Idrees Malaz Hassan Dafaalla, Bashir Moez Mohammed Ibrahim, Mohamed Balqees Abdeen Ahmed, Ahmed Amal Essam Ali, Abdalla Hamid Mohieldin Mohamed, Shaaban Kamil Mirghani Ali
Faculty of Medicine, University of Khartoum, Khartoum, Sudan.
Faculty of Dentistry, University of Khartoum, Khartoum, Sudan.
BMC Public Health. 2025 Jan 20;25(1):230. doi: 10.1186/s12889-025-21369-4.
On April 15th, 2023, intense clashes involving heavy weapons and airstrikes occurred between the Sudanese Armed Forces (SAF) and the paramilitary Rapid Support Forces (RSF) in Khartoum, the capital of Sudan, leading to the displacement of almost 8.1 million people. The ongoing armed conflict in Sudan has led to a worsening humanitarian catastrophe, posing serious challenges to the country's health-care system and even its collapse. Healthcare facilities have been severely affected, with barely one-third of hospitals operating in conflict zones. Hemodialysis patients are among the most affected by this war's aftermath, which ranges from obvious dangers like violence-related injuries and deaths to more indirect effects like the suspension of access to preventive and curative medical care.
This was a descriptive cross-sectional multicenter health facility-based study aiming to study the impact of the April 15 war on hemodialysis patients in Sudan. The study was conducted in five centers in four different states in Sudan, including Gezira State, Red Sea State, River Nile State, and Kassala State. The study included 316 participants. Data was collected using structured interviews guided by a questionnaire. The questionnaire encompassed five primary domains: demographic data, healthcare access (Levesque's Conceptual Framework of Access), physical implications, psychological impact (Generalized Anxiety Disorder scale and Patient health questionnaire), and quality of life (Kidney disease quality of life 36 scales). Statistical Package for the Social Sciences (SPSS) version 26 was used for data analysis.
This study involved 316 participants, with an average age of 47.14 and 63.9% being males. After the war, 74.7% reported being unemployed. 30.1% of participants had to flee their homes, and 18.7% had a renal ailment limiting their travel. Among the components of healthcare access affordability, it received the lowest score (5.6 out of 10). More than half of the participants were unable to maintain their regular hemodialysis sessions (56.9%) throughout the war, and 65.2% of the participants developed medical complications as a result. The GAD assessment showed 62.7% of participants had significant anxiety symptoms, while 40.5% had significant depression symptoms.
Hemodialysis patients' suffering has increased as a result of the war. Hemodialysis patients experience severe mental health problems in addition to physiological problems, including depression and anxiety, as a result of internal displacement and their inability to continue regular hemodialysis sessions. The study advocates for the implementation of a permanent ceasefire in conflict zones to ensure the delivery of critical humanitarian medical aid, particularly hemodialysis care. The study encourages stronger advocacy for hemodialysis in war-torn areas as well as collaboration with international organizations to provide such specialized care. Finally, it encourages the use of telemedicine services as a backup plan to provide continuous hemodialysis consultation and care in the event of conflict disruptions.
2023年4月15日，苏丹武装部队（SAF）与准军事快速支援部队（RSF）在苏丹首都喀土穆发生了涉及重型武器和空袭的激烈冲突，导致近810万人流离失所。苏丹持续的武装冲突导致人道主义灾难不断恶化，给该国的医疗系统带来了严峻挑战，甚至使其濒临崩溃。医疗设施受到严重影响，冲突地区仅有约三分之一的医院仍在运营。血液透析患者是这场战争后果的最受影响群体之一，这些后果既包括暴力相关伤害和死亡等明显危险，也包括预防和治疗性医疗服务中断等更间接的影响。
这是一项基于多中心医疗机构的描述性横断面研究，旨在研究4月15日战争对苏丹血液透析患者的影响。该研究在苏丹四个不同州的五个中心进行，包括杰济拉州、红海州、尼罗河州和卡萨拉州。研究包括316名参与者。数据通过由问卷指导的结构化访谈收集。问卷涵盖五个主要领域：人口统计学数据、医疗服务可及性（勒维克的可及性概念框架）、身体影响、心理影响（广泛性焦虑障碍量表和患者健康问卷）以及生活质量（肾脏病生活质量36量表）。使用社会科学统计软件包（SPSS）26版进行数据分析。
本研究涉及316名参与者，平均年龄为47.14岁，男性占63.9%。战争结束后，74.7%的人报告失业。30.1%的参与者不得不逃离家园，18.7%的人患有肾脏疾病限制了他们的出行。在医疗服务可及性可负担性的各项指标中，该指标得分最低（满分10分，得5.6分）。超过一半的参与者在整个战争期间无法维持定期血液透析治疗（56.9%），65.2%的参与者因此出现了医疗并发症。广泛性焦虑障碍评估显示，62.7%的参与者有明显的焦虑症状，40.5%的参与者有明显的抑郁症状。
战争导致血液透析患者的痛苦加剧。由于国内流离失所以及无法继续进行定期血液透析治疗，血液透析患者除了生理问题外，还经历了严重的心理健康问题，包括抑郁和焦虑。该研究主张在冲突地区实现永久停火，以确保提供关键的人道主义医疗援助，特别是血液透析治疗。该研究鼓励在饱受战争蹂躏的地区加强对血液透析的宣传，并与国际组织合作提供此类专业护理。最后，它鼓励使用远程医疗服务作为备用计划，以便在冲突中断时提供持续的血液透析咨询和护理。
