Nearly every building in Khartoum, Sudan, bears the marks of war—bullet holes, shattered glasses, empty windows, broken fences, shelled walls, and looted apartments. The presidential palace is in ruins. The Sudan National Museum now holds a collection of spent bullet casings piled next to broken equipment. An 80-year-old church remains in ashes.
Once-bustling streets are mostly deserted, a casualty of Sudan’s more than three years of brutal conflict between two main military factions—the officially recognized Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF), which originated as Janjaweed militia that sought to crush rebels in Darfur in the 2000s.
At Al-Saudi Maternity Hospital in the city of Omdurman, Safa Ali attends to women and girls, many of them victims of sexual assault. Girls as young as 13, some bleeding and traumatized, sometimes stop her on her way to the hospital and plead for help. She treats them, then offers counsel and emotional support. If they face at-risk pregnancies, she admits them and monitors them daily. Some nights she stays late performing cesarean sections.
She’s one of the few doctors still practicing in Khartoum. Many others have fled.
Ali said the fighting destroyed the hospital—beds flipped, walls poked with holes from bullets and shelling, medical wards emptied. The staff had to move 2.5 miles away into Al-Nao Hospital’s operating room and clinic for six months before the nonprofit Sudanese American Physicians Association restored and reopened Al-Saudi’s building last year.
The United Nations reported that fighting has killed or injured 4,300 children and displaced 14 million people. Many remain without adequate food, shelter, and health care. According to the International Committee of the Red Cross in Africa, the war has left 70–80 percent of conflict-area health care infrastructure “non-operational or critically under-resourced.”
The deadly fighting first broke out in Khartoum on April 15, 2023, as the SAF, led by the country’s de facto ruler, Abdel Fattah al-Burhan, and the RSF, led by militia leader Mohamed Hamdan Dagalo, or Hemedti, struggled over control of the government. Burhan and Dagalo had worked as allies in the October 2021 coup overthrowing a joint military-civilian government but couldn’t agree on how to share power.
The RSF captured much of Khartoum within hours, including the Khartoum International Airport, the presidential palace, and the Sudan National Museum, from which the RSF looted more than 4,000 artifacts, according to the government. The SAF later retook Khartoum in March 2025.
During the worst of the conflict in 2023, Ali said hospital workers helped pregnant mothers deliver their babies while bullets cracked and bombs roared by. As an ob-gyn, Ali doesn’t usually treat battle wounds but said she sometimes saw women come in with gunshot wounds.
“[These were] very difficult days, but we decided to continue,” she said. “I had to be strong and give support to the people.”
Ali said one day RSF fighters bombed her hospital, killing a colleague in front of her: “The bomb split his head,” she said. “[After this] we relocated to another hospital in a safer environment to continue providing care.”
The UN said both the SAF and RSF have committed war crimes, including coordinated attacks on civilians and the demolition of displacement camps, hospitals, and markets. The UN reported at least 100 attacks on health care facilities in the first year and five months of the war. Drones have made the situation worse, especially when they take aim at hospitals.
Meanwhile, the fighting has “damaged or destroyed” more than 100 churches, according to Open Doors.
In September, the RSF shot at church buildings in North Darfur and used drones to bomb Saudi Maternity Hospital in El Fasher—the only functional hospital in the city at the time. More than 460 patients and healthcare workers died in the attacks. In early April, two drone attacks—reportedly directed by the RSF—targeted Al‑Jabalain hospital in White Nile state. The strikes hit the operating rooms and maternity ward.
Interference from other African and Middle Eastern powers have fueled this domestic conflict. Colombian mercenaries backed by the United Arab Emirates helped operate drones during RSF’s seizure of El Fasher. Meanwhile, Egypt, Qatar, Saudi Arabia, and Turkey have partnered with the SAF. Iran also provided weapons to the SAF for a time.
Despite the ongoing violence, Sudan’s government claimed victory after the SAF recaptured Khartoum in March 2025.
“We can say with total confidence that we won this war,” Prime Minister Kamil Idris told a group of foreign journalists.
But the RSF still controls parts of Sudan, including Darfur, where it set up a parallel government in four of the region’s five states. Khartoum residents still live in fear of possible drone attacks.
Despite the dangers, Ali remains in Khartoum, alone. Her husband and four children fled to Cairo, Egypt, early in the war. She told CT it’s too dangerous for them to return to Sudan, but as a doctor she needs to stay.
“This is my choice,” she said. “I stayed here to care for these babies and women.”
Ali has treated at least 400 women who were sexually assaulted during the conflict. The UN has accused the RSF militia of tactically using sexual violence “to terrorize civilians.” Doctors Without Borders reported that nearly 3,400 survivors of sexual violence sought treatment in the organization’s Sudanese health facilities in North and South Darfur—only two of Sudan’s 18 states—between January 2024 and November 2025. The full scope of the abuse is unknown.
Because of abuse and displacement, Ali said, some mothers abandon their babies after giving birth in the hospital. In other cases, infants become orphans when their mothers die during childbirth from limited resources: “Each case was heartbreaking in its own way.”
For now, Ali works with the government to put the babies in the care of families. She said some families come from the minority-Christian population in Sudan. Though Ali is not a Christian, she said she felt encouraged to see Christian families taking some of the children into their homes.
For Christians in Sudan—who make up just over 5 percent of the population—the SAF’s declared victory hasn’t brought full relief. Rafat Samir, chairman of the Evangelical Community Council for Sudan, told Open Doors last year the Islamic government is actively preventing churches’ recovery: “They will not allow the reconstruction of churches that were bombed and burned during the war.”
Samir also said the SAF’s de facto government has demolished churches in Khartoum and outlying areas.
Still, Christians are rebuilding fellowship. On April 10, for the first time in years, Episcopal archbishop Ezekiel Kondo told Religion News Service he held an Easter service at the site of his bombed-out church—Episcopal Church of Our Savior in Omdurman. He expressed optimism for peace as church services resume and aid organizations return to the city.
Despite the lurking threat of drone attacks, Ali agreed. She hopes a rebuilt Khartoum will allow residents to live without fear and will enable hospitals to provide medical care safely. Meanwhile, Ali tries to process her own trauma while attending to the ongoing needs of her patients.
“Being constantly busy has helped me push through, and the support from colleagues makes a difference,” she said. “Still, the emotional impact of what we experienced doesn’t simply disappear.”
Next week, Emmanuel Nwachukwu will provide the second part in this series showing how internally displaced persons in Sudan fight for hope and survival entering the fourth year of war.
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