The City Without Doctors: Sudan, War, and the Collapse of Health

Ahora, con la guerra de Irán y otras crisis, Sudán desaparece.

Now, with the Iran war and other crises, Sudan disappears.

The hierarchy of suffering in global media is real and it's brutal.

I've written about this.

Your conflict gets coverage if it's geopolitically useful, if there's a Western interest angle, or if the images are dramatic enough to break through.

Y Sudán no tiene petróleo suficiente para que los grandes países se interesen mucho.

And Sudan doesn't have enough oil for major countries to be very interested.

Tiene oro, tiene agricultura, pero no tiene el poder político para atraer atención.

It has gold, it has agriculture, but it doesn't have the political power to attract attention.

Y la gente muere sin que nadie mire.

And people die without anyone watching.

Let's talk about what's actually killing people.

Because in these situations, the war itself is rarely the leading cause of death after the first phase.

It's what the war enables.

Sí, exactamente.

Yes, exactly.

En Sudán ahora mismo, los grandes problemas de salud son el cólera, la malaria, y el dengue.

In Sudan right now, the big health problems are cholera, malaria, and dengue.

También hay muchos niños con desnutrición grave.

There are also many children with severe malnutrition.

Y las mujeres embarazadas no tienen acceso a hospitales.

And pregnant women have no access to hospitals.

Cholera is one of those diseases that we essentially know how to prevent.

Clean water, basic sanitation.

It's a disease of infrastructure failure.

When you see cholera, you're seeing a state that can no longer provide the basics.

Y en Sudán, el agua limpia es un problema enorme.

And in Sudan, clean water is an enormous problem.

Muchos sistemas de agua en Jartum están dañados por la guerra.

Many water systems in Khartoum are damaged by war.

La gente bebe agua de ríos o de pozos contaminados.

People drink water from rivers or contaminated wells.

Y después se enferma.

And then they get sick.

Y no hay hospitales para tratarlos.

And there are no hospitals to treat them.

It's a cascade.

One failure enables the next, which enables the next.

This is what the public health literature calls a complex emergency, and it's genuinely one of the hardest things to intervene in.

Quiero hablar de la historia, porque Sudán no siempre fue así.

I want to talk about the history, because Sudan wasn't always like this.

En los años setenta y ochenta, Sudán tenía universidades de medicina buenas.

In the seventies and eighties, Sudan had good medical universities.

Había médicos sudaneses muy respetados en todo el mundo árabe.

There were Sudanese doctors who were highly respected throughout the Arab world.

That surprises people, I think.

There's this assumption that a country in crisis today must have always been in crisis.

But Sudan had a functioning bureaucracy, universities, a professional class.

It was genuinely middle-income territory at points.

Pero décadas de mala política económica, de guerra en el sur, de sanciones internacionales, y después la separación de Sudán del Sur en 2011 fueron destruyendo todo.

But decades of bad economic policy, war in the south, international sanctions, and then the separation of South Sudan in 2011 gradually destroyed everything.

Con la separación, Sudán perdió el setenta y cinco por ciento de su petróleo.

With the separation, Sudan lost seventy-five percent of its oil.

Which funded the government.

Which funded the hospitals.

Which funded everything.

I remember covering the referendum in 2011 and thinking, whatever joy this brings the South Sudanese, and it brought a lot, the north is about to have a fiscal catastrophe.

Y así fue.

And so it was.

Y después vino Bashir, y las sanciones de Estados Unidos, y la economía empeoraba cada año.

And then came Bashir, and US sanctions, and the economy got worse every year.

Cuando Bashir cayó en 2019, la gente pensó: ahora va a mejorar todo.

When Bashir fell in 2019, people thought: now everything will improve.

Pero en 2023 empezó la guerra entre las RSF y el ejército.

But in 2023 the war between the RSF and the army began.

The RSF, for listeners who haven't followed this, grew out of the Janjaweed militias.

The same militias that carried out the Darfur genocide.

So the force that's now bombarding Khartoum has that lineage.

Sí.

Yes.

Y esto es importante para entender por qué la crisis humanitaria es tan grave.

And this is important for understanding why the humanitarian crisis is so severe.

Las RSF no respetan las zonas civiles.

The RSF don't respect civilian zones.

Atacaron hospitales.

They attacked hospitals.

Atacaron mercados.

They attacked markets.

La violencia no tiene límites claros.

The violence has no clear limits.

Attacking hospitals is a war crime under the Geneva Conventions.

Has been since 1949.

And it happens anyway, in Sudan, in Syria, in Yemen.

The prohibition exists;

the enforcement essentially doesn't.

Y cuando un hospital es atacado, no muere solo la gente que está dentro en ese momento.

And when a hospital is attacked, it's not just the people inside at that moment who die.

Muere también la gente que iba a llegar la semana siguiente, el mes siguiente.

The people who were going to arrive the following week, the following month, also die.

El hospital desaparece de la comunidad para siempre, o por muchos años.

The hospital disappears from the community forever, or for many years.

Long-term mortality from a single strike.

That's something the casualty figures never capture.

The five people who died in this week's drone strike are reported.

The three hundred who couldn't get dialysis over the following six months are not.

Muy bien dicho.

Very well said.

Y hay otro problema que no se habla mucho: la salud mental.

And there's another problem that doesn't get talked about much: mental health.

Millones de personas en Sudán vivieron, y viven, con violencia constante, con miedo, con pérdidas terribles.

Millions of people in Sudan lived, and are living, with constant violence, with fear, with terrible losses.

El trauma psicológico es enorme.

The psychological trauma is enormous.

And there's essentially no mental health infrastructure to speak of.

Globally, low and middle income countries have on average one psychiatrist per million people.

In a war zone with a collapsing health system, it's far less than that.

Y los niños son los más vulnerables.

And children are the most vulnerable.

Hay una generación de niños sudaneses que no van a la escuela, que no tienen médico, que crecen en campos de refugiados.

There is a generation of Sudanese children who don't go to school, who have no doctor, who grow up in refugee camps.

Las consecuencias de esto van a durar décadas.

The consequences of this are going to last for decades.

The phrase researchers use is 'lost generation,' and I've always found it inadequate, because it sounds like an abstraction.

These are specific children, with names, who are not being vaccinated against measles right now.

Hay un número impresionante: antes de la guerra, Sudán tenía una tasa de vacunación de casi el ochenta por ciento para algunas enfermedades.

There's a striking number: before the war, Sudan had a vaccination rate of almost eighty percent for some diseases.

Ahora, en algunas regiones, la cobertura cayó a menos del veinte por ciento.

Now, in some regions, coverage has fallen to less than twenty percent.

Which means the conditions for large-scale measles outbreaks, for polio resurgence, are being actively created right now.

We built those vaccination rates over decades.

We can lose them in a year.

Exactamente.

Exactly.

Y lo más frustrante es que el mundo tiene los recursos para ayudar más.

And the most frustrating thing is that the world has the resources to help more.

Hay organizaciones internacionales, hay dinero en los gobiernos ricos.

There are international organizations, there is money in wealthy governments.

Pero la ayuda no llega suficiente, ni suficientemente rápido.

But the aid doesn't arrive in sufficient quantities, or quickly enough.

Access is part of it.

You can't deliver medicine to a city where two armed factions are fighting for every neighborhood block.

But political will is also part of it.

Sudan doesn't move the needle for enough powerful governments.

Oye, quiero señalar algo del español que usé antes, porque creo que fue útil para los oyentes.

Hey, I want to point out something from the Spanish I used earlier, because I think it was useful for listeners.

Dije 'impresionante' para describir el número de vacunas.

I said 'impresionante' to describe the vaccination number.

Pero 'impresionante' en español no siempre significa bueno.

But 'impresionante' in Spanish doesn't always mean something good.

Hm.

In English, 'impressive' leans positive.

An impressive performance, an impressive building.

You're saying 'impresionante' works differently?

Sí.

Yes.

'Impresionante' significa que algo te impacta mucho, que te deja sin palabras.

'Impresionante' means something hits you hard, that it leaves you speechless.

Puede ser positivo o negativo.

It can be positive or negative.

Una caída al veinte por ciento es impresionante porque es un número que te golpea.

A fall to twenty percent is 'impresionante' because it's a number that strikes you.

No porque sea bueno.

Not because it's good.

So it's closer to 'striking' in English than 'impressive.' Or 'staggering.' The emotional weight without the positive connotation.

Perfecto.

Perfect.

'Staggering' es una buena traducción para ese contexto.

'Staggering' is a good translation for that context.

En español, los adjetivos como 'impresionante', 'increíble', o 'terrible' son muy flexibles.

In Spanish, adjectives like 'impresionante', 'increíble', or 'terrible' are very flexible.

Dependen del contexto para saber si son positivos o negativos.

They depend on context to know if they're positive or negative.

That's actually useful.

So if I say 'la comida fue increíble,' that's a compliment.

But if I say 'el número de muertos fue increíble,' that's horror, not admiration.

Context carries the whole thing.

Exactamente.

Exactly.

Y la próxima vez que quieras usar 'impressive' en español, piensa si quieres decir algo bueno.

And the next time you want to use 'impressive' in Spanish, think about whether you mean something good.

Si sí, también puedes decir 'excelente' o 'extraordinario'.

If so, you can also say 'excelente' or 'extraordinario'.

Así evitas confusiones.

That way you avoid confusion.

Noted.

Though knowing me, I'll describe a really good taco as 'impresionante' and you'll tell me that's perfectly fine and I'll still feel like I made a mistake somehow.

Para los tacos, Fletcher, nunca cometes errores.

For tacos, Fletcher, you never make mistakes.

Para todo lo demás, seguimos hablando.

For everything else, we keep talking.