Challenges in anatomy education among Sudanese medical students during the 2023 armed conflict: a cross-sectional survey

Abstract

Background

Anatomy is a cornerstone of medical education, requiring hands-on and interactive learning for effective comprehension. Armed conflicts, however, pose substantial threats to educational continuity. In 2023, Sudan’s ongoing conflict severely disrupted medical education, particularly anatomy instruction, due to displacement, infrastructure damage, and limited access to practical training.

Objectives

This study aimed to explore the challenges faced by Sudanese medical students in anatomy education during the 2023 armed conflict, including access to practical sessions, use of online learning platforms, and overall satisfaction with alternative educational methods.

Methods

A descriptive cross-sectional survey was conducted among 109 first- to third-year medical students from 20 institutions affected by the conflict. Data were collected using an online questionnaire distributed via student networks. Descriptive statistics were generated using SPSS version 29.

Results

The majority of students (70.91%) reported no access to practical anatomy sessions, and 56.36% rated educational infrastructure as poor. Technology integration was limited or absent in 94.55% of cases, and 52.73% faced difficulties accessing online platforms. Although 55.45% of students resorted to self-study and 41.82% used online resources, only 10% were satisfied with online anatomy learning, with students outside Sudan reporting higher satisfaction (p-value 0.001). Qualitative feedback emphasized the need for improved internet access, development of virtual anatomy tools, and establishment of safe practical training centers.

Conclusion

The 2023 conflict in Sudan has severely disrupted anatomy education, particularly the availability of practical training. While students demonstrated resilience through self-directed learning, significant investment in digital infrastructure, alternative training solutions, and institutional support is critical to preserving educational quality in conflict-affected regions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-025-08457-0.

Introduction

Anatomy serves as a foundational component of medical education, providing essential insights into human structure and function, which are crucial for subsequent clinical disciplines and surgical training [1]. Because anatomy is a very hands-on and three-dimensional subject, students need to be able to visualize the body’s structure and how they are working together. Usually, a combination of lectures and hands-on labs are used to accomplish this. Students can engage with human cadaveric material to grasp the real-world anatomy, and they frequently remark on how these lab sessions truly make their lectures come to life [2]. Learning through human cadaver dissection has benefits that are not easy to measure, like enhancing deep and active learning and getting students ready for clinical practice [3].

However, armed conflicts significantly disrupt educational settings by damaging infrastructure, causing displacement of students and educators, and negatively affecting learners’ psychological well-being [4]. In 2023, Sudan experienced intensified armed conflict, resulting in widespread displacement and considerable destruction of critical educational infrastructure [5]. This conflict had a severe impact on medical students, particularly those in regions such as Khartoum and Wad Madani, causing disruptions to their academic schedules, limited access to essential practical resources, and heightened psychological distress among students [6].

Despite the recognized significance of anatomy education, there remains a scarcity of research focused specifically on how armed conflicts affect the teaching and learning processes in anatomy. Existing literature largely addresses general educational disruptions without delving deeply into discipline-specific consequences [7, 8]. Given that effective anatomy education is vital for the competency of future healthcare professionals, understanding the specific challenges encountered during conflict situations becomes essential for sustaining the quality and continuity of medical training.

This study aims to investigate the challenges faced by medical students concerning anatomy education during the ongoing armed conflict in Sudan. Specifically, it examines students’ perspectives on the accessibility of educational resources, disruptions to practical training, and satisfaction with alternative teaching methods such as online platforms. The findings of this research intend to inform strategic recommendations aimed at mitigating educational disruptions and supporting medical education continuity in conflict-affected settings.

Methods

Study design

A cross-sectional descriptive study design was employed to investigate the challenges faced by medical students in anatomy education during the armed conflict in Sudan. This design was selected as it efficiently captures data from participants at a single point in time, allowing for immediate insights into current conditions and experiences. The study took place between October and December 2023, including methods preparation, data collection, and analysis.

Study population

The study targeted medical students enrolled in their first, second, and third years at various universities across conflict-affected regions in Sudan, as these are the critical academic years when anatomy education typically occurs. Students displaced due to the armed conflict, both within and outside Sudan, were included to capture diverse experiences and challenges.

Sampling technique

A convenience sampling method was employed, utilizing accessible online platforms, including social media, WhatsApp, and Telegram, to recruit participants. This method facilitated the rapid enrolment of geographically dispersed students affected by the armed conflict, making it particularly appropriate given the limitations imposed by unstable conditions.

Sample size

Given the exploratory nature of this research and the challenging context of armed conflict, the determination of the sample size was pragmatic. Considering the difficulties associated with communication disruptions and participant displacement, a minimum target of 100 respondents was initially set, given the descriptive nature of the study. Ultimately, 109 students completed the questionnaire, adequately meeting this threshold and allowing for descriptive analyses.

Data collection

Data were collected using a structured online questionnaire administered via Google Forms. The questionnaire was distributed through student networks and academic social media groups over a period of four weeks. The questionnaire was developed for this study (supplementary) and it consisted of sections addressing demographic information, accessibility of anatomy education resources, faculty support, infrastructure quality, practical anatomy session availability, technological integration, coping strategies, student satisfaction with online learning, and recommendations for improvement.

A pilot test was conducted with ten medical students to validate the clarity and comprehensibility of the questionnaire. The pilot responses were excluded from the final dataset.

Data analysis

Collected data were imported into SPSS (version 29) and Microsoft Excel (2021) for analysis. Descriptive statistics were calculated, including means, standard deviations, frequencies, and percentages, to summarize demographic characteristics, challenges, coping strategies, and satisfaction levels. Chi-square test was used to explore proportional differences in students’ experience according to their subgroups, with significance set at 0.05.

Qualitative data and recommendations were analyzed using a straightforward inductive content analysis method. Two authors independently reviewed all open-ended responses, created initial codes, and then grouped similar codes into broader thematic categories (e.g., strengthening online infrastructure, improving access to safe practical training spaces, enhancing institutional and psychosocial support). Any discrepancies were discussed and resolved through consensus, and the final themes were used to structure the recommendations. The frequency of each theme’s appearance was also taken into account when the recommendations to be emphasized in the text were chosen.

Results

Demographic characteristics

A total of 109 students completed the questionnaire. The mean age of participants was 21.48 ± 1.99 years. The study population was predominantly female, comprising 80 participants (73.39%), while males constituted 29 participants (26.6%). Geographically, 64 participants (58.7%) were located inside Sudan, while 45 participants (41.3%) had relocated outside Sudan due to armed conflict. Students outside Sudan were primarily residing in Egypt (19.3%) and Saudi Arabia (18.3%). Most respondents were second-year students (52.7%), followed by third-year (31.8%) and first-year students (15.5%) (Table 1).

Table 1.

Demographic characteristics of study participants (n = 109)

Variable	Frequency (%)
Gender
Female	80 (73.39%)
Male	29 (26.60%)
Current Location
Inside Sudan	64 (58.7%)
Outside Sudan	45 (41.3%)
Year of Study
First Year	17 (15.5%)
Second Year	57 (52.7%)
Third Year	35 (31.8%)

A total of 109 participants were recruited from 20 institutions. Neelain University alone contributed just over a quarter of the sample (25.7%), while Wad Madni College and Karary added 11.0% and 10.1%, respectively. Together, these three institutions made up nearly half of all respondents (46.8%), showing that the sample is somewhat concentrated in a few large centers (Fig. 1).

Fig. 1.

Distribution of students participated in the study by their universities (n = 109)

Access to practical anatomy sessions

Regarding practical anatomy sessions and cadaveric dissections during the armed conflict, the majority of students (70.91%) reported having no access. A further 24 students (21.82%) indicated limited participation, and only eight students (7.27%) had regular sessions. This signifies a substantial disruption in traditional hands-on anatomy education (Table 2).

Table 2.

Challenges, coping Strategies, and learning experiences in anatomy education during the study period (n = 109)

Category	Subcategory	Frequency (%)
Access to Practical Sessions	No Access	77 (70.91%)
	Limited Participation	24 (21.82%)
	Regular Sessions	8 (7.27%)
Infrastructure Rating	Poor	61 (56.36%)
	Average	33 (30.00%)
	Good	10 (9.09%)
	Excellent	5 (4.55%)
Technology Integration	Not Integrated	46 (41.82%)
	Somewhat Integrated	57 (52.73%)
	Fully Integrated	6 (5.45%)
Access to Online Platforms	Faced Challenges	58 (52.73%)
	No Challenges	37 (33.64%)
	Not Applicable	15 (13.64%)
Coping Strategies	Increased Self-Study	61 (55.45%)
	Online Resources	46 (41.82%)
	Stress Management	31 (28.18%)
	Peer/Mentor Support	13 (11.82%)
Satisfaction with Online Learning	Dissatisfied	44 (40.00%)
	Neutral	55 (50.00%)
	Satisfied	10 (10.00%)

Infrastructure and technological integration

The infrastructure for anatomy education during the armed conflict was rated poor by more than half of the students (56.36%). About 30% rated the infrastructure as average, while only a small minority (13.64%) rated it as good or excellent. Similarly, technological integration into anatomy education was limited; 57 respondents (52.73%) described technology as somewhat integrated, whereas 46 respondents (41.82%) reported no integration at all. Only six students (5.45%) indicated full technological integration into their anatomy education (Table 2).

Challenges in accessing online learning platforms

More than half of respondents (52.73%) reported facing significant challenges accessing online learning platforms or anatomy education resources due to issues like internet connectivity, financial constraints, and inadequate institutional support. Conversely, 33.64% did not face challenges, and 13.64% indicated the question was not applicable, possibly due to their inactive status in formal educational programs during this period (Table 2).

Coping strategies

Students employed various strategies to mitigate the impact of disruptions. The most common coping mechanism was increased self-study, utilized by 61 respondents (55.45%), frequently through textbooks, atlases, and lecture notes. Utilizing online resources such as YouTube tutorials and digital applications was another significant method employed by 46 respondents (41.82%). Additionally, 31 students (28.18%) managed stress by taking breaks, and 13 students (11.82%) sought help from peers or mentors (Table 2).

Satisfaction with online learning

Overall satisfaction with online anatomy learning during the armed conflict was low. Only 10% of respondents reported satisfaction, while 40% expressed dissatisfaction. Half of the students (50%) remained neutral, reflecting a critical need for improvements in online education delivery methods and greater institutional support (Table 2).

Subgroup analysis

Cross tabulation for students’ experience by their location (inside or outside Sudan) or the year of study revealed no significant difference except for satisfaction with online learning; students outside Sudan showed higher satisfaction with online learning (p-value 0.001) (Supplementary Tables 1–2).

Recommendations from participants

Qualitative responses from students provided several key recommendations for improving anatomy education under conflict conditions (Fig. 2). These recommendations emphasized:

Fig. 2.

Streamlined Recommendations for Anatomy Education During Conflict

• Enhancing online learning infrastructure, including reliable internet access, robust digital platforms, and interactive learning resources through 3D anatomical models, virtual dissections, and digital cadaveric simulations.

• Establishing safe, practical study centres outside conflict zones or internationally in collaboration with foreign institutions.

• Improving institutional support for technology integration and student well-being through enhanced communication, mentoring, and counselling services.

• Implementing policies to sustain medical education through government, NGO collaborations, and professional associations to address logistical and financial challenges.

Discussion

This study highlights substantial disruptions in anatomy education experienced by Sudanese medical students during the 2023-armed conflict, with specific issues identified including a notable lack of access to practical anatomy sessions (70.91%), significant barriers in utilizing online educational platforms (52.73%), and overall low student satisfaction levels with the alternative online learning modalities (10%).

The inability of over 70% of participants to access practical anatomy sessions underscores a critical educational deficiency, as practical dissection and laboratory sessions are fundamental in achieving comprehensive anatomical knowledge and proficiency required for clinical and surgical practices [9, 10]. Previous studies have established the significance of cadaveric dissection, demonstrating improved anatomical understanding and exam performance among students who engaged in regular, hands-on dissection compared to those who experienced limited or no practical exposure [9]. Consistent with this, research conducted in Turkey found students who participated in cadaveric dissection exhibited accelerated and deeper learning of anatomical concepts compared to their peers without such access [10].

Disruptions comparable to those observed in Sudan have been documented in other conflict-affected regions. For instance, research in Iraq highlighted how ongoing conflict adversely impacted medical training quality, exacerbating psychological stress and reducing academic standards, subsequently motivating many students to seek opportunities abroad upon graduation [11]. Similarly, in Syria, continuous armed conflict significantly hindered medical training and compromised the quality of practical clinical education due to resource limitations, exacerbating existing infrastructural inadequacies [12]. These findings collectively underscore that armed conflicts profoundly disrupt core components of medical education, extending beyond theoretical deficits to encompass practical and psychological dimensions.

The anticipated role of online education as a compensatory mechanism during periods when practical sessions are inaccessible was notably undermined by numerous challenges identified in this study. More than half of participants reported substantial barriers in accessing digital learning platforms, primarily due to unreliable internet connectivity, financial constraints, and inadequate institutional support. These obstacles resonate with global findings during emergency shifts to online education, such as those observed during the COVID-19 pandemic, wherein students in Iran and Pakistan faced comparable infrastructural inadequacies that severely restricted their educational engagement [13, 14]. These parallels emphasize that without addressing fundamental disparities in digital infrastructure, online education cannot effectively mitigate disruptions in practical medical training.

Overall student satisfaction with online anatomy education remained notably low, with only 10% expressing satisfaction. This is consistent with results from the armed conflict in Ukraine, where students’ satisfaction levels before and during the conflict showed significant declines in perceived comfort, safety, and collaborative learning opportunities (p < 0.05). In contrast to our findings, however, general satisfaction with educational quality stayed largely constant during the conflict [15]. In line with these findings, another study explored the experiences of 245 Sudanese medical and pharmacy students who were displaced during the violence. Overall satisfaction with the educational experience turned out to be extremely low (mean = 1.69 ± 1.66), particularly with regard to clinical training and faculty engagement. While those who remained in Sudan reported improved faculty interaction (p = 0.030), students who were displaced outside of Sudan reported significantly more challenges getting an education (p = 0.047) and were less satisfied with their clinical training (p = 0.016). The multifaceted influence of conflict on student happiness was further highlighted by the identification of institutional flaws, financial difficulty, and psychological anguish as major obstacles [16].

The profound and enduring impacts of armed conflict on medical education extend beyond immediate disruptions, affecting long-term educational quality, institutional integrity, and workforce preparedness. A global review highlighted how conflicts precipitate declines in educational standards, student enrolment, and staff retention [17]. Specifically, a nationwide survey conducted during the Sudanese crisis reported extensive loss of essential educational facilities and reduced curriculum quality, highlighting the multidimensional impacts of conflict on medical education [18]. These extensive disruptions further underline the complex and profound effects of armed conflict on anatomy instruction and broader medical education in Sudan.

Implications

Addressing the educational disruptions identified in this study needs both immediate and long-term interventions tailored to conflict-affected settings. In the short term, implementing low-cost, accessible online platforms—supplemented by virtual dissection tools and 3D anatomical models—could offer interim solutions to the widespread lack of practical exposure. International collaboration, as seen during the Syrian crisis, where displaced students were accommodated in regional universities through joint academic programs, may serve as a model for supporting Sudanese students [19]. Unreliable internet connectivity emerged as a major barrier to accessing online anatomy resources. Short-term solutions include using low-bandwidth and offline-capable tools, complemented by institutional support through subsidized data packages or shared connectivity hubs. Strengthening partnerships with external institutions may further improve access to digital learning platforms for affected students.

Additionally, studies have revealed that structured peer mentoring programs in medical education significantly improve psychosocial well-being, lower stress levels, and enhance academic adjustment, offering a low-cost, scalable support mechanism particularly valuable for displaced and under-resourced students [20]. Despite mobility constraints during conflict, peer mentoring can still be implemented through social media platforms and small location-based student groups. These flexible, remote formats allow mentoring relationships to function even when students cannot physically meet. Such models have been effective in other disrupted settings and offer a feasible support mechanism for displaced learners.

In the longer term, establishing safe, well-equipped regional centers for hands-on training and promoting government–NGO–academic partnerships will be vital in rebuilding anatomical education. These measures should be combined with funding for infrastructure and legislative frameworks that give priority to continuing medical education during emergency events. Without such systemic responses, disruptions like those observed in Sudan risk producing long-term deficits in clinical competence and workforce preparedness.

This study has several limitations that need to be acknowledged. First, the use of convenience sampling via online platforms potentially limited the representativeness of the sample, as students without reliable internet access may have been inadvertently excluded. Second, the relatively modest sample size reflects inherent constraints associated with connectivity and participant displacement during conflict conditions. Third, reliance on self-reported data might introduce recall or response bias. Lastly, the cross-sectional nature of this study captures data at a single time-point, limiting insights into temporal trends and changes over time. Nevertheless, these findings align with and extend existing research from similar conflict-affected contexts, affirming their internal validity and generalizability.

Conclusion

The 2023 armed conflict in Sudan has significantly disrupted anatomy education, primarily by restricting access to practical sessions, exacerbating infrastructural challenges, and leading to low satisfaction levels with online educational alternatives. Although students exhibited resilience through increased self-study and utilization of digital resources, urgent improvements in educational infrastructure, provision of safe and accessible practical training opportunities, and enhancement of digital learning platforms are necessary. Addressing these educational gaps is crucial to maintain the quality and continuity of medical education, ultimately safeguarding the future healthcare workforce in conflict-affected regions.

Authors’ contributions

The study was conceptualized and designed by Qusai Dafallah Ali Eltieb and Abubakr Muhammed. Material preparation, data collection, and analysis were carried out by Lina Nasr Mahmoud Ahmed, Mie Sami Arbab Saeed, and Eltayeb Abdalla. The results were interpreted by Safaa Mohammed and Zinab Alatawi. The initial draft of the manuscript was written by Eltayeb Abdalla, Moram Abdelrahim Osman Abdelrahman, and Reel Khider. This draft was then revised and edited by Safaa Mohammed and Zinab Alatawi. All authors read and approved the final version of the manuscript.

Funding

This research received no fund or grant from any governmental or non-governmental organization.

Data availability

The data analyzed in this study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

The study was conducted in compliance with the Declaration of Helsinki. Ethical approval for the study was obtained from the Research Ethics Committee of the Faculty of Graduate Studies and Scientific Research at the National University, Sudan. Informed consent was obtained from all participants before their involvement in the study.

Consent to publication

Not applicable.

Competing interests

The authors declare no competing interests.