruption in routine immunisation programmes in several locations, sometimes for months. In Sortony, for example, an internally displaced people (IDP) camp of North Darfur hosting more than 55,000 people, vaccination totally stopped from May 2024 to February 2025.

These constraints and shortages have also limited the medical actors’ capacity to roll out proper response campaigns. Last year, MSF carried out several vaccination campaigns such as in November 2024 in North Jebel Marra where 9,600 children were vaccinated. However, due to limited vaccine supplies, MSF teams were forced to reduce the target and to exclude children over five, despite clear needs. This inevitably reduced the long-term impact of these campaigns. In North Jebel Marra, while the vaccination campaign initially slowed the outbreak, cases began to rise sharply again from February.

Although mass vaccination campaigns are now happening in different parts of Darfur, negotiations and procedures have been lengthy. After MSF first raised the alarm about the multiple surges it was witnessing, it took months before the Federal MoH in Port Sudan and UNICEF released the needed vaccines from their stocks: finally enabling mass vaccination campaigns to be launched in different areas of Darfur. Last week, 55,800 children from nine months to 15 years old were therefore vaccinated in Forbrenga as part of a campaign led by the MoH and supported by MSF. 93,000 more children are set to receive the vaccine in North Jebel Marra and Sortony by the end of this week, in a similar campaign.

Years of armed conflict have destroyed critical infrastructure in Deir ez-Zor governorate, including healthcare facilities. Streets and fields across the governorate are contaminated with mines and explosive devices, making daily life hazardous for returnees and hampering rehabilitation efforts. MSF teams have already discovered four unexploded devices in health facilities we had planned to support, with more likely hidden underground.

In Syria, Deir ez-Zor governorate has the highest number of recorded incidents with explosive remnants of war; in the five months to 6 May 2025, just over one-quarter – 26 per cent – of the 471 incidents recorded in the country occurred in Deir ez-Zor. * 

Ahmad, a teenage boy from Hawaij, 50 kilometres southeast of Deir ez-Zor city, lost his right leg and part of his left foot while herding sheep in the desert.

“I feel sad now because I can’t run anymore,” says Ahmad. “But I like playing marbles and riding a motorbike.”

“He is not the only one from Hawaij,” his mother, Umm Mohammad, added. “The same thing happened to one of his friends, and to other people in the village.”

Between 8 December 2024 and 14 May 2025, 91 children were killed and 289 injured in accidents involving explosive ordnance across the country, according to Mine Action Area of Responsibility. Many of these tragic cases involve children who come across mines while collecting truffles, herding sheep, or playing in contaminated areas.

South Darfur experienced intense urban warfare in 2023, which destroyed hospitals and critical infrastructure. The humanitarian presence, substantial before the outbreak of civil war in April that year, disintegrated as fighting took hold. Although ground fighting in South Darfur has ceased for now, insecurity remains, as people are subject to appalling violence on roads and farmland, and in markets and their own homes. Reports of arbitrary detention, theft and looting are also commonplace. Air strikes and drone strikes continue to hit South Darfur and other parts of the country

Sexual violence is widespread with MSF providing care to 659 survivors from January 2024 to March 2025. Fifty six percent of survivors were assaulted by non-civilians.

A 25-year-old woman from South Darfur living in a displacement camp told MSF, “When the women try to go outside the camp to farm… they will beat me, they will torture me… There is no way to go out… My aunt’s daughter, she was raped by six men, just six days ago… I feel insecure, because if I go out, I will be raped.”

People describe the fear and anxiety of children, and their own feelings of helplessness, indignity and of being trapped.

“Our farms are completely destroyed – we have nothing. My husband was killed four months ago. We have nothing now,” a 21-year-old internally displaced woman told MSF in Beleil locality. “For three days, I haven’t eaten anything… I don’t know what will happen to me on the way home. I am afraid, because those people who killed my husband, maybe they will do the same to me.”

The violence has shattered the healthcare system, and adequate care is simply not available for people due to a range of compounding issues: facilities have been destroyed, damaged or abandoned; healthcare workers have fled or are no longer receiving salaries; supplies are absent or interrupted; and people struggle to afford transport to reach what remains of the healthcare system.

Insecurity is intertwined with hunger, as the threat of violence has cut off access to farmland and incomes. Between January 2024 and March 2025 MSF supported programmes in South Darfur that treated over 10,000 acutely malnourished children younger than five years old and provided nutrition treatment to thousands of malnourished pregnant and breastfeeding women and girls.

The malnutrition crisis is expected to deteriorate even further with the imminent arrival of the rainy and lean seasons.

Amid soaring costs of food, families are forced to subsist on one meal a day – sometimes not even that. “I just depend on what I can find, day to day,” a 24-year-old woman in Al-Salam displacement camp told MSF. “If I get something, we will eat. If I don’t get something, we won’t. This is my life.”

Since the war started, the response from international organisations and UN agencies has been sparse, inconsistent and slow to arrive in South Darfur, as a 23-year-old woman in Nyala explained in November 2024: “We heard that international organisations help people, but they never bring anything for us.”

There have been some recent signs of improvement, with UN agencies increasingly finding ways to bring humanitarian supplies to South Darfur. NGOs are gradually scaling up their presence and activities. However, due to severe access constraints, UN agencies are still not on the ground in South Darfur to lead and coordinate the response, more than two years into the conflict, and NGOs are moving slowly and with caution.

Nasser hospital is a large referral hospital with many specialist wards not found anywhere else in the south of Gaza including operating theatres, an oxygen plant, ventilators, a blood bank, and incubators. Reducing access to this hospital and blocking the referral of patients who need specialist, emergency care, stops people from receiving treatment that may safe their life.

In the past few months, MSF medical teams in Nasser hospital have provided care to over 500 patients in the maternity ward, including women requiring surgical care, as well as to more than 400 newborn babies and paediatric patients. The hospital is full of patients with burns and severe trauma.

Healthcare is under attack everywhere in Gaza. In the morning of 4 June, Israeli forces struck the  MSF supported Al Aqsa hospital three times, the main facility in Deir Al Balah, central Gaza. Although no casualties were reported, it is a stark reminder of how patients, medical staff and health facilities are constantly at great risk in Gaza.

Our teams have received patients who have been critically injured while trying to get food, as a result of the shootings which have taken place around the Gaza Humanitarian Foundation food distribution centres. This is in addition to the people who have been wounded in the ongoing bombardment of the Gaza Strip. Hospitals are overflowing with patients.

It’s essential that Israeli authorities protect Nasser hospital and guarantee full and unimpeded access to patients and medical staff alike, to avoid more deaths.

MSF teams at Nasser hospital treated patients with serious injuries today. Some patients in critical condition are still undergoing surgery. But with the blood banks almost empty, medical staff themselves have had to donate blood.

Sexual violence has become so widespread in Darfur that many people chillingly speak about it as unavoidable. “Some people came at night to rape the women and take everything, including animals. I heard some women being raped at night. The men were hiding in toilets or in some rooms they could close, like my husband and brothers, otherwise they would get killed. The women didn’t hide because it was just beating and rape for us, but the men would get killed,” a 27-year-old woman told MSF’s team in West Darfur.

It is not only during attacks on villages and towns or during the journey to safety that people have been raped and beaten. Limited humanitarian assistance is forcing people to take risks to survive: people are walking long distances to meet their basic needs and taking work in dangerous places. Others decide against taking the risk but are then cut off from their sources of income, reducing further their access to water, food and healthcare. This is no guarantee of safety, with people attacked at home as well.

MSF provided care to 659 survivors of sexual violence in South Darfur between January 2024 and March 2025

• 86% reported that they were raped
• 94% of survivors were women and girls
• 56% said they were assaulted by a non-civilian (by a member of military, police or other security forces or non-state armed groups)
• 55% reported additional physical violence during the assault
• 34% faced sexual violence while working in, or travelling to, the fields.
• 31% were younger than 18, 29% were adolescents (aged between 10 and 19), 7% were younger than 10 years old and 2.6% were younger than 5 years old

These disturbing statistics are likely an underestimate of the true scale of sexual violence in South Darfur.

The situation is similar in other places where MSF is able to provide care for survivors such as Eastern Chad, which currently hosts over 800,000 Sudanese refugees. In Adre almost half of the 44 survivors treated by MSF since January 2025 were children. In Wadi Fira Province, 94 survivors were treated between January and March 2025, 81 under the age of 18. The testimonies of patients and caregivers in both eastern Chad and Darfur, Sudan bear this out. One man told MSF’s team in Murnei, West Darfur, “Three months ago there was a little girl of 13 years old who was raped by three men…They caught her and raped her, then they abandoned her in the valley… They called some people to carry the girl to the hospital. I was one of them. She was a little girl.”

Many survivors report being raped by more than one person. In Metché in eastern Chad, 11 out of 24 survivors treated between January and March 2025 were attacked by multiple assailants. The experiences patients share in various locations bear this out. “When we arrived in Kulbus, we saw a group of three women with some RSF [Rapid Support Forces] men guarding them. The RSF also ordered us to stay with them. They told us, ‘You are the wives of the Sudanese army or their girls.’ … Then they beat us, and they raped us right there on the road, in public. There were nine RSF men. Seven of them raped me. I wanted to lose my memory after that,” one 17-year-old rape survivor told MSF.    

In some cases, the attackers directly accused the survivors of supporting the other side. One woman shared her story: “I have a certificate for first aid nursing. [When they stopped us], the RSF asked me to give them my bag. When they saw the certificate inside, they told me, ‘You want to heal the Sudanese army, you want to cure the enemy!’ Then they burnt my certificate, and they took me away to rape me. They told everyone else to stay on the floor. I was with some other women, including my sister. They only raped me, because of my certificate.”

It is vital that survivors access services after the attack, as sexual violence is a medical emergency. The immediate and long-lasting physical and psychological consequences which can be life-threatening.  Yet survivors struggle to access medical care and protection because of a lack of services, limited awareness of the few services that exist, the high cost of traveling to facilities, and a reluctance to speak about the abuse due to shame, fear of stigma or retaliation.

“I cannot say anything to the community because it will be a shame for my family. So, I didn’t say anything about what happened to me before today. I’m only asking for medical help now. I was too afraid to go to the hospital. My family told me, ‘Don’t tell anybody,’” a 27-year-old female survivor told MSF in eastern Chad.

Where services exist, survivors need clear and accessible referral pathways to get the help they need. In South Darfur, the state with the greatest number of displaced people in Sudan, in late 2024, MSF added a community-based component to its care for survivors of sexual violence. Midwives and community healthcare workers were trained and equipped to provide emergency contraceptives and psychological first aid to survivors. They also supported survivors’ referral to MSF-supported primary healthcare clinics and secondary hospitals for comprehensive care. Since the addition of this community-based model, MSF has seen a steep increase in women and adolescents seeking care.

MSF teams continue to see new survivors of sexual violence. In Tawila, where people continue to arrive after attacks on Zamzam camp and in Elf Fasher, North Darfur, the hospital received 48 survivors of sexual violence between January and the beginning of May, most of them since the start of fighting in Zamzam camp in April.  

Before October 2023, 500 aid trucks were entering Gaza every day, according to the UN. The current authorisation for 100 per day, when the situation is so dire, is woefully inadequate.

Meanwhile, evacuation orders are continuing to uproot the population, while Israeli forces are still subjecting health facilities to intensive attacks.  

On 19 May, between 6am to 6.30, MSF teams reported hearing almost one strike per minute in Khan Younis. One of these strikes hit Nasser hospital compound, 100 metres away from the intensive care unit and the inpatient department that are run by MSF. This is the third time in two months that Nasser hospital compound has been struck, once again depriving people of treatment and care. To reduce exposure, our teams were forced to temporarily close both the outpatient department and sedation room for patients awaiting or recovering from surgery, as well as suspend physiotherapy and mental health activities, which are essential for burn patients – most of whom are children. 

Yesterday’s strike also severely damaged the Ministry of Health pharmacy store in Nasser Hospital. This puts additional pressure on supplies at a time when medical stocks are running critically low due to the siege.  

“They came with their machineguns. They attacked and killed people – including children. They burnt our house, with everything we had inside. They raped the women. They killed, they looted… says Mariam*, 40, who reached Tawila three days after the attack on Zamzam took place. “Even before the attack, people had died of thirst and of starvation because of the siege that had been imposed on Zamzam for the past year. Everything was so expensive and so unaffordable in the end.”

She has arrived with her mother, her sisters and their own children. A household of 20 people. All of them now spend their days squeezed against each other under the makeshift shelter they build with a few branches and a piece of fabric, sharing the little shade it provides. “Here, there is no food. A few people in Tawila shared a bit of millet flour with us, which we used to make porridge. This is how we have survived so far: begging. We get the water from a tank, but they only let us fill one jerrycan per family, and we are 20 in ours. We only have one blanket for all of us”

Since April 12, when the people first began reaching Tawila from Zamzam, the areas surrounding the town have been completely transformed, with tens of thousands of people now estimated to be living in makeshift shelters in fields that were totally uninhabited just a few weeks ago.

“For four days now, we have been staying here as you see us, with nothing: no walls, no roof,” says Ibrahim*, 42, who fled Zamzam on foot with 11 of his family members. He carried one of his children on his shoulders and another on his back for five days. It’s the fourth time in ten years he’s displaced in similar circumstances. He describes how soldiers entered people’s homes, brought them outside and opened fire. Three of his brothers were killed like this. On his way to Tawila, he got looted and witnessed people being beaten so harshly that they could no longer move. 

“Under this tree, it is so crowded, we’re lacking water, or shelter… there is nothing to eat, everyone is hungry,” he says. “We’re getting some food from the community kitchens. Sometimes, we manage to get some rice when they distribute the meals, but if we don’t, we must wait until the next day to eat something. For water, we go to a borehole, but there are so many people, and we have to wait hours to be able to drink.”  

A handful of organisations are present in Tawila, but the numbers in need of assistance far exceed the capacity to respond. MSF teams have set up two health posts on the main arrival sites to provide the newcomers with water and immediate nutritional and medical support, and are referring critical patients to Tawila local hospital that MSF has been supporting since October 2024.