Sudan’s War Has Left Only 14 Plastic Surgeons to Rebuild a Nation’s Wounded

When war erupted in Sudan on April 15, 2023, the country’s fragile health system began a collapse that would touch nearly every corner of medicine. Now, one of the first systematic snapshots of that collapse has emerged from an unlikely and revealing vantage point: the country’s plastic surgeons. A new survey, published in BMC Plastic and Reconstructive Surgery, reached every identified plastic surgeon still practicing inside Sudan during wartime — just 14 in the entire country — and found a specialty pushed to the brink of extinction, even as the demand for its core skills, from facial trauma repair to limb salvage, has never been higher.

The study, led by Mohammed Yousof Bakhiet, a surgeon affiliated with Al-Baha University in Saudi Arabia and the University of Kordofan in Sudan, used a structured online questionnaire distributed between June 15 and 20, 2025. Every one of the 14 plastic surgeons working in Sudanese governmental hospitals responded, a 100 percent response rate that itself speaks to the tiny size of the workforce. The respondents had a median age of 48.5 years, and 13 of the 14 were men, a distribution the author attributes to the pre-existing gender imbalance in Sudanese plastic surgery rather than any war-specific effect. Half were consultants and half were specialists who had completed postgraduate training within the previous five years, and half reported more than a decade of surgical experience.

The most striking demographic finding was displacement. Nearly two-thirds of the surgeons — nine of the 14 — had been forced from their homes by the fighting, joining the millions of Sudanese internally displaced since the conflict began. Most plastic surgery units in the country were run by a single surgeon, and when those surgeons fled, the units effectively ceased to exist. Before the war, plastic surgery services were concentrated in Khartoum, with smaller regional units in Atbara, Kassala, Port Sudan and Shendi. As fighting engulfed the capital, most Khartoum-based services stopped, and the burden shifted to the already under-resourced peripheral centers. A single plastic surgeon in Elobied, a city under active fighting and siege, now represents the only provider of plastic surgery services in a combat zone in the country.

The survey’s central result is bleak: 86 percent of respondents said the availability of plastic surgery services in their facilities had been severely disrupted or had ceased entirely. Only a small minority reported no impact. Reconstructive work — burn management, complex wound reconstruction, facial trauma repair and limb salvage — was universally affected, with nearly 79 percent of surgeons reporting that all of these procedure categories had been compromised. Half of the respondents said reconstructive operations were often delayed, and another 28 percent said they were always delayed. For patients with war wounds, where soft tissue loss, exposed bone, and damaged vessels and nerves demand advanced reconstructive techniques within tight time windows, such delays translate directly into amputations, disfigurement and death.

Perhaps counterintuitively, the raw numbers of operations did not collapse. Before the war, half of the surgeons reported performing three to six emergency operation lists per month; during the war, 64 percent reported more than six. Elective lists and outpatient clinics showed no statistically significant change before versus during the conflict, with p-values of 0.357 and 0.564 respectively. But the author cautions that these figures mask a profound shift in the character of surgical work. Personal communication with colleagues suggests the operation lists have swung heavily toward emergency and trauma-related procedures, while elective reconstruction and patient follow-up have withered. This pattern — where a surge in trauma volume conceals the erosion of routine surgical services — has been documented in other conflict zones, including Syria, Yemen and Ukraine, and it carries a hidden long-term cost: surgeons who operate only on blast and gunshot injuries for years risk losing the broader technical repertoire that defines their specialty.

The logistical failures underpinning this erosion were consistent across respondents. Limited access to surgical equipment and disruption of supply chains for medications and disposables were each cited by 86 percent of surgeons as major challenges. Close behind, 71 percent pointed to the lack of intensive care or post-operative capacity — a critical gap for patients undergoing complex reconstructions, who often require prolonged ventilatory support and flap monitoring in the hours after surgery. Shortages of qualified plastic surgeons and inadequate anesthesia support, each reported by 57 percent, rounded out the list. These findings mirror earlier reports from Sudan, including a 2024 study that found more than half of surgical practitioners in conflict zones had ceased practice entirely, and analyses showing that only about one-third of hospitals in war-affected areas continue to function at all.

The human resource picture may be the most consequential for Sudan’s recovery. Twelve of the 14 surgeons — 86 percent — reported a severe impact on the availability and retention of trained staff. Continuing medical education was rarely available for 64 percent of respondents and only occasionally available for the rest; just 7 percent reported regular access. The author links this academic isolation to a documented decline in training quality, citing a separate study of Sudanese surgical residents that found widespread concern about reduced case volumes and learning opportunities in operating theaters. The risk is a compounding brain drain: as training pipelines dry up, the next generation of reconstructive surgeons never materializes, and the country’s capacity to treat war injuries — and, eventually, the enormous backlog of untreated deformity and disability — shrinks further.

Institutional support, which in most humanitarian crises cushions health systems against exactly this kind of shock, was largely absent. Half of the respondents’ hospitals received no external support for surgical services at all, and only 29 percent reported receiving any. The author contrasts this isolation with other conflict settings, where international partnerships with non-governmental organizations have helped sustain at least essential medical services, and suggests that insecurity, access difficulties and competing organizational priorities have left Sudan’s surgical services outside the reach of the global humanitarian response. The result is a health system running on local goodwill and improvisation, with surgeons continuing to operate despite unpaid salaries, personal displacement and physical danger.

When asked what they needed most urgently, the surgeons’ answers formed a stark roadmap. Medical equipment and supplies topped the list at 43 percent, followed by trained plastic surgeons and personnel at 36 percent. Education and training programs and health system logistics each drew 21 percent, and funding 7 percent. The emphasis on training, even amid active combat, reflects a professional conviction that sustainable care requires continuous development — that a surgeon who cannot learn cannot long remain effective. The author acknowledges the study’s limitations: a sample of 14, self-reported data vulnerable to recall bias, restriction to governmental hospitals, and the use of categorical ranges for case volumes, which limited statistical analysis. But with only 14 plastic surgeons in the entire country, the sample is effectively the population, and the picture it paints is unlikely to be distorted by small numbers.

What emerges from this survey is a case study in how war hollows out a surgical specialty from the inside — not through a single dramatic event, but through the slow attrition of supplies, staff, training and institutional support. Plastic surgery occupies a peculiar position in wartime medicine: it is simultaneously a frontline necessity for the complex wounds that modern violence inflicts and a long-horizon discipline whose value is measured in function restored and lives rebuilt over years. Sudan’s 14 wartime plastic surgeons are holding that dual mandate together under siege conditions. The survey’s message to the international community is unambiguous: without urgent deliveries of equipment, supplies and trained personnel, the specialty that Sudan’s wounded most need may simply not survive the war that created the need.

Subject of Research: The impact of armed conflict on plastic surgery services and surgical workforce in Sudan

Article Title: Survey of challenges faced by plastic surgery services during the current Sudan conflict

Article References: Bakhiet, M. Y. (2025). Survey of challenges faced by plastic surgery services during the current Sudan conflict. BMC Plastic and Reconstructive Surgery, 1(1), Article 8. https://doi.org/10.1186/s44452-025-00008-2

Image Credits: AI Generated

DOI: 10.1186/s44452-025-00008-2

Keywords: Sudan conflict, plastic surgery, reconstructive surgery, war injuries, health system collapse, humanitarian crisis, surgical workforce, trauma surgery, displacement, supply chain disruption, medical education, global surgery