Surgery Without Surgeons: Equity and Access in Sudan’s Health System

Introduction: Surgical care in Sudan faces widespread challenges that threaten the principle of health equity. Across both urban and rural regions, patients encounter barriers to safe, timely, and affordable surgical interventions. Decades of political instability, economic decline, and conflict have weakened the country’s health infrastructure. Limited surgical workforce, inadequate insurance coverage, and chronic shortages of essential supplies have left millions without access to life-saving procedures. This study examines the systemic factors undermining surgical equity throughout Sudan. Method: A qualitative observational study was conducted across various Sudanese health facilities, including hospitals in both urban and rural settings. Data were collected from healthcare providers, field observations, and patient case reviews. The study explored workforce capacity, supply chains, insurance access, and patient outcomes. Results: Surgical care across Sudan is frequently delivered by general practitioners or clinical officers due to a shortage of trained surgeons and anesthesiologists. Many facilities lack functioning operating theaters, electricity, sterilization tools, and anesthesia machines. Patients are often responsible for bringing their own surgical instruments, gloves, medications, and even blood for transfusions. The national health insurance system, where present, offers limited coverage, leaving most costs to patients. These conditions delay care, increase complications, and deepen socioeconomic inequalities in health outcomes. Conclusion: Surgical care in Sudan is marked by widespread inequities driven by systemic resource shortages, workforce gaps, and weak financial protection. National and global stakeholders must act urgently to strengthen surgical capacity, expand insurance coverage, and ensure equitable access to safe surgery for all Sudanese citizens.