Sudan's war has cut dialysis and chronic-disease patients off from care

The clearest way to read the health cost of Sudan's war is through the patients who depend on the health system continuing to function — and in two peer-reviewed studies, that system has largely stopped functioning for them. Among 122 Khartoum haemodialysis patients whose outcomes could be confirmed, 53.3% were alive after up to 18 months of follow-up, and survival tracked almost entirely with whether and how far patients managed to flee [s1].

The war between the Sudanese Armed Forces and the Rapid Support Forces began in April 2023 and turned Khartoum, the capital and the country's medical hub, into a front line. For people on maintenance dialysis — treatment that must be delivered several times a week or the patient dies — that made staying a lethal proposition.

Survival followed the exits

The dialysis study, published in Conflict and Health, retrospectively tracked 158 adults on maintenance haemodialysis in Khartoum at the onset of the conflict; outcomes were confirmed for 122, while 36 could not be traced and were censored at their last verified contact [s1]. Grouping patients by their displacement in the first three months, the authors found survival of 81.8% among those who relocated internationally early, 53.3% among those who reached a stable internal settlement, 34.6% among those pushed into a second displacement, and 13.8% among those who remained in the capital [s1].

The gradient is the finding. The authors examined associations using risk ratios and time-to-event methods, with sensitivity analyses to gauge how much the untraceable patients might have skewed the result [s1]. It remains a retrospective cohort from a single city with substantial loss to follow-up, both of which the authors treat as limits on how far the numbers can be pushed [s1]. But the direction is hard to explain except through access: the further a patient got from the fighting and the more stable their destination, the more likely they were to keep receiving the treatment keeping them alive.

The study also frames survival as inseparable from cost. It tracks the financial burden of continuing dialysis under conflict — out-of-pocket payments for sessions, transport and relocation — as a factor bound up with whether patients could sustain treatment at all [s1]. In a collapsed system, keeping a chronic patient alive shifts from the state to the household, and not every household can carry it.

The wider chronic-disease picture

The second study widens the frame from one treatment to chronic illness generally. A cross-sectional survey of 1,116 chronic-disease patients living in what were described as Sudan's safest states found that 13.3% had never visited a health facility for a regular check-up during the war, and 15.9% rarely or never accessed health services at all over that period [s2]. Distance was part of it: 20.1% reported the nearest facility was more than 5 km away on foot, and 22.0% said the war had a very large effect on their ability to get care [s2].

That these figures come from the safer parts of the country is the point worth holding onto. If one in seven chronic-disease patients in relatively stable areas had effectively fallen out of care, the picture in contested and besieged areas is, by construction, worse — and largely unmeasured [s2].

Why this is the sober way to count a war

Neither study estimates deaths from violence, and neither tries to. They measure something quieter and, for the majority of a population, more consequential: what happens to the routine machinery of care — dialysis chairs, chronic-disease clinics, the ability to reach them — when a health system collapses. Sudan's crisis has also driven cholera and other communicable disease, but the chronic-disease toll accrues without an outbreak curve to mark it, one missed session and one unreachable clinic at a time.

The evidence base is thin, drawn from the settings and patients researchers could still reach, and should be read as a floor rather than a full accounting. What it establishes is narrow and firm: in Sudan's war, staying put has meant losing care, and losing care has meant dying — most starkly for those who could not leave.

Sources

• Survival under armed conflict: displacement, dialysis continuity, and financial burden among hemodialysis patients in Sudan — Conflict and Health, 2 June 2026
• Access and satisfaction with healthcare services among chronic disease patients during the Sudan armed conflict: a cross-sectional study — Conflict and Health, 11 August 2025