As Sudan’s next generation of doctors, we need support to continue our medical education

The eruption of war in Sudan in April 2023 between the Sudanese Armed Forces and the Rapid Support Forces has left the nation in a humanitarian and educational crisis.12 Thirty four medical schools across Khartoum, Darfur, and Kordofan have reportedly been attacked. The true scale of destruction, however, is likely far greater due to under-reporting and limited physical access to affected areas.1 The ongoing risk of violence and displacement makes it increasingly challenging for medical students to continue their education. This is jeopardising students' futures and preventing them from contributing to Sudan’s healthcare system at a time when their support is vital.

As a medical student who was based in Khartoum (SM), I was forced to move to another state to continue my education after recurrent attacks on residential areas, universities, and hospitals. As the war spread to other states the number of deliberate attacks on healthcare staff and hospitals increased, in violation of international humanitarian law. The violence meant I was unable to relocate to a safe area to continue my education. Many students face the same problem, though some have been able to access non-teaching hospitals in rural areas. Despite a lack of well structured clinical rotations in rural hospitals, they have become the only option for many medical students wanting to continue their education. This has led to overcrowding and a lack of access to proper classrooms and training facilities, limiting the quality of education and supervision.

Many medical students including myself (USAE) have migrated to neighbouring countries including Egypt and Rwanda. This has led to further delays accessing educational opportunities because of high tuition fees for Sudanese refugees, visa restrictions, and a lack of financial support. To circumvent some of these barriers, many migrating students have applied for refugee status with the United Nations High Commissioner for Refugees (UNHCR), in an effort to catch up with their medical studies.34 Students who have migrated, report cultural and language barriers, making adapting to foreign education systems challenging.3

Reduced access to education and associated difficulties have led to delays in sitting exams, including for final year students. This has resulted in further educational delays, with many students taking several years longer to complete their degrees, beyond the expected five year duration. Many medical schools and students’ associations in Sudan have found alternative solutions to bridge the gap. Some have established dedicated online educational platforms, enabling students to take exams remotely. These remain inaccessible for many, however, due to internet bans, poor service, or technical issues within the websites. These barriers are preventing 80% of displaced students from participating in necessary assessments.5

Students face challenges to their mental health resulting from the trauma of war and ongoing displacement. This is compounded by educational delays, reduced academic opportunities, and lack of access to basic living requirements. The trauma of the conflict, alongside the rigorous demands of medical training, is leading to burnout. Of students who have been displaced, 68% are experiencing emotional exhaustion, symptoms of depression, and academic demotivation.6 More than 60% of young people in conflict zones such as Sudan report psychological distress.7

It is vital to consider the implications of war on students' mental and emotional health. Ongoing access to psychological support to help them to cope with the stress and trauma they have experienced is needed urgently. This can be achieved through the provision of services aimed at medical students, including online counselling as well as collaboration with humanitarian agencies to provide mobile clinics in places without a stable internet connection.

The lack of international support for Sudanese medical students has left medical education in a state of collapse. Although there have been some global aid efforts to provide humanitarian relief, the disruption to education has largely been overlooked. Less than 5% of international aid is allocated to supporting education systems in conflict zones.8 Without pathways to validate prior learning in other countries, many are forced to start from scratch or abandon their medical careers entirely. The lack of research documenting the full extent of the educational challenges further exacerbates the issue and hinders progress that could be made towards mitigating the harms of the war.9

As medical students in Sudan, we are calling on medical schools globally, as well as the World Federation for Medical Education, governments, and UN agencies, to work towards a plan to support Sudanese students in continuing our education. This should involve the recognition of prior medical training to facilitate integration into new educational programmes abroad. Support should include streamlining visa and refugee application processes in line with international law.10 Furthermore, students who remain in Sudan need financial aid to facilitate relocation to safe places where medical schools are still operating. International collaboration is key to ensuring Sudanese medical students are not left behind and can continue their education, contributing to the future of both national and global healthcare systems.