Impact of the 2023 armed conflict on Sudan's healthcare system.

The armed conflict in Sudan erupted in mid-April 2023, resulting in many casualties, internal displacement, and refugees. Sudan's health system was severely affected by multiple attacks on healthcare facilities and workers, closure of hospitals, and occupation of medical facilities by armed groups. Critical services such as immunization, nutrition, and emergency care have been suspended, disrupting health services in conflict states and increasing strain on neighboring states' healthcare facilities. The conflict also caused shortages of essential medical supplies, looting of healthcare facilities and humanitarian supplies, and destruction of infrastructure, affecting the supply chain and availability of healthcare resources. The deployment and distribution of the health workforce have become challenging and may lead to a further brain drain of healthcare professionals. The financial challenges in healthcare financing are expected to worsen due to the conflict's economic impact on fiscal space and fiscal capacity. The health system's governance has been affected by a leadership vacuum, and decision-making may shift to the state level. The conflict has also exacerbated the burden of diseases, including communicable diseases, malnutrition, and mental health issues, with potential outbreaks of dengue fever, measles, and spikes of gender-based violence reported. In response to the conflict, the restoration and maintenance the health system is pivotal via coordinating efforts between the Sudanese Ministry of Health and international partners. The safety of healthcare workers and the delivery of essential supplies need to be restored via strengthening compliance with international humanitarian law, pooling of funds, and services at primary care level. This commentary discusses the impact of the 2023 conflict on Sudan's health and health system, particularly on different building blocks of Sudan's health system as well as the burden of disease and humanitarian response priorities.