From crisis to opportunity: the shift of Sudanese physicians to non-clinical careers and its global health implications

SUMMARY BOX.

• The ongoing war in Sudan has forced many physicians to leave clinical practice due to safety risks, infrastructure collapse, burnout, and transit to non-clinical careers in medical research, public health, health insurance, and medical education.

• This article analyzes the shift to non - clinical roles highlighting both challenges (e.g., training gaps, social stigma and financial issues) and opportunities (e.g., global health contributions, policy influence).

• Recognizing and supporting this transition through education, international collaboration, and credential validation can help Sudanese physicians continue making an impact in global health.

Background

The ongoing war in Sudan has decimated the country’s healthcare system, forcing thousands of physicians into an impossible dilemma: risk their safety in collapsing hospitals or abandon clinical practice altogether.¹ With over 70% of healthcare facilities non-functional, and many doctors displaced,² a significant number of Sudanese physicians are shifting towards non-clinical careers including medical research, public health, health insurance and medical education. This shift, while born out of necessity, presents both challenges and opportunities. On the one hand, Sudan risks losing a generation of clinical practitioners, further straining an already broken healthcare system. Investing in non-clinical careers could empower Sudanese physicians to drive healthcare reform, influence policy and contribute to global health beyond the front lines.

A war that ended clinical careers

Sudan’s healthcare system has been in crisis for years, but the conflict that erupted in April 2023 created an unprecedented exodus of doctors from clinical practice. Sudan is not the first country to suffer this crisis; the war and the economic instability have forced many physicians in Yemen, Syria and Ukraine to leave their country and the front-line medicine. Although this displacement exacerbates and threatens the fragile system, it provides an exceptional opportunity to excel and gain expertise in non-clinical careers. The key drivers behind this shift include safety threats from attacks on hospitals, targeted violence against healthcare workers, and forced displacement.^{2 3} Furthermore, in conflict zones, physicians often lack the basic resources to provide care due to the collapse of infrastructure, disrupted medical supply chains and widespread hospital closures. These dangers made clinical work life-threatening and contributed to psychological burn-out and distress among doctors.

Consequently, the emotional toll of working under war conditions, witnessing mass casualties and dealing with personal displacement has driven many to reconsider their career paths. Adding to employment insecurity resulting from these challenges, many displaced doctors struggle to find clinical positions abroad due to licensing barriers. For many Sudanese physicians, these challenges have made continuing in clinical medicine an unsustainable option, forcing them to explore alternative career pathways.

Emerging non-clinical careers for sudanese physicians

While leaving clinical medicine is often seen as a last resort, it has opened doors to new opportunities. Sudanese doctors are increasingly pursuing non-clinical roles, where they can still contribute to healthcare in meaningful ways.⁴ One such pathway is in medical research and academia. The war has severely disrupted local research institutions in Sudan; however, international collaborations, fellowships and online research opportunities have become viable alternatives and allowed Sudanese doctors to remain active. Sudanese researchers are now focusing on war-related health crises, including trauma, infectious diseases and mental health. The Mycetoma Research Center at the University of Khartoum, a globally recognised research hub, is an example of how Sudanese academics have made significant contributions to global health even amidst the ongoing conflict. Remote research networks and international funding from global organisations like WHO and NIH represent expanding opportunities to continue growth. However, the lack of local research infrastructure and mentorship may hold up the development of early-career researchers.

Public health and policy roles have also attracted many Sudanese doctors. With war displacing millions and creating humanitarian crises, Sudanese doctors are joining public health efforts through NGOs and international agencies such as Médecins Sans Frontières and the International Committee of the Red Cross. These roles are often related to epidemiology, disease surveillance and emergency response coordination.^{5 6} These positions have the capabilities to influence large-scale health policies and emergency response strategies and interventions to help serving conflict-affected populations. Nevertheless, many of these roles require specialised and formal training, which is currently inaccessible for many Sudanese doctors due to the ongoing conflict.

Another emerging sector is health insurance and healthcare administration. With Sudan’s fragile economy, growing financial strain and rising healthcare costs, there is increasing demand for healthcare workers proficient in managing medical claims, advising health policy and supervising healthcare administration operations.⁷ With their understanding of the healthcare delivery system, physicians are well-suited for these roles. This transition provides a chance for financial sustainability and creates stable employment for physicians; yet, it may necessitate further training in business administration and health economics.

In recent years, medical education in Sudan has seen transformation. As the war impacted medical education in Sudan, forcing universities and hospitals to close, there is a critical shortage of medical educators. As a result, many Sudanese doctors have transitioned into roles such as online medical educators, curriculum developers and international medical exam trainers (eg, United States Medical Licensing Examination, Membership of the Royal College of Physicians, Professional and Linguistic Assessments Board). This transition will definitely sustain and support the next generation of Sudanese doctors and strengthen medical education both locally and globally.

Challenges of the non-clinical shift

While transitioning to non-clinical careers provides an alternative for Sudanese doctors, it comes with significant barriers. One of the most prevalent barriers is social stigma. Sudanese doctors who moved away from clinical practice are usually facing criticism and perceived as having abandoned their professional duties. This concept continues to exist even amidst the conflict. Limited training and formal programmes are another major obstacle. Sudanese medical education heavily focuses on clinical training, with only limited opportunities for postgraduate study in non-clinical roles such as public health, health economics or medical education. Thus, Sudanese doctors interested in these roles usually find themselves unprepared and lacking the obligatory knowledge to compete and excel in these positions. Compounding these difficulties is the issue related to job market limitations. Non-clinical positions often require additional postgraduate degrees such as a master’s degree or advanced certificate, which are difficult to obtain or simply unavailable in conflict settings. Even for Sudanese doctors who manage to relocate abroad, a financial burden exists.

Another significant challenge Sudanese doctors face during the conflict is the risk of a clinical or experience gap; a period without hands-on practice, which can make re-entering clinical roles, especially in major healthcare settings, more difficult after the conflict ends. This issue is particularly concerning for junior doctors, as many job markets today prioritise candidates with recent clinical experience. A viable solution is the introduction and establishment of gap year programmes in major hospitals, allowing doctors to work closely with physicians, assess patients and refine their clinical skills. Another potential solution is clinical attachment, which typically lasts for a short period but provides valuable clinical experience. Furthermore, participating in volunteer work at clinics and medical camps can provide crucial clinical experience and further bridge the gap. We believe that these approaches could help rebuild doctors’ confidence and better prepare them for a return to clinical practice.

Recognising and supporting the shift

The transition of Sudanese doctors into non-clinical careers should not be seen as a loss, but rather an opportunity to strengthen healthcare resilience in Sudan. To make this shift sustainable, several key actions are needed. Medical schools should introduce courses in public health, research methodology and health policy into the curriculum to prepare students for diverse careers. Also, by offering online certification programmes universities and medical institutions can help support doctors aspiring for clinical roles to gain experience and build their knowledge in the relevant field. Organisations like WHO and global health bodies can help Sudanese doctors by providing grants and stipends to support their transition, and by accelerating credential validation for Sudanese doctors in non-clinical roles.

Conclusions

Sudan’s war has forced many doctors out of clinical medicine, but instead of marking the end of their careers, this shift highlights how conflict can drive innovation in global health careers. If properly supported, Sudanese physicians can lead medical research, public health policy and healthcare reform, creating a more resilient and innovative healthcare sector. Rather than seeing this as a brain drain, the global medical community should recognise the potential of Sudanese doctors in shaping healthcare beyond the frontlines.

Data availability statement

There are no data in this work.