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The role of public health in preventing further mass atrocities in Sudan: a call to action  

By guest contributors Danielle N. Poole ScD1*, Nathaniel A. Raymond BA1, Kaveh Khoshnood PhD1, Hani Mowafi MD2

1 Yale Humanitarian Research Lab, Epidemiology of Microbial Diseases Department, Yale School of Public Health, New Haven CT, USA

2 Department of Emergency Medicine, Yale School of Medicine, New Haven CT, USA

Following the escalation of atrocities in El-Fasher and surrounding communities in North Darfur, Sudan, the United Nations Security Council has adopted a resolution calling for paramilitary Rapid Security Forces (RSF) to halt their siege.1 This current civil war includes many of the same targeted communities, including the population of North Darfur, perpetrators, and patterns of violence as the genocide of the early 2000s, portending dire outcomes. Already, members of the RSF and the Sudanese Armed Forces have been determined to have committed war crimes by the US State Department. The RSF is additionally determined to have committed crimes against humanity and ethnic cleansing in Darfur, which is currently under investigation by the International Criminal Court.

The present civil war has resulted in civilian casualties and widespread destruction of civilian infrastructure, representing potential violations of International Humanitarian Law. Already, satellite imagery analysis of combatant positioning and offenses has generated evidence of mass atrocities. As early as March, 2024, events documented via satellite imagery analysis foreshadowed heightened risk to the population in El-Fasher and surrounding communities in North Darfur. By June 12, 2024, military activity razed a total of 43 communities in North Darfur, with a total of 2·088 km2 – or over 278 football pitches – of damage.3 The timeline and radiating spread of burn damage, known in imagery analysis as thermal scarring, indicative to the destruction of communities, is presented in Figure 1. The damage has progressed inward (west) from the outer (east) edges of the city towards the northwest as well as towards the Al-Salaam Internally Displaced Persons (IDP) camp.

Figure 1. Burn damage indicating 43 razed villages in North Darfur, March 21-June 12, 2024

Thermal scarring assessed via Sentinel satellite imagery, VIIRS data, and open source reporting. Adapted from Howarth et al. 20243

Deteriorating conditions in North Darfur also include forced displacement and deprivation of food, water, medical care, and shelter with significant short- and long-term impacts on public health.

Now is the time for preventative public health action in Sudan. As the central principle of public health, prevention involves addressing the fundamental causes of disease and death,4 including armed conflict.5 Motivation for public health involvement in the prevention of armed conflict derives from ethical principles affirming the focus on “the fundamental causes of disease and requirements for health, aiming to prevent adverse health outcomes.”6 Moreover, the WHO has stated that, “The role of physicians and other health professionals in the preservation and promotion of peace is the most significant factor for the attainment of health for all.”7

The recent resolution represents a critical inflection point for deterring further human rights abuses and mass atrocities. In the civil war in Sudan, satellite imagery analysis indicates significant escalation of the humanitarian crisis. The intensification of the conflict will have further devastating consequences for civilians and demands urgent public health advocacy aligned with government calls for ceasefire. It is up to the international community, including public health practitioners, to heed these warning signs before it is too late.

All authors had final responsibility for the decision to submit to for publication. DNP, NAR, and KK received funding from the US Conflict Observatory. We declare no competing interests.

References

1        Security Council demands end to siege of El Fasher in Sudan | UN News. 2024; published online June 13. https://news.un.org/en/story/2024/06/1151031 (accessed June 17, 2024).

2        Van Schaak B. Digital press briefing on war crimes, crimes against humanity, and ethnic cleansing determination in Sudan. US Department of State, 2023 https://www.state.gov/digital-press-briefing-war-crimes-crimes-against-humanity-and-ethnic-cleansing-determination-in-sudan/ (accessed May 3, 2024).

3        Howarth C, Khoshnood K, Raymond NA. Cargo plane over RSF territory & continued civilian displacement from El-Fasher. New Haven, CT USA: Yale Humanitarian Research Lab, 2024 https://medicine.yale.edu/lab/khoshnood/publications/cargo-plane-over-rsf-territory-06-12-2024_480446_284_26865_v3.pdf.

4        Rose GA, Khaw K-T, Marmot M. Rose’s strategy of preventive medicine. Oxford University Press, 2008.

5        Wiist WH, Barker K, Arya N, et al. The role of public health in the prevention of war: rationale and competencies. Am J Public Health 2014; 104: e34–47.

6        American Public Health Association. Principles of the ethical practice of public health. 2002.

7        World Health Organization. Realities from the field: what has WHO learned in the 1990s. World Health Assembly Resolution 34.38, 1981.

8        Darfur network reports ‘alarming humanitarian situation’ in El Fasher. Dabanga Radio TV Online. 2024; published online Feb 24. https://www.dabangasudan.org/en/all-news/article/darfur-network-reports-alarming-humanitarian-situation-in-el-fasher (accessed April 24, 2024).

9        International Organization for Migration. DTM Sudan weekly displacement snapshot 27. https://dtm.iom.int/datasets/dtm-sudan-weekly-displacement-snapshot-27 (accessed May 3, 2024).

Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.

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