The war in Sudan has often been overlooked amid high-profile conflicts ongoing on several continents. Yet the lack of media and geopolitical attention to this 18-month-long conflict has not diminished its devastation in terms of human lives.
Since fighting began in April 2023 between Sudanese armed forces and the paramilitary Rapid Support Forces, both part of a power-sharing military government, the country has seen the displacement and separation of more than 14 million people. Countries by geography and ideology.
And although we will never know the exact death toll, the conflict in Sudan is certainly the deadliest in the world today.
As public health, conflict and human rights scholars and Sudanese-American health workers, we are well aware of how risky it can be to estimate war mortality for a number of practical and political reasons. But such estimates are extremely important: they help us understand and compare conflicts, target humanitarian aid to those involved, launch investigations into war crimes, bear witness to the conflict, and compel states and armed groups to intervene or change Allow to do.
the difficult task of counting the dead
A profound humanitarian crisis is unfolding in Sudan, including ethnic cleansing, mass displacement, food shortages and the spread of disease, compounded by flooding in northern states.
Considering the death toll in such conflicts involves not only counting those who have died as a direct result of violence – a difficult thing to determine in real time – but also counting those Including those who have died from conflict-provoked factors, such as the absence of emergency care, the breakdown of vaccination programs and lack of essential food and medicine. Estimating this later mortality, called indirect mortality, presents its own challenge, as the definition itself varies among researchers.
In congressional testimony, Tom Perriello, the US special envoy to Sudan, acknowledged the challenges of the estimate, when he noted that there were anywhere between 15,000 and 150,000 deaths in Sudan – an extremely wide range that may reflect, in part, indirect deaths. This was responsible for the complexity of setting the rate.
Armed Conflict Location and Event Data (ACLED), a non-profit organization specializing in conflict-related data collection, has recorded an average of more than 1,200 direct conflict deaths per month in Sudan, including nearly 19,000 deaths in the first 15 months of the conflict. Are. This figure is similar to the 20,000 deaths estimated by the Sudan Doctors Union and the figure of 19,000 used by the Sudan Protection Cluster, a centralized group of UN agencies and NGOs that uses data from the World Health Organization.
ACLED derived its estimates of deaths from reports from traditional media, international NGOs, and local observers, complemented by new media such as verified Telegram and WhatsApp accounts. On the other hand, the Sudan Doctors Union provides on-the-ground estimates of deaths in the conflict.
When available, specific data sources such as surveys, civil registers and official body counts can make estimates more accurate. However, this data is often only available retrospectively after the end of the conflict. It is therefore important to use both available data and examples from past conflicts to obtain a reasonable estimate of the humanitarian cost of an ongoing conflict.
A 2010 article in The Lancet estimated that for every direct conflict death, there are 2.3 indirect deaths, based on data from 24 small-scale surveys conducted in Darfur from 2003 to 2005. Thus, using ACLED’s data of 18,916 direct deaths, we estimate that in the current Sudan conflict, there have been an additional 43,507 indirect deaths – or a total of more than 62,000 deaths.
We believe our estimate is very conservative. When estimating the death toll in the ongoing conflict in Gaza, a different group of scholars, also writing in The Lancet, used a multiplier of four indirect deaths for each direct death to estimate the overall death toll there.
Meanwhile, a report by the Geneva Declaration Secretariat showed an average of 5.8 indirect deaths for every direct death in 13 armed conflicts from 1974 to 2007.
Using that latter multiplier, the number of indirect deaths in Sudan would be around 110,000 – meaning total deaths in the region would be 130,000 – double our estimate.
This scope is broad, but recognizes how difficult it can be to estimate indirect deaths and how they can vary significantly with the size of the conflict.
Sudanese conflict in context
These figures reflect enormous loss of life and property, but they certainly underestimate the true human cost of the conflict.
Sudan had a fragile and underfunded health system even before the fighting began. And compared to other ongoing conflicts such as Gaza and Ukraine, there was already a more precarious bottom line, with higher child mortality rates and lower life expectancies.
Since the beginning of the war in Sudan, there have been persistent reports of mass killings, enforced disappearances, sexual violence, deliberate blocking of food and medicine, and other forms of violence against civilians.
Much of the violence is ethnically targeted, and the Darfur region – where full-scale famine has been declared – has suffered disproportionately.
The destruction of civilian infrastructure and disrupted aid systems are preventing medicine, food, clean water and vaccinations from reaching populations in need.
Health care workers and facilities have become targets of attacks not only in at-risk Darfur but throughout the country. About 80% of medical facilities have become inactive. And at least 58 physicians have been killed, in addition to many who have died in previous crises.
Given the continued targeting of health care systems and limited access to humanitarian corridors, due to bombings, ground attacks, and shortages of critical supplies, indirect deaths in Sudan are likely to increase as hospitals remain closed, even Even in the capital Khartoum.
The cost to Sudanese children is particularly worrying. According to Doctors Without Borders, thirteen children die per day in the Zamzam camp in North Darfur, mostly due to malnutrition and lack of food.
And approximately 800,000 Sudanese children will face severe, acute malnutrition by 2024, a condition that requires intensive care and supplemental nutrition to prevent death. Even before the conflict, children were at grave risk due to lack of access to care, including basic preventive care such as early vaccination.
Finally, transmission of communicable diseases thrives in conflicts such as Sudan, where there is widespread population displacement, malnutrition, limited water and sanitation, and lack of proper shelter. In August, a cholera outbreak led to a death toll of more than 31 deaths per 1,000 cholera cases. And instances of such disease effects are likely to be lower in a country with less access to health care and monitoring.
limits of estimation
The widespread internal displacement of more than 14 million people in Sudan complicates mortality estimates, as changing populations make it almost impossible to establish a baseline.
Furthermore, there is usually a lack of official information collected and released during conflicts.
Establishing a solid estimate of the true impact of armed conflict therefore often occurs after the cessation of hostilities, when expert teams are able to conduct field studies.
Nevertheless, projections will require assumptions about direct deaths, indirect-to-direct death ratios, and the quality of existing data.
But as scholars working at the intersection of public health and human rights, we believe such work, even if imperfect, is essential to documenting conflict and its future prevention. And while there are many current global conflicts that require our immediate attention, the conflict in Sudan should not get lost in the mix.
_Editor’s note: Isra Hassan, a physical medicine and rehabilitation resident at Texas Rehabilitation Hospital-Fort Worth and advocacy director at the Sudanese American Physicians Association, contributed to this article.
,Author: Sarah Elizabeth Scales, Post-Doctoral Researcher, Department of Environmental, Occupational and Agricultural Health, University of Nebraska Medical Center; Blake Erhart-Oren, DrPh Candidate, University of California, Berkeley; Debarti Guha Sapir, Professor of Public Health, Université Catholique de Louvain (UCLouvain); Khidir Dalouq, Assistant Professor of Medicine, Oregon Health & Sciences University, and Rohini J. Haar, Faculty, Division of Epidemiology, School of Public Health, University of California, Berkeley)
,disclosure statement: Rohini J Haar receives funding from FCDO. Blake Erhart-Oren, Debarati Guha Sapir, Khidir Dalouq, and Sarah Elizabeth Scales do not work for, consult, hold shares in, or receive funding from any company or organization that is relevant to this article. will benefit, and have not disclosed any relevant affiliations beyond their academic ones. Appointment)
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