OTTAWA — As Canada crafts its response to the crisis in Sudan, a doctor trying to co-ordinate basic medical services after the country's rapid descent into chaos says bandits and bureaucracy are hampering life-saving aid and leaving children to die.
"The people of Sudan are not getting as much care as they could, because our warehouses are being looted and we don't have safe access to them," said Javid Abdelmoneim, a Doctors Without Borders emergency-room physician.
In a recent call from Sudan's Gedaref state, near the border with Ethiopia, Abdelmoneim said the crisis is unlike ones he's seen in Syria, Ukraine or Ethiopia, not just because of random violence, but also because of bureaucratic hurdles.
In mid-April, a longstanding feud between the country's military and its paramilitary force broke out into a turf war in the capital of Khartoum and led to violence across the country of 46 million people.
That caused Canada and other western countries to evacuate their citizens, who Foreign Affairs Minister Mélanie Joly said last month "went through hell."
The conflict has also sparked fears of a massive refugee crisis, with the United Nations migration agency saying last week that 1.3 million people had been displaced.
In Khartoum, a handful of hospitals are running with a skeleton crew of volunteers and staff who put themselves in the line of danger, with sporadic access to fuel, electricity, clean water and basic medical supplies.
It's even worse outside the capital. At the Gedaref Teaching Hospital, "a number of children died for want of blood in the last week, because blood bags are not available," Abdelmoneim said.
Across the country, cell service is frequently interrupted as armed groups disable telecommunication networks. An interview with Abdelmoneim was abruptly cut off when he lost internet connectivity for five hours.
"There's trauma from increased lawlessness and looting. So, you have injured civilians presenting to hospitals late, because they can't get there if it's unsafe to move across the city."
Abdelmoneim said the calamity in Khartoum has led to people fleeing north, where he saw rural hospitals crowded with wounded people from the city of 12 million people, which is no longer sending rural hospitals their basic supplies.
At the coastal city of Port Sudan, where Canadians and others from rich countries have been flown or shipped out to safety, Abdelmoneim saw less-fortunate foreigners languishing.
He said Nigerians, Yemenis and especially Syrians are staying in the homes of strangers, in government buildings or simply camping in the open air.
And his colleagues elsewhere are seeing tens of thousands of Sudanese displaced in the Darfur region and crossing into Chad.
Last week, International Development Minister Harjit Sajjan visited Chad to better understand the flow of refugees and how Ottawa can help support efforts by that country's government and Canadian groups.
Sajjan has said Canada will be unveiling more aid based on refugee flows and requests from those on the ground.
Yet in Sudan, Abdelmoneim said he's been able to help Sudanese people far less than he'd expected because of the country's bureaucracy.
Doctors Without Borders staff who have been stationed inside Sudan for years require bureaucratic approval from the government to cross lines between states within the country, or even to move equipment between states.
Abdelmoneim is a British citizen with Sudanese roots, making him one of the few aid workers who could visit the country without facing a the weeks-long wait for a visa that his colleagues abroad are facing.
He said Sudan seems to have made no effort to streamline any of these processes in the weeks since clashes started. The Canadian Press has sought comment from the Sudanese embassy in Ottawa.
For weeks, the United Nations's highest officials have urged both warring factions to allow humanitarian groups to access people in need, a plea Abdelmoneim said is being ignored by multiple armed groups.
In mid-May, bandits looted one of his organization's warehouses, where 140 tonnes of medical and logistical supplies had been allocated for hospitals, clinics and a network of obstetricians and gynecologists.
Already, it was a struggle to move out equipment from the warehouse in the Gabra area, which has become the scene of "overt warfare," Abdelmoneim said.
Still, he said it's crushing for him to know his team braved danger without access to a vehicle to prepare 200 rape kits for pick-up, only to have armed men seize them along with other medical equipment.
“We were getting supplies out in a trickle, but then the looting started," he said.
"You have men with weapons, be they civilian or in uniform, aggressively and violently entering a warehouse space full of medical stock, rendering it completely inaccessible and unusable."
Armed men ransacked another warehouse in the city of Nyala, but Doctors Without Borders staff managed to hand over some remaining equipment to health officials.
Abdelmoneim says other non-governmental organizations are seeing their offices, warehouses and clinics raided, making it harder for them to help people in desperate need. MSF has gone public with the issue out of a conviction that the world needs to know about violations of the rules of war, even if raising the issue makes donors less likely to donate.
"Even war has rules. Every government needs to pressure warring parties in conflict to respect those rules," he said.
"The government of Canada has a responsibility to uphold international humanitarian law."
This report by The Canadian Press was first published June 1, 2023.
Dylan Robertson, The Canadian Press