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

The study’s starting point is a striking geographic coincidence. Although areas lying within five kilometres of a conflict event covered only about three percent of the global land surface by 2020, those same buffer zones contained roughly six percent of the world’s cropland. In other words, agricultural land is disproportionately likely to sit in the line of fire. This is no accident of geography alone. Throughout human history, settlements and their surrounding fields have clustered in river valleys, coastal plains and other fertile, accessible terrain, and it is precisely these productive, densely populated landscapes that rival factions contest. The result is a systematic overlap between violence and cultivation that holds across continents and decades.

To move beyond correlation, the researchers deployed a difference-in-differences design, a statistical technique borrowed from economics that compares changes over time in conflict-exposed areas against changes in otherwise similar areas that escaped violence. This approach controls for the many factors that drive cropland change everywhere, from urban expansion to commodity prices, and isolates the effect attributable to conflict itself. The estimates show that conflict exposure caused an average annual cropland loss of 14.46 hectares per buffer-year, equivalent to a three percent decline in cropland area within affected zones. Spatial matching analyses, which pair each conflict-affected location with its statistically closest non-conflict counterpart, reinforced the finding: cropland loss was 23.7 percent greater in places touched by armed conflict than in comparable peaceful areas.

The regional pattern is as revealing as the global average. Losses were concentrated in West Africa, Eastern Africa and Southeast Asia, regions where smallholder agriculture dominates, state institutions are often fragile, and rural populations depend directly on the land they till. In such settings, the mechanism of loss differs from that of a shell crater. Farmers flee violence and abandon fields that are never reclaimed; irrigation systems fall into disrepair; land mines and unexploded ordnance render soil untouchable for years; and contested ownership discourages anyone from reinvesting in the land. The study’s technical framing recognises these channels, incorporating data on refugee displacement from the UNHCR, night-time lights as a proxy for economic activity, and population density to account for the demographic upheaval that accompanies fighting.

Behind the headline numbers lies a methodological achievement worth appreciating. The cropland data came from the GLC_FCS30D dataset, a global land-cover product generated at 30-metre resolution from dense time series of Landsat satellite imagery using continuous change-detection algorithms. That means the researchers could watch individual parcels of land, each about the size of a baseball diamond, transition in and out of cultivation year by year. Conflict events were drawn from two independent sources, the Armed Conflict Location and Event Data project and the Uppsala Conflict Data Program’s Georeferenced Event Dataset, providing more than 460,000 geolocated incidents. Weather controls came from high-resolution temperature and precipitation records, and crop yield information from the Spatial Production Allocation Model, allowing the team to translate lost hectares into lost dietary energy.

That translation yields the study’s most sobering figure. Had the conflict-driven cropland losses between 2000 and 2020 been prevented, the researchers calculate, the resulting production could have supplied sufficient dietary energy for 255.54 million people annually. To put that in perspective, it is more than the population of Germany, France and the United Kingdom combined, going hungry every single year because of farmland erased by war. Food insecurity was measured in the study using the prevalence of severe food insecurity as reported in the World Bank’s World Food Security Outlook, linking the physical loss of cropland directly to human deprivation rather than treating them as separate problems.

The findings arrive at a moment when the world’s food system is under unprecedented strain. Previous research has documented conflict-agriculture interactions in specific places: satellite studies revealed cropland abandonment in South Sudan, cultivation collapses in territory once held by the Islamic State, war-induced agricultural damage in Ukraine and Gaza, and civil-war-driven production losses in Syria. Earlier work in Nature Food also showed that violent conflict exacerbated drought-related food insecurity across sub-Saharan Africa between 2009 and 2019. What distinguishes the new study is its global scope and causal rigor. Where prior analyses documented single conflicts, this one quantifies the aggregate, worldwide effect, and where earlier work described associations, the difference-in-differences and matching designs allow stronger claims about causation.

The study also examines what moderates the damage. Governance quality, captured through three World Bank indicators covering government effectiveness, regulatory quality and the rule of law, enters the analysis as a potential buffer. The underlying logic is intuitive: capable institutions can protect farmers, maintain input supply chains, and support post-conflict land rehabilitation, whereas weak governance leaves rural communities exposed. The moderation analysis, presented among the paper’s central figures, situates cropland loss within a broader web of economic, demographic and institutional variables, underscoring that war’s agricultural toll is not uniform but shaped by the resilience of the societies it touches.

For policymakers, the implications cut in two directions. First, humanitarian and development agencies increasingly recognise that food crises and armed conflict are inseparable; the Global Report on Food Crises has repeatedly identified conflict as a leading driver of acute hunger. This study gives that recognition a hard quantitative footing, suggesting that protecting cropland during hostilities, for example through demining programmes, support for displaced farmers, and rapid post-ceasefire land rehabilitation, should be treated as food security policy of the first order. Second, the calorie calculations provide a way to weigh the costs of conflict prevention against its benefits. If preventing agricultural losses in conflict zones could feed a quarter of a billion people annually, then investments in peacebuilding acquire an economic and nutritional dividend that conventional security analyses rarely count.

There are, as with any study, limits to keep in mind. Satellite-derived cropland maps classify land cover but cannot fully distinguish a weedy abandoned field from an actively cultivated one, nor capture the intensity of management on land that remains in production. Conflict databases depend on reporting that may be incomplete in the most chaotic settings. And the five-kilometre buffer, while grounded in literature on the distance constraints of peasant farming, is a simplification of how violence radiates across landscapes. Yet the convergence of two independent statistical strategies, the difference-in-differences and the spatial matching, on consistent estimates lends the central conclusion considerable weight. Armed conflict, the evidence now shows, is not just a humanitarian emergency measured in casualties and refugees. It is a slow-motion catastrophe for the land itself, one whose hectares, once lost, take decades to recover, and whose absent calories are felt on plates far from the battlefield.

Subject of Research: The impact of armed conflict on global cropland loss and food insecurity

Article Title: Armed conflict accelerates cropland loss and food insecurity worldwide

Article References: Li, G., Qi, W., Sun, S., Liu, X., & Wang, Z. (2026). Armed conflict accelerates cropland loss and food insecurity worldwide. Nature Food. https://doi.org/10.1038/s43016-026-01436-8

Image Credits: AI Generated

DOI: 10.1038/s43016-026-01436-8

Keywords: armed conflict, cropland loss, food security, remote sensing, difference-in-differences, land use change, Nature Food, global hunger, conflict zones, agriculture, satellite data, humanitarian crisis