LITERARY | Sudan: A Maternity Doctor’s Escape from El Fasher
November 2024 | Humanitarian Bazaar Magazine
Written by Eilaf Mohamed, MD, with Daniel J. Gerstle. Top image by Mohamed Zakaria, second image courtesy of Eilaf Mohamed.
Eilaf Mohamed, MD, is a doctor from the Saudi Maternity Hospital, also known as the Saudi Specialized Hospital for Obstetrics & Gynecology, in El Fasher, the capital of North Darfur in western Sudan. While helping to transform the maternity hospital into the city’s last war hospital, Eilaf was wounded by a stray bullet. She ultimately escaped with her family and started to advocate for the hospital in the region. This story was published in cooperation with the El Fasher medical community, Dar Productions, Untold Magazine, and the International Center for Journalists
I.
That Sunday 14 April 2024, I met a soldier on the way to the hospital in El Fasher who warned me that there would be fighting in a few hours between the Sudan government joint forces and the Rapid Support Forces who had surrounded the city. When I was young here during the earlier Darfur War, I imagined it would only come into the city briefly. Then I got to the market, a woman asked:
“Where are you going? You should go home there are going to be clashes!”
“It’s my job as a doctor,” I told her. “If we are afraid to go to the hospital, how will patients survive? I’ll be safe there because it’s a hospital, so they won’t hit us.”
I believed the war would never come near a hospital, that soldiers would never treat a hospital as a target. That was after the Eid, so we didn’t have a lot of patients, just the sound of the clashes, the guns, the firing, the bombs, and the planes. Two of my colleagues, Drs. Aisha and Aliya, were with me at the hospital courtyard in a cement room in case things became dangerous, but I went out to look for colleagues.
In the neighboring room, I found a new mother who had just given birth a few hours earlier, breastfeeding her child. There were no other patients going into labor, so I sat in the courtyard and called a friend to warn him the clashes were nearby.
That’s when I heard the sound of the bullet coming in through the ceiling. I tried to move but it came in the blink of an eye, the spark of a second.
Growing up in El Fasher, whenever the doctor relieved my pain, they were like a superhero. Many women and children have no access to medical care in Sudan, so I was really fortunate, and along with my family wishes, it was why I became a doctor. I wanted to be a superhero.
Originally, I chose psychiatry as a specialty because I’m very interested in the human mind, how it works, how it’s affected by your parents, your society, by all the circumstances around you, even by the nature around you, the environment. There were only two psychiatrists in Darfur, so many never have an opportunity to meet one. I never imagined I would witness and endure such violence, but it proves this important connection between the body, the mind, and how we get through these terrible experiences.
But when it was time to do my medical rotations, the war came. Maternity has always been a big issue in Darfur, so I decided to help fill the gap working with my colleagues at the maternity hospital in the surgical and pediatric departments. Even before the war, women were dying from miscarriage because they were so far from medical care. There were also a lot of rape cases leading to complications.
Now there was not only war, but also fighters targeting hospitals. After I was shot, the violence would get much worse for my colleagues, friends, and family. Our hospital would be hit numerous times.
II.
“My foot!” I shouted, as my colleagues Aisha and Aliya were just three meters away inside the cement shelter. When the bullet hit my foot, I felt the most terrible pain in my life. Everyone told me when you get shot by a bullet you don’t feel it. No, no, no, I had the most terrible pain. When they opened the door, there was blood all over the place.
There was a wound seven to ten centimeters in length, and it was deep, so they were terrified. We have worked together and had many of trauma patients, but they were so terrified it was difficult even to do the trauma A, B, C’s. While they held me, I asked to elevate my limb. They told the medical director Dr. Modther Ibrahim and other staff. Then I was on my way to South Hospital, which was El Fasher’s main health center for trauma and primary care. I couldn’t cry. I just wondered how I should tell my family.
As a doctor, I always wanted to prevent pain. I know I cannot prevent death, but I can relieve pain, so when it came to my turn even early on in the siege, we were running out of medication. They had to suture the wound without anesthesia. Despite the terrible pain, I kept smiling and telling my colleagues that I’m okay.
They told me I took the honor to be the first medical personnel who got shot in North Darfur, so I told them at least I didn’t take the honor to be the first to die! The other colleagues found the bullet itself back at the hospital. Five centimeters in length, pretty big for me. Thank God it went through my foot and not my head! But now wounded, with the war coming closer, how would I continue to help at the hospital under bombing and gunfire? How would anyone?
During the war, the team of the maternity hospital was the most unified of all. They do their work with love. Everyone there is there because she or he wants to give to the society, to women, not because it’s their job or because they have to or because they are paid, but because you know that financially the maternity hospital was suffering and it’s still suffering. They cannot give enough money for the staff, but we were working unpaid because that’s what we like so they have been kind to me, to each other, to the patients.
The priority is like any other medical institution or any other hospital anywhere in the world. We deal with emergencies first and then you deal with the other cases. In Obstetrics and Gynecology, or maternity, there can be emergencies like bleeding, eclampsia, convulsions, cramps, one child born while another is still in the womb, fistula, and much more.
There was a women’s health case of fistula I remember from before the war. Most women with fistula stay in the hospital for more than ten years. Most of the time they lose their family because no one wants to be around them when the vaginal and urinary areas are affected, and it is tough to stay clean. Their husbands leave them, so they are all by themselves. The hospital workers and some of the NGOs were working to get those women better lives, but when the war came it got much worse.
There was another case in which a young girl who got pregnant accidentally went through an illegal abortion. They did it with a stick from a tree, so she went through sepsis, which led to acute kidney injury. She went through dialysis, investigation, but it took ultrasound to find the foreign body, a large piece of wood in the uterus. I attended the operation to remove it.
But when she came back for treatment after the war started, she couldn’t get dialysis. Clashes were close by our maternity hospital then, so she was evacuated to South Hospital, our main health center, and I found her there but, unfortunately, she passed away. It shows how an accidental pregnancy, especially during a war, can kill a girl. Unfortunately, a lot of women go through this.
III.
When I was about five during the earlier Darfur War, my extended family came from small areas like Tawila and Kutum, taking shelter in our houses until they made it to Neevasha and the border camps. Children coming from the war zones, they were so afraid of airplanes. When I saw an airplane as a child, I felt excited. I felt joyful. But those children who were the same age at that time, when they saw an airplane or they hear the sound, they were running and trying to hide. They were crying.
The day the clashes were in El Fasher, I remember that my mother and other family members were gathering small stuff, food, water, to go out from El Fasher. My father was not in the clashes, but he tried to tell us how to deal with the stray bullets. He told us when there are clashes, you should stay on the ground. You should lie flat on the ground and just wait there. You should not move at all.
Those memories didn’t help in the new experience of war because the clashes in El Fasher back then were only for a day. There were safe areas where people could go to. But now we learn by seeing people who’ve died from stray bullets because they were moving between clashes, so no one moved during the fighting. We’ve seen people who were injured because when a bomb comes to an area, falls in your place, if you felt afraid and tried to run, you will be more badly injured than when you lie flat in the ground. You will get injured, but not as badly.
My family were surprised by this civil war. None of us saw it coming, actually. We thought Sudan is safe and the government and the other forces are making an agreement to become a democratic country. I wish we had someone to tell us that this war might continue because we had waited, having faith.
My family didn’t decide to escape. They refused to go out, actually. I begged them since even before my injury. I begged them to move, but they were quite sure that everything will be alright and that we are going to be safe. Due to my injury, when there were clashes, I couldn’t eat or even drink water. I was just lying there flat waiting for my death. I was feeling physical pain every time I hear a sound of a bomb or shell. There were very loud weapons. I never heard them before. Even though the war was for one year, the whole year I never heard those types of weapons.
After the rebels launched their direct attack on our city, closing the siege from May 10th, the clashes were so bad, the past year was nothing compared to those days. Over those first ten days, the fighting continued from from 5am to 7pm. During this time, I couldn’t do anything. I was terrified, depressed, in a very bad psychological situation.
Finally, I decided to escape El Fasher, even if I go by myself, still wounded unable to walk. I told my family that if they would come with me, we should go together, and if not, I’m not waiting for you. I didn’t have enough money to buy a ticket, but I had a friend who helped me, so my mother decided to go with me, and one of my sisters with her two children. That made five of us.
My oldest sister and other family members chose to stay. They didn’t want to go out even though our neighborhood would become the hardest hit area in El Fasher, near the South Hospital, which would be targeted again and again. But they are still there.
IV.
We left on May 22nd, months into the approaching violence, a month since I was shot, and twelve days into the heavy bombardment. And we made it out right before the rebels closed off the entire city, blocked the water, and blocked all food and humanitarian aid from coming in. Fortunately, my friend found a normal vehicle which could slip through the first checkpoints if we were just women and children.
But as soon as we left the government and joint forces controlled area into the RSF area, some fighters who recognized a cousin in our vehicle and said hello decided they would drive along with us.
From El Daein, a dry town in east Darfur to the border with South Sudan, we traveled with the RSF. They had their vehicle, maybe a stolen one they wanted to sell at the border, so my cousin acted friendly to reduce any risks they would threaten us. As an adult, I did not travel so much because when I traveled with family as a child I came to hate it. This journey, however, was a quite an adventure.
We were terrified we were with people who belong to the same group that was killing our people, starting the fighting that led to bombs hitting our neighborhood and the bullet that hit me. Now we were seeing a different side, other fighters who were different who decided because they knew my cousin or some other reason to help us through checkpoints. So we were not stopped or attacked because of that. We were scared and then somehow not hurt. It was quite an experience.
Until this war, I had always been in places of comfort and luxury, like having a bed, a separate room, or a bathroom, so during this travel I learned that in a blink of an eye, in a second or even less, you can lose whatever you’ve had in life. I went from being a doctor, someone who is middle class to becoming a refugee. I walked through the refugee camp in El Fasher, curious how we would work to prevent gender-based violence and the things they suffered, but I had never been in their shoes until now.
Now on this journey across my country Sudan, crossing the border to South Sudan, and finally arriving to Uganda to recover from my wound, learn to walk again, and consider what we can do next, I had to learn to be patient. I’ve learned to accept my reality. I’ve learned that if I can’t handle something or if I can’t control something I should not stress myself over it, I should just try to do my best and everything will be okay. I learned that it’s okay for me to live in whatever situation, if it’s safe. Safety comes first, and then the other luxurious things. Now I am sharing living space with almost two hundred people, so yeah, it humbled me. My life before the war made me feel lucky, blessed actually, and I just hope one day I will build again what I lost.
V.
From the moment I got shot until right now, I have had a very odd feeling. While being the one injured, I kept thinking about how others feel, how they are going to be hurt. I worried it was my fault for being hurt because I should have not gone out of the shelter area. However anyone goes through this, they should not be afraid to get an appointment with a psychiatrist or shrink or whatever, someone who can give you psychosocial support.
Now most of my family are still in the most dangerous area inside the siege of El Fasher. Bombs and shells are everywhere near them. Most of our neighbors escaped but we had more than ten neighbors killed by bombing, more injured. From my friends, most of them are out of El Fasher now, fortunately. We escaped horrible violence and now reached different sides of the world. They made it to the USA, UK, and Canada, others in Ethiopia, Kenya, or near me in Uganda. But my friend Dr. Modther—we have nkown each other since high school—and my best friend in the world Dr. Eman are still there working at the maternity hospital in El Fasher to save lives under terrible bombing.
I used to have a very peaceful life. I miss those old days going to work, going out with my friends, going to my neighbors, having coffee with them, talking to the girls, watching Harry Potter films, listening to country and R&B, having my bed, I do miss my bed actually. I miss my colleagues. I hope I could have one last family meeting with all my family members.
To laugh a lot about everything. I miss my troubles, my problems, you know? Now I think those were not even troubles. It feels like I was in Heaven and right now I’m in Hell. I miss everything about Sudan, actually, from the roads to the buildings to the people to the weather to everything. My freedom. My bear. My privacy. I miss my job. I miss my patients. But hey it is what it is, huh? Life must go on.
For those who may face what we have, remember to cherish your life. Like us, you may have to take cover, to escape, to travel when you are not ready to travel. Even if you have something now, you may lose it. You may end up in a displacement camp. They are going to give you an empty piece of ground, and you will have to build on it.
They may give you building materials, so you build your own small block shelter, more like a tent than a house. You are going to share a bathroom with a lot of people. You are not going to have a water source near to you. You’re not going to have electricity. You’re not going to have a market beside you. You are going to walk more than one hour to the city, more than one and a half hours, I think. You may even have to walk on a painful wound. It is a tough challenge, but you can handle it. I can handle it.
For my country Sudan, I think we face a very dark future because clashes are going to the areas where it was safe. I hope they will find a way to solve this violence, at least to stop these clashes for a while. Inside that terrible war, there are superheroes like my friends risking everything to save lives, but it’s not easy. We can never forget them.
Dr. Eilaf Mohamed, Sudan. Image: Courtesy of EM.