LITERARY | Sudan: Butterflies in the Night
November 2024 | By Afrah Yousif Hussain, MD, interview essay with Danie J. Gerstle | Humanitarianbazaar.org
Afrah Yousif Hussain, MD, is a maternity doctor from El Fasher, the capital of North Darfur, Sudan. As part of an obstetric and gynecology team, she treated conditions ranging from complication with pregnancies like eclampsia to gynecological challenges which led women to face stigma such as rape recovery and fistula. When the Sudan civil war led to the siege of El Fasher, she was on the team having to prepare the maternity hospital for incoming wounded. She now lives across the border in Chad. This is a first draft produced as an interview essay edited by Daniel J. Gerstle, proposed for publication and can be shaped and revised based on an editor’s request. August 2024.
When I was a child in El Fasher, my family to Khartoum, the capital of Sudan, where I grew up. I studied at the Faculty of Medicine at National Ribat University. During my university studies, I was passionate about writing, traveling, and volunteer work, so I worked with the International Federation of Medical Students Associations (IFMSA) and was a member of the Office of Human Rights and Peace and the Office of Public Health. I also established my voluntary initiative concerning health and health education. We held many educational workshops. I also worked with other voluntary organizations and went out with many medical convoys, about 10 medical convoys around Sudan and one of them was for El Fasher.
After graduating from college, I chose to spend my medical internship in El Fasher, so I traveled from Khartoum to El Fasher, and from here the story began. I started my work in El Fasher’s Saudi Hospital for Obstetrics and Gynecology. I can describe those days as my happiest days in El Fasher. Kind and helpful colleagues, the beautiful Butterflies Unit, unit number 4. We call our unit “Butterflies Unit” because we were all girls in the unit at the level of house officers, medical officer, and registrars.
We worked with love, and the hospital became our safe-haven and warm home where we work, learn, and have fun. We formed a family. Our relationships extended even outside the hospital walls. We learned that the patient’s benefit comes first and that the patient is our responsibility. We learned that the life of our patient means the life of an entire family, so we did our best for our patients.
After 3 months, I moved to the surgery department at El Fasher Teaching Hospital as a house officer doctor. We were still in constant contact with the maternity hospital. We used to go there to have breakfast with friends during Ramadan and share happy meetings with them.
One day during the month of Ramadan, the weather was hot and we were fasting, and while we were working in the surgical wards, we heard the sounds of bullets here and there. The sounds are close and intense because the army buildings are close to the hospital. It was the beginning of the war.
The day passed quickly between treating the injured and fear of the unknown
The power went out and drinking water ran out. It was a night full of terror and sadness. The next day in the middle of the day. We were transferred by ambulance to El Fasher South Hospital.
My colleagues and I were living in the female doctors’ dormitory because we came from outside El Fasher and the female doctors’ housing was located within the conflict zone, so we took the female doctors’ break room at South Hospital as our new residence. Where we sleep little and work a lot.
There were a lot of patients. The operating room is open throughout the day. New injuries in the ER. Patients in the wards need care. Many must undergo operations. Everyone works hard, but the war violence is stronger. Some died in their homes and some were present in their final moments.
Imagine working under the sound of bullets, with the hopes of many people pinned on you that you succeed at times and fail at saving them at other times. They were sad days filled with the smell of death and sadness. They passed with the presence of Allah, with the support of family, and the love of friends.
After two months, my family insisted that I should travel away from El Fasher. I traveled with the Turkish evacuation mission from the Turkish hospital in Nyala to Port Sudan. A few days later, I went to the city of Damazin and started working in the pediatrics department and stayed there for 3 months.
After that, I felt a craving for El Fasher and a desire to return and work with my friends and colleagues for the people of that good city. And so, despite the war, I returned. It took me about 10 days of travel. A risk that could have cost my life.
When I returned, I worked as a general practitioner at the Maternity Hospital and the South Hospital and as a volunteer with the Goal international organization.
In the Saudi Hospital, during my work, we received many rape cases in the areas west of El Fasher, which were subjected to violations by the Rapid Support Forces, and in the Southern Hospital, which was crowded with war victims day after day. I participated in many rapid assessment missions and the distribution of emergency aid in shelters for displaced persons.
The situation worsened as a result of violent indiscriminate shelling in all directions. We say goodbye to friends and colleagues at the end of every day, and we didn’t know whether we will meet again or not.
And under these difficult circumstances and the dire need for medicine, emergency, and surgical medical supplies, the Rapid Support Forces continued to practice their favorite hobby outside the city walls, stealing and looting all the supplies coming from outside the city. Therefore, most of the time, hospitals suffered from a scarcity of resources as the need increased, which constituted Psychological pressure on doctors and health sector workers. Sometimes we were cut off from gloves and gauze.
Although international and local organizations try to fill the need, the gap is large. Doctors have done and are still doing their best to make the reality less bad and help patients despite the deterioration situation, directly targeted, saving lives under fire.