Since the outbreak of war in 2023, lmost 100,000 people fleeing violence in Sudan have crossed the border into Ethiopia (April 9, 2025) | Peter Biro / © European Union / CC BY-NC-ND 4.0
On October 28, 2025, the Rapid Support Forces (RSF) overran the Saudi Maternity Hospital in El Fasher. Satellite images show what Yale’s Humanitarian Research Lab identified as bodies scattered across the hospital grounds. Videos filmed by RSF fighters themselves show militia walking through ransacked wards, stepping over piles of dead bodies, shooting anyone left alive at point-blank range. The UN reports 460 patients and companions killed that weekend. Among them: pregnant women, newborns, healthcare workers who had performed surgeries by torchlight for 540 days under siege.
This was not the chaos of war. This was the systematic destruction of the infrastructure that keeps women alive.
Since civil war erupted between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) in April 2023, the RSF has systematically targeted ethnic minorities in Darfur and Kordofan. Secretary of State Antony Blinken formally recognized these atrocities as genocide in January 2025.
Sudan’s genocide operates through a specific logic: Target health facilities, weaponize sexual violence, destroy the systems designed to protect women. The RSF has attacked health facilities at least 519 times since April 2023, killing more than 119 healthcare workers and rendering 70–80 percent of hospitals nonfunctional. More than 12.1 million Sudanese people, particularly women and girls, face risk of sexual violence, an 80 percent increase from 2024. These are not separate catastrophes. They are coordinated strategies to eliminate specific populations by destroying the medical infrastructure that would document, treat, and prevent their deaths.
The Saudi Hospital fell after enduring repeated attacks. Médecins Sans Frontières (MSF) teams had supported the facility through months of shelling, electricity blackouts, and supply shortages. Doctors performed cesarean sections using mobile phone flashlights while explosions continued outside. The hospital was the last functioning surgical facility for 400,000 trapped civilians. When it fell, more than 6,000 pregnant women lost access to any medical care. The destruction was deliberate. The RSF did not accidentally shell a maternity hospital again and again.
Health facility destruction accelerates every other dimension of genocide. Without functioning hospitals, cholera kills 3,368 people across 120,496 cases. Measles spreads unchecked. Dengue fever overwhelms the remaining clinics. Famine conditions affect millions of people because therapeutic feeding centers were looted and burned. MSF documented RSF forces executing humanitarian workers in hospitals, then looting therapeutic food meant for malnourished children. They burned community kitchens feeding hundreds of thousands of displaced families.
This meets the legal definition of genocide: deliberately inflicting conditions calculated to bring about the physical destruction of a group. The RSF does not need to shoot every Masalit person when they destroy the hospitals that would treat them, burn the food that would feed them, eliminate the health workers who would document their deaths.
The weaponization of sexual violence operates through the same logic. Between January 2024 and March 2025, MSF treated 659 survivors of sexual violence in South Darfur alone. Fifty-six percent reported assault by armed forces. Thirty-one percent were under 18. Seven percent were under 10. Four 1-year-olds were among the youngest survivors documented by UNICEF. These numbers represent only those who reached care. The UN Fact-Finding Mission documented rape, gang rape, sexual slavery, and forced marriage as systematic RSF strategy. Amnesty International interviewed 16 women and girls raped or gang-raped by RSF soldiers. Human Rights Watch documented 262 survivors treated by healthcare providers in Khartoum between April 2023 and February 2024, ranging from ages 9 to 60.
The UN describes sexual violence as “pervasive” and used to “humiliate, dominate, disperse, forcibly relocate and terrify an entire population.” When RSF forces entered displacement shelters near El-Fasher University, they selected women and girls at gunpoint, gang-raped at least 25 of them, then forced 100 families to flee amid gunfire. This is not incidental violence. This is population elimination through terror and reproductive destruction.
Health system destruction prevents any response to sexual violence. The RSF blocks survivors from accessing post-rape care. The Sudanese Armed Forces (SAF) imposes bureaucratic restrictions on medical supplies. Both sides attack healthcare workers. Less than 10 percent of targeted populations access comprehensive services including clinical management of rape, mental health support, and safe shelters. Survivors face kidney problems, irregular periods, walking difficulties, psychological trauma. A 20-year-old woman told Human Rights Watch: “I have slept with a knife under my pillow for months in fear from the raids that lead to rape by RSF.”
The international response demonstrates whose bodies matter. The UN’s 2025 Humanitarian Response Plan for Sudan identified $4.16 billion in required funding. As of now, only $1.18 billion (28.3 percent ) has been secured, leaving more than 70 percent of needs unmet. When white Europeans face threat, the global reaction mobilizes military aid, sweeping sanctions, diplomatic isolation, and billions in assistance. When Black African women endure systematic sexual violence and the destruction of health facilities, the world provides less than a third of what is required to keep them alive.
The United States recognized genocide in January 2025. Then in May, the State Department announced plans to sell $1.4 billion in arms to the United Arab Emirates, which congressional members confirmed provides weapons to the RSF. Secretary of State Marco Rubio called Darfur a “real genocide” and acknowledged the UAE “openly supports an entity carrying out genocide.” The weapons sale proceeded.
This is what institutional failure looks like through the lens of health governance. It is selling arms to the financiers of forces that execute healthcare workers in hospitals. It is 28 percent funding for health services while 12.1 million women face sexual violence risk. It is the African Union requesting civilian protection strategies in May 2024, repeating the request in June, repeating it again in September without defining timelines. As of October 2025, no protection force exists.
The European Union sanctioned individuals and entities, but the measures remain symbolic. The United Kingdom sanctioned nine entities but no individuals. These responses cost nothing, risk nothing, protect no one. They are performances of concern while health facilities burn and women are raped in displacement camps.
Russia vetoed a UN Security Council draft aimed at civilian protection and humanitarian access in November 2024, blocking meaningful action. The struggle has become a regional proxy war with Egypt and Saudi Arabia backing the Sudanese Armed Forces while the United Arab Emirates supports the Rapid Support Forces. Sudan’s women die in the gaps between these geopolitical calculations.
When we examine health system destruction and gender-based violence together, we see the genocidal intent: eliminate the medical infrastructure that would document atrocities, treat survivors, and prevent deaths. The Emergency Response Rooms in Sudan run community kitchens and free clinics while both SAF and RSF forces harass and kill their volunteers. Sudanese healthcare workers stay when international organizations leave. MSF stopped operating in El Fasher in August 2024 because it became too dangerous. The Saudi Hospital staff stayed until the RSF killed them.
