Kiwi nurse in war-torn Sudan: Life and death inside a Khartoum hospital

Hawke’s Bay nurse Malaika El Amrani says while serving in Sudan she has been dreaming of the sea and open sky back home.

A Kiwi nurse working in war-torn Sudan says death is a reality every minute at a hospital in Khartoum, as the threat of drone attacks and bombing looms over the city. The chaos, desperation and stifling heat of Bashair Teaching Hospital has not swayed her from her calling to help patients.

Infectious disease nurse Malaika El Amrani has traded in a comfortable life at Hawke’s Bay Hospital for the reality of working in a country plagued by civil war.

Daily life at Bashair Teaching Hospital involves a never-ending stream of patients, while close by, large trucks loaded with heavily armed police and military soldiers roll past in the baking sun. The hospital may not be under attack, but the presence of war is constant.

More than 12 million people have been displaced since the civil war in Sudan began, with more than four million fleeing to neighbouring countries such as Chad and South Sudan.

The small, under-resourced hospital where El Amrani is based serves more than 250,000 people. At times, families of up to six people share a single hospital bed.

El Amrani has twice been escorted to a safe room at the hospital due to targeted drone attacks. Hospital staff often have to manage the tension of armed soldiers arriving at the ward demanding treatment.

However, unlike other areas of Sudan, El Amrani says where she is stationed is relatively quiet and peaceful, as the Government army – the Sudanese Armed Forces – currently control the area.

Most bombing and strikes are targeted on specific sites, such as the opposition’s base, which lies about 5-10km away from the hospital. The fighting is mostly strategic and not directed at random individuals or aid workers, El Amrani says.

El Amrani checks on a sick child at Bashair Teaching Hospital in Sudan.

In her living quarters, El Amrani has access to cold running water and is given meals of meat with bread and rice or falafel. Temperatures in Sudan can skyrocket to more than 40C in the summer months, and the dust and heat is unforgiving, making the hospital, with its crowds of people and noise, a chaotic environment.

El Amrani came to Sudan last October on a mission with Doctors Without Borders – an international, medical humanitarian organisation – and says the security surrounding the team is tightly monitored which makes her feel well-protected.

It’s her fifth placement with the organisation. She’s also worked in Nigeria, Afghanistan, Syria and Papua New Guinea.

El Amrani, who quit her role at Hawke’s Bay Hospital, has had an abiding calling throughout her life. An itch that won’t go away.

“I’m not doing it because I want an adventure, it’s the people and patients that are in the forefront of my mind,” she says.

“I always wanted to push myself, right from when I was a little girl, and I knew that my path would not always be considered easy or conventional by most, but it was the right decision for me.

“When I’m doing this work, I find peace internally despite the roar of high-pressure environments such as Sudan. I find volatile areas in the world a challenge for any human to endure, but I know I have some skills which can be useful, and so for me it’s not even a second thought.”

Chatting with a colleague in the corridor of the hospital in Khartoum.

Such work is not for the faint hearted.

Sudan’s health infrastructure has been decimated by the ongoing civil war and there are restrictions on medical equipment coming into Khartoum. Basic health equipment such as air compressors and suction machines takes months to arrive, and the spread of disease is rampant due to low vaccination rates and poverty.

Many Sudanese people live in homes without running water or electricity and struggle to earn enough to buy basic food such as bread or grain. Widespread famine has been declared in some areas of the ravaged nation.

“I do get upset about particular patients, especially the small ones, the children that die unnecessarily,” El Amrani says.

“You can’t let it consume you or drag you down because then you’re not helpful for anyone else who is living.”

There is one memory of a patient from her time working in Sudan that is imprinted in her mind.

At the hospital, there are several malnutrition therapeutic feeding clinics that provide care for severely malnourished children whose families have often travelled far, from other states.

El Amrani was visiting such a clinic when she met a recently admitted mother cradling a baby so malnourished it resembled a tiny, shrivelled old man.

As she was being assessed by El Amrani, the woman burst into tears.

She explained she had been sleeping at her home in rural Sudan when she heard a kitten crying in a field.

Unable to ignore it, she followed the mewling.

She discovered the noise was not an animal but a tiny baby who had been dumped in a paddock.

Medical supplies can take months to reach Khartoum because of lengthy delays and restrictions.

El Amrani was shocked to realise that the baby in the mother’s arms was not her own child.

In Sudan it’s illegal to be pregnant and unmarried and this was likely the reason the newborn baby had been abandoned in the first place. El Amrani was amazed that this woman, who did not have a husband and was struggling to provide for herself, had been so selfless.

“Awful things have happened to these people, especially the women, and yet they’re still human and they still care,” El Amrani says.

“I see examples every day of people helping each other in small ways. The capacity to love, even though they’ve been through horrible things is still there.

“They’re still human underneath all the trauma and pain and anger they might have felt from losing someone in the war. To see this woman embracing this child, it was just heartwarming.”

The doctors and nurses she’s worked with are some of the most tireless, dedicated people she has ever known, and she admires their capacity to continue despite the torrent of need.

There are vast language barriers between El Amrani and the Sudanese medical staff, but they overcome them through signing to each other and picking up simple phrases in each other’s dialects.

“They are super strong because they see death every minute of the day,” she says.

“I guess that’s part of what my motivation is, where would I ever meet these people in my normal life? Yet they’ve changed the trajectory of my whole life. Their words stay with me and drive me to do more.

“It makes you realise the distinct privilege it is to be able to access healthcare in New Zealand, even though the system is under strain. Here in Sudan the system is entirely dysfunctional.”

El Amrani’s main role at the hospital has been helping to manage the flow of work and to introduce protocols such as the routine checking of vital signs. The masses of patients can mean this gets overlooked which can lead to a person quickly becoming septic and dying unnecessarily.

An outbreak of cholera led to an influx of up to 1000 patients per day who had to be treated outside the hospital in quarantined tents.

A 40-year low in vaccination rates in Sudan means childhood illnesses are commonly seen at the hospital, with only 20-25% of people in Sudan having been vaccinated against measles, mumps and whooping cough.

El Amrani often misses home and her family in Hawke’s Bay and says it’s especially hard not being able to sit down and have a cup of coffee with them.

“I’m forever grateful for my life in New Zealand, wherever I am in the world, I often think of the sea, open sky with no chance of a drone flying over or guns firing in the background,” she says.

“The security that we take for granted, no enormous political upheavals that spark war or regional unrest, friends and family, and how precious a normal, everyday life really is.”

To donate to Doctors Without Borders visit their website: msf.org.nz.

Eva de Jong is a reporter covering general news for the New Zealand Herald, Weekend Herald and Herald on Sunday. She was previously a multimedia journalist for the Whanganui Chronicle, covering health stories and general news.

Sign up to The Daily H, a free newsletter curated by our editors and delivered straight to your inbox every weekday.