Relationship between Armed Conflict and Sudden Death: An Analysis of Causes and Consequences, Sudan 2025

Abstract

Background and Aims: The ongoing conflict between the Rapid Support Forces and Sudanese Armed Forces since April 2023 has triggered a severe humanitarian crisis, displaced over 8.4 million people and rendered 70% of hospitals in conflict zones non-functional. Methods: A cross-sectional survey was conducted, involving 412 family members or acquaintances of individuals who experienced sudden death during the war. Data were collected through structured questionnaires, covering demographic characteristics, causes of death, psychological factors, healthcare access, and family impact. Statistical analyses involved descriptive and inferential methods to examine associations between mortality determinants, healthcare accessibility, and psychological distress. Results: The highest mortality rates were observed among males (60.9%) and older adults (45.6% aged ≥56 years). Cardiovascular events, including heart attacks (35.2%) and strokes (5.3%), were the leading medical causes of death, while psychological trauma was reported in 78.9% of cases. Healthcare access was severely restricted, with 37.4% of individuals receiving no medical care, and 47.8% experiencing delays in emergency services. Soldiers and employees faced higher physical and psychological trauma, whereas teachers and freelancers encountered the most significant healthcare barriers. Families of the deceased reported severe emotional distress (71.6%) and financial instability (16.3%). Conclusion: War exacerbates sudden mortality through trauma, chronic disease aggravation, and healthcare collapse. Urgent interventions, including mental health support, improved emergency care, and mobile healthcare units, are essential to mitigating these crises. Further research is needed to address conflict-related health disparities and develop targeted health interventions.

References

1. 1.Levy BS, Sidel VW, editors. War particularly regarding psychological and Public Health. Oxford: Oxford distress and healthcare access. Lastly, the University Press; 2008. findings may not be fully generalizable to
2. 2.International Committee of the Red other conflicts or regions, as war-related Cross. ICRC. In: How is the term health outcomes vary based on contextual “armed conflict” defined in international factors. humanitarian law? [Internet]. 2024. ACKNOWLEDGMENT p. 13–4. Available from: https://www. Our heartfelt appreciation goes out to the icrc.org Sudanese people who continue to endure
3. 3.Murray CJL, King BA, Lopez AN, the hardships of war, especially those who 230 to expand Relationship between Armed Conflict and Sudden Death: An Analysis of Causes and Consequences, Sudan 2025 Majmaah Journal of Health Sciences ,Vol. 14, Issue 1, January - 2026, Rajab - 1447 Tomijima AE. Armed conflict as a public health problem. [Details missing—please provide journal name, year, volume, and pages].
4. 4.World Health Organization. Sudan - WHO 2024 Health Emergency Appeal [Internet]. 2024. Available from: https://cdn.who.int/media/ docs/default-source/documents/ emergencies/2024-appeals/sudan--who-2024-health-emergency-appeal. pdf
5. 5.EMRO. Sudan Health Emergency Situation Report No. 4 - 15 December 2023 [Internet]. 2023. Available from: https://www.emro.who.int/images/ stories/sudan/WHO-Sudan-conflictsituation-report-15-December_2023. pdf
6. 6.Sapre AA, Singh S. Between war and peace: Exploring the role of refugee law in the context of Sudan political conflict. Int Migr. 2024;62(4):41–56.
7. 7.Korinek K, Young Y, Teerawichitchainan B, Chuc NTK, Kovnick M, Zimmer Z. Is war hard on the heart? Gender, wartime stress, and late-life cardiovascular conditions in a population of Vietnamese older adults. Soc Sci Med. 2020;265:113380.
8. 8.Al Sadig Al Mahdi T, Fahal AH, El Mardi AS. Health ramifications and recovery avenues for Sudan’s April 2023 armed conflict: A review. Sudan J Med Sci [Internet]. 2024;19(1):132–
9. 9.Available from: https://www. ajol.info/index.php/sjms/artic le/ view/269013/253922
10. 10.Badri R, Dawood I. The implications of the Sudan war on healthcare workers and facilities: a health system tragedy. Confl Health [Internet]. 2024;18(1):22. Available from: http:// dx.doi.org/10.1186/s13031-02400581-w doi:10.1186/s13031-02400581-w
11. 11.Martineau T, Ensor T, Fustukian S, Ssengooba F, Chirwa Y, Vong S, et al. Leaving no one behind: lessons on rebuilding health systems in conflictand crisis-affected states. [Details missing—please provide journal name, year, volume, and pages].
12. 12.Haar R, Rayes D, Tappis H, Rubenstein L, Rihawi A, Hamze M, et al. The cascading impacts of attacks on health in Syria: A qualitative study of health system and community impacts. PLoS Glob Public Health. 2024;4(6):e0002967.
13. 13.Papautsky EL, Rice DR, Ghoneima H, McKowen ALW, Anderson N, Wootton AR, et al. Characterizing health care delays and interruptions in the United States during the COVID-19 pandemic: Internet-based, cross-sectional survey study. J Med Internet Res. 2021;23(5):e25446.
14. 14.Heszlein-Lossius H, Ismail A, Al- Relationship between Armed Conflict and Sudden Death: An Analysis of Causes and Consequences, Sudan 2025 231 Majmaah Journal of Health Sciences ,Vol. 14, Issue 1, January - 2026, Rajab - 1447 Borno Y, Shaqqoura S, Skaik N, Al Abuse. 2010;11(3):159–68. Hinnawi I, et al. Long-term health 20. Akbulut-Yuksel M. War during effects after conflict-related traumatic childhood: The long-run effects of amputation among patients in Gaza. warfare on health. J Health Econ. Lancet. 2021;398:S30. 2014;36:61–76.
15. 15.Zeleke TK, Ayal BM, Chanie GS, 21. Patel RB, Burkle FM Jr. Rapid Alemu MA, Limenh LW, Yismaw MB, urbanization and the growing threat et al. Worsening of medication nonof violence and conflict: A 21stadherence among patients with chronic century crisis. Prehosp Disaster Med. diseases during times of armed conflict 2012;27(2):194–7 in the war-torn region of Ethiopia. Sci Afr. 2024;25:e02336.
16. 16.Comtesse H, Powell S, Soldo A, Hagl M, Rosner R. Long-term psychological distress of Bosnian war survivors: An 11-year follow-up of former displaced persons, returnees, and stayers. BMC Psychiatry. 2019;19:1–10.
17. 17.Bwirire D, Crutzen R, Ntabe Namegabe E, Letschert R, de Vries N. Health inequalities in post-conflict settings: A systematic review. PLoS One. 2022;17(3):e0265038.
18. 18.Devakumar D, Birch M, Osrin D, Sondorp E, Wells JC. The intergenerational effects of war on the health of children. BMC Med. 2014;12:57.
19. 19.1Iqbal Z, Zorn C. The political economy of child soldiering. J Peace Res. 2010;47(5):537–47.
20. 20.Catani C. War at home—A review of the relationship between war trauma and family violence. Trauma Violence 232 Relationship between Armed Conflict and Sudden Death: An Analysis of Causes and Consequences, Sudan 2025