Mazin Omer, Neurosurgery ResidentDepartment of Neurosurgery, University Hospital of Freiburg, Germany
Since April 2023, Sudan has been engulfed in a large-scale armed conflict that has profoundly disrupted state institutions, civilian life, and the healthcare system. What began as a power struggle rapidly evolved into a nationwide crisis marked by widespread displacement, destruction of infrastructure, and prolonged insecurity. Within this context, healthcare delivery has been particularly vulnerable. Neurosurgery, as a highly resource-dependent specialty reliant on trained personnel, functional referral networks, and advanced technology, provides a clear lens through which the broader consequences of the conflict on medical care and training can be understood.
The conflict has led to a near-collapse of Sudan’s healthcare system. Recent reports from international organizations estimate that approximately two-thirds of hospitals across the country are now partially or completely nonfunctional. Facilities in major urban centers, particularly Khartoum and parts of central Sudan, have sustained extensive damage or have ceased operations because of insecurity, looting, power outages, and shortages of medical supplies. Health information systems and centralized data registries have largely been destroyed, making accurate nationwide assessments increasingly difficult.
Furthermore, Healthcare workers have been directly affected. Attacks on medical facilities and personnel have been repeatedly documented, resulting in injuries, deaths, and widespread fear among staff. Many physicians have been forced to flee conflict zones, relocate within the country, or emigrate abroad. Financial instability, interrupted salaries, and the absence of basic workplace safety have further accelerated this exodus. As a result, Sudan is experiencing a rapid depletion of its already limited medical workforce, with long-term implications for service provision and training capacity.
Neurosurgical services in Sudan were limited even before the outbreak of the current conflict. Advanced neurosurgical care was concentrated in a small number of tertiary and secondary hospitals, primarily in Khartoum and Gezira State. These centers served as referral hubs for a population exceeding 40 million people. Since the escalation of hostilities, many of these hospitals have been damaged, occupied, or rendered inaccessible, leaving large regions of the country without any neurosurgical coverage. It is estimated that less than 20 neurosurgeons are practicing at the moment in the country (Figure 1). In areas where services continue to operate, care has been reduced to the most essential interventions, predominantly emergency neurotrauma. Elective procedures, subspecialty care, and complex cranial and spinal surgeries have largely ceased. Critical shortages of equipment have further constrained practice. Operating microscopes, neuronavigation systems, neurophysiological monitoring, and digital subtraction angiography are unavailable in most centers. Imaging capacity has been severely reduced, with only a handful of magnetic resonance imaging units remaining operational nationwide.
These limitations have forced neurosurgeons to adapt to austere conditions, often relying on basic techniques and limited diagnostics. Patients with complex conditions, such as vascular pathologies or intracranial tumors, face delayed treatment, referral abroad when feasible, or sometimes no definitive care. Neurosurgery thus illustrates how the breakdown of infrastructure, workforce, and technology converges to restrict access to life-saving care.
Figure 1. A map of Sudan showing the states of the country with the number of inhabitants in millions (m) and the distribution of neurosurgical services in those states during the current conflict. Reprinted with permission of Omer et al. Urgent Call for International Support and Research Focus on Neurosurgery in Conflict-Affected Sudan. World Neurosurg. 2024 Sep;189:291-295.doi: 10.1016/j.wneu.2024.06.089. Epub 2024 Jun 21. PMID: 38909754.
The impact of the conflict on medical training has been profound. Neurosurgical residency training in Sudan is centrally regulated and depends on rotations through accredited hospitals, formal examinations, and structured supervision. Since the onset of the war, new admissions to the residency program have been suspended, and final examinations for senior trainees have been repeatedly postponed or canceled. Recent survey-based data indicate that nearly all neurosurgical residents have experienced major disruption to their training. Many have been displaced internally to safer regions, while others have relocated abroad, most commonly to neighboring countries or the Gulf region (Figure 2). Training exposure has been markedly reduced by the closure of hospitals, loss of mentors due to emigration, and the absence of essential surgical equipment. Research activities and academic progression have similarly been affected, as institutional support structures and collaborative networks have collapsed.
Beyond structural barriers, the conflict has imposed a substantial psychological burden on trainees. Increased stress, anxiety, and uncertainty regarding career progression are commonly reported. While residents have demonstrated resilience and adaptability, the prolonged
interruption of training raises concerns about a potential lost generation of specialists. In a country already facing a severe shortage of neurosurgeons, disruptions to training today threaten to translate into an even more critical workforce deficit in the years ahead.
Figure 2. Current demographics and employment patterns of Sudanese neurosurgical residents amid conflict. Source: Omer M, Ahmed M, Bissolo M, et al. The impact of the ongoing armed conflict on residents’ neurosurgical training and practice in Sudan. Neurosurgery. 2025. DOI: 10.1227/neu.0000000000003710
Despite extreme constraints, local institutions and individuals have made efforts to sustain neurosurgical services and training. Some neurosurgeons have relocated to less affected regions and continued practicing under limited conditions. The national training authority has attempted to reorganize rotations, maintain trainee registration, and explore alternative examination pathways. Informal teaching initiatives and diaspora-led educational support have provided partial relief. However, these measures remain fragmented and insufficient to offset the scale of disruption. International support for neurosurgical services and training during the conflict has been limited, often short-term, and constrained by security concerns. While humanitarian organizations have addressed aspects of emergency surgical care, sustained engagement focused on specialist training, equipment provision, and system rebuilding has been largely absent. This gap highlights the difficulty of maintaining complex medical disciplines in conflict settings without coordinated, long-term strategies.
The situation in Sudan carries implications beyond national borders. It demonstrates how rapidly specialist services and training programs can deteriorate in the absence of institutional stability and protection of healthcare systems. Recovery, even under favorable conditions, is likely to take many years and will require substantial investment in human capital, infrastructure, and education.
For global neurosurgical organizations, Sudan represents both a warning and a responsibility. Documentation of these experiences contributes to a growing body of evidence on the effects of
armed conflict on specialist care. More importantly, it underscores the need for sustainable models of engagement that extend beyond emergency response, including support for training continuity, remote education, mentorship, and eventual system reconstruction.
In conclusion, the ongoing armed conflict in Sudan has severely compromised neurosurgical services and medical training, reflecting the broader collapse of the healthcare system. Workforce displacement, destruction of infrastructure, and interruption of education threaten not only current patient care but also the future availability of specialist services. Neurosurgery, as a highly resource-dependent field, highlights the long-term consequences of conflict on medical capacity. Continued documentation, international collaboration, and sustained commitment from the global neurosurgical community will be essential to support recovery efforts and to mitigate similar outcomes in other conflict-affected settings.
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