What Sudan's war does to the abdomen: 253 trauma cases, mostly gunshots

Among 253 patients treated for abdominal trauma at three Sudanese hospitals during the country's civil war, more than nine in ten injuries were penetrating and gunshots were the single most common cause — a profile of modern urban warfare inflicted overwhelmingly on civilians, according to a retrospective study published in August 2026 [s1]. The paper is one of the first empirical accounts of how the war wounds people internally, in a conflict where routine clinical data are scarce and hard to collect [s1].

The setting explains why the data are rare. Since fighting erupted in April 2023, Sudan's war has displaced more than 14.5 million people, four million of them into neighbouring countries, and left displaced populations facing cholera outbreaks and widespread malnutrition — the kind of collapse that also destroys the medical-records systems researchers rely on [s2].

Who was injured, and how

The study drew on trauma centres in Omdurman, Al-Obeid and Al-Fashir and covered patients presenting between May 2023 and January 2025 [s1]. The median age was 26 years (interquartile range 19–35), and 23.3% of patients were female [s1]. Most were civilians — 86.6% — and 86.2% came from urban areas, locating the burden in cities rather than on front lines [s1].

The injury pattern is the study's core finding. Penetrating trauma accounted for 92.5% of cases, with bullet wounds the most common mechanism at 44.3%, followed by shell injuries at 32.4% [s1]. Inside the abdomen, the small bowel was hit most often (48.2% of patients) and the colon next (28.9%) — a distribution that matters clinically because hollow-organ injuries spill contents into the abdominal cavity and drive the infections that follow [s1].

Care under strain, and how patients fared

Most patients — 85.5% — were taken to surgery, while 14.6% were managed conservatively [s1]. The demand on scarce resources was heavy: 65.2% required a blood transfusion and 8.7% were admitted to intensive care [s1]. Among patients who survived the first 24 hours after admission, in-hospital mortality was 6.7% [s1].

That figure needs reading carefully. It is not the overall lethality of abdominal war wounds in Sudan; by design it counts only patients who reached a hospital and lived through the first day, so it excludes everyone who died before or shortly after arrival [s1]. What it measures is the outcome of care once a patient is in the system — and on that measure, most survived, with the deaths concentrated among those who arrived physiologically unstable or with severe associated injuries [s1]. The most common complications were wound infection (12.6%), sepsis (5.5%) and shock (5.1%), the predictable sequelae of contaminated penetrating injury treated in a strained system [s1].

What a single dataset can and cannot say

The limits are the ones that attach to any retrospective, single-region record. These are the patients who made it to one of three functioning trauma centres; the study cannot speak for those in besieged areas with no surgical access, and it draws no conclusions about the war's total mortality [s1]. The authors frame their contribution modestly — as descriptive evidence to support trauma-system strengthening in conflict-affected, resource-limited settings — rather than as a casualty estimate [s1].

Read alongside what is already known about Sudan's collapsing chronic-care system, the picture is of a health system absorbing acute war trauma while the rest of it comes apart. The civilian share of these injuries — 86.6% — is the number that lingers, and it echoes hospital records from other recent wars, including Lebanon's 2024 conflict, where the wounded are mostly not combatants [s1].

This article is informational and is not medical advice.

Sources

• [s1] "Abdominal trauma in the Sudan conflict: A multicentre analysis of injury patterns, surgical management, and mortality," Injury, 13 August 2026. https://doi.org/10.1016/j.injury.2026.113599
• [s2] "Drought and armed conflict as drivers of overcrowding in Sudan's refugee camps," International Health, 1 July 2026. https://doi.org/10.1093/inthealth/ihag002