Khartoum, Sudan - The ill and injured swarm the clinics, pharmacies and laboratories along the Street of Emergencies here in Sudan's capital. At one corner, a woman approaches a group of twenty-somethings sitting on stools next to tea stalls, and hands them a doctor's order for a brain scan of an eight-month-old boy.
A young man jots down the details in the notebook of the El Hawadith Street Initiative, a volunteer-led effort that collects targeted funds for children treated at the adjacent Gaafar Ibnauf Children's Specialised Hospital and a few other institutions.
"When you see one of those kids, you will immediately love him," says Yousif Abubaker, a member of the initiative. "You feel that you have to support him, you have to do something to change that situation."
By their count, they have helped thousands of patients pay for medical expenses. Because Sudan's public hospitals lack resources, the group turns to private donors to cover the services. It's symptomatic of what critics call Sudan's crumbling public health system, in which they claim officials are cutting services and pocketing funds while promoting the lucrative private health care industry. Meanwhile, public health experts say Sudanese doctors are leaving the country in droves.
SpongeBob SquarePants, Winnie the Pooh and their fellow cartoon characters brighten the walls of the Ibnauf hospital. Its wards are filled with children suffering from cancer, heart diseases and other serious ailments.
Amal, a four-year-old stricken with severe anaemia, lies on a metal cot. A drip injects into her body an antibiotic paid for by donors. On this hot summer day, Amal's mother fans her dress above her daughter, who is wearing a pink frock and plaits. Abubaker, with a light goatee, brushes the back of his hand across Amal's forehead. She is still.
Depending on donations
Volunteers at the hospital post daily Facebook updates describing individual patients' needs and the cost of treatment: Sara, CAT scan, 200 Sudanese pounds ($45); Jalal, pelvis X-ray, 75 Sudanese pounds ($17); Ibrahim, Omeprazole, 68 Sudanese pounds ($15).
They have more than 43,000 "likes" on their page and maintain a nearly round-the-clock presence at the hospital. Doctors verify patients' requirements and donors specify to which cases they want to contribute.
They started, systematically, to dismantle the hospital and destroy major parts in the hospital.
Many of the 100-odd volunteers are recent university graduates who have not yet found jobs, but find meaning in their role here. They run to pharmacies to fill prescriptions, or ferry patients to labs for testing, ensuring the money is used properly.
The Ibnauf hospital is not what it once was. It started out as Sudan's first paediatric hospital, founded by Gaafar Ibnauf Suliman, a doctor considered the pioneer of children's health in the country. Suliman built the first iteration of the hospital in the late 1970s, and then, in 2002, opened a new facility - the one standing today - through donations from individuals and international NGOs. The hospital fell under the aegis of the government's health care system, allowing patients free cutting-edge care.
The hospital receives funding from the federal ministry of finance but administratively falls under the Khartoum state ministry of health. When new leadership took over the hospital in the past decade, Suliman says paediatric care was no longer a priority.
"They started, systematically, to dismantle the hospital and destroy major parts in the hospital," says Suliman. Medication and procedures that would have been free at the hospital have been limited, forcing the mostly poor patients to private institutions. Last spring, the state health ministry shut down the hospital's emergency room, which is said to have been the only public paediatric ER in central Khartoum.
Suliman and patients' families have held protests outside the hospital, with some saying parents travelling to the hospital for emergency care are now being turned away. The doctor has filed a legal complaint, demanding the administrative order shuttering the ER be overturned. The request was initially dismissed, but the Supreme Court has reversed the decision and the case is headed to the appeals court in late January.
At issue is why the ER was closed. Mamoun Homeida, the health minister for the state of Khartoum, has said the idea was to redirect ER services to facilities closer to patients' neighbourhoods, so they do not have to travel to downtown Khartoum. In addition, he has asserted that the move allows the hospital to return to its original purpose, which was to serve as a centre for tertiary care.
However, advocates for the Ibnauf hospital say the three hospitals to which Homeida has ordered the emergency services be performed are in the south of Khartoum, far from most city residents, and lack the same level of expertise and equipment as the Ibnauf wards. Children's lives are at risk, they say.
Homeida wears two hats. He has had a successful career as head of the private University of Medical Sciences & Technology in Khartoum, and as the owner of several private hospitals. One of these, the Alzaytouna hospital, towers close to the Ibnauf hospital. In an interview with Sudanese television, Homeida said his roles were separate and denied allegations that he was seeking to "dry out" public health facilities. Elsewhere, he's encouraged the private sector's involvement in health care.
Nabil Adib, the lawyer appealing the Ibnauf case, questioned Homeida's stance - saying private hospitals owned by the minister in central Khartoum house paediatric units, which suggests that he is competing for the business of patients. "There is a contradiction of interest here," Adib said. "It is not possible for a minister to have such a personal interest in what he is doing as a public servant, and this is really causing a lot of people concern."
In September, President Omar al-Bashir faced the largest demonstrations against his rule since coming to power two dozen years ago. The deadly protests began over a hike in fuel prices, with slogans calling for "freedom" and the fall of the regime. Since the separation with South Sudan two years ago, Khartoum's economy has struggled. Being affiliated with the ruling party can be the ticket to a government job, but it's the private sector that's booming. Local economic observers say the government lacks the funds to develop major sectors, so many industries are being privatised.
The government has become commercially minded, says Adib, the lawyer, selling off prime real estate in the capital's centre to private buyers.
'Health worker crisis'
Meanwhile, a series of recent studies conducted by Sudan's Public Health Institute, a part of the federal ministry of health, concluded that the nation was confronting a "health worker crisis". They estimated that three-quarters of Sudanese doctors are working abroad, especially in the Gulf, with nurses following suit. "Poor financial rewards, lack of chances for postgraduate studies together with bad work environment is pushing health professionals out," researchers said.
No one in their right mind would want to work in these conditions.
Additionally, one study found the private health sector to be growing, with more health professionals being simultaneously employed at both private and public institutions, especially in Khartoum. If unregulated, this trend could bring about "inequity and maldistribution of health services". Other findings included the health ministry offering few jobs for recent graduates and a lack of doctors in rural areas.
At a trendy cafe, Reem Gaafar recounts her experience working as an emergency room physician in Khartoum. Her face shows horror as she recalls losing patients because she didn't have the necessary supplies to treat them. "No one in their right mind would want to work in these conditions," says Gaafar, the advocacy coordinator at the Public Health Institute.
Money, she says, isn't the issue. Funding is allocated for public health services, not to mention millions of dollars arriving from international organisations for preventive health programmes such as fighting malaria. "The money is not going where it should for two reasons," says Gaafar, who openly criticises the government on her personal blog. "It's either because it's going into someone's pocket - which it almost always is - or because it's not being coordinated the way it should."
Despite the dire conditions, Gaafar says her generation is looking to fix things.
Back at the Street of Emergencies, the sunset call to prayer cuts through the clamour of cars and motorcycles speeding by. Young men and women from the initiative again huddle together, divvying up tasks for their next shift.
Follow Nafeesa Syeed on Twitter: @NafeesaSyeed