Impact of armed conflict on women and children in Sudan: psychological, educational, and health crisis, 2023–2024

Abstract

Background

The armed conflict that erupted on April 15, 2023, in Khartoum, Sudan, between the Sudanese Armed Forces (SAF) and the paramilitary Rapid Support Forces (RSF), has resulted in catastrophic humanitarian consequences. Over 61,000 people have been killed in Khartoum State alone, and more than 8.2 million have been displaced, making it one of the worst displacement crises in the world. The violence in Khartoum, Darfur, Jazeera, and Kordofan, as well as in other states, has made women and girls more vulnerable to exploitation and abuse. Furthermore, children and teenagers have experienced major disruptions to their education, health, and future prospects.

Methods

A cross-sectional survey was conducted in Sudan, targeting women and children, from 1 December 2023 to 31 October 2024. The survey included 243 women and 122 children, and data were collected using a structured online submission form.

Results

Among the surveyed population, 48.8% of women were aged 36 and older, and 11.6% were between 18 and 23 years old. Approximately 90% of them were in Khartoum on April 15, 2023, and reported significant psychological and physical impacts. Symptoms of depression among the surveyed included 47.8% experiencing loss of energy and 48% reporting loss of interest. 93.5% of participants reported sleep-related difficulties such as insomnia or excessive tiredness. Educational disruption was profound, with 74% of women still seeking solutions to resume their studies. Health challenges were also significant, with 27.4% of women suffering from chronic diseases and facing irregularities in medication intake due to the conflict. The impact of war on children was equally severe. The depression symptoms reported by their mothers included sadness or a low mood (19.7%) and irritability or anger (16.4%). There was a clear, significant difference (p-value = 0.000639) between children who witnessed armed conflict (87.6%) and those who were unable to continue their education (37.2%), as they were trapped within the country and unable to resume their education. Self-reported signs of malnutrition were a significant concern, with 44.4% of mothers reporting reduced food intake and 19.4% experiencing limited access to nutritious food for their children.

Conclusion

The ongoing conflict in Sudan has sparked a severe crisis that is primarily affecting women and children, with expected repercussions at both the family and community levels. The violence has caused significant damage to health services, education, and mental well-being. Urgent intervention from civil society organisations and policymakers is essential to stop this devastating war and address the critical needs of those impacted by the conflict.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-026-26799-2.

Introduction

On the morning of Saturday, April 15th, 2023, a war erupted in Khartoum, the capital city of Sudan, between the military and the Rapid Support Forces (RSF). The conflict escalated rapidly, forcing many families to flee either to other countries or to safer regions within Sudan. The war has caused significant destruction to the city’s infrastructure and has resulted in many lives being lost.

Armed conflict has a severe impact on stability and the mutual support of family life, disrupting the normal functioning of society, including family dynamics. It particularly affects children and young people who depend on family support. Additionally, the nation’s social services, including psychological, educational, health, and community systems, are severely impacted by the conflict’s effects. The ongoing armed conflicts in Sudan have had a significant impact on families and individuals in the affected areas, leading to forced migration and displacement. Women and children are the most affected by the traumatic events of war, and they are especially vulnerable to various forms of exploitation and abuse [1]. Women are the basic unit of the family, and their care for children is significant. When they are affected by war, children are affected as well [2].

The impact of war on society’s health and well-being is catastrophic. Research shows that armed conflict results in more deaths and suffering than any major illness [3]. Burnham et al. reported approximately 601,000 deaths attributed to violence during the Iraq war. Additionally, the study found that the crude mortality rate in Iraq increased from 5.5 deaths per 1,000 people per year before the invasion to 13.3 deaths per 1,000 people per year following the invasion, more than doubling during the conflict period [4]. Wars are likely to persist, leading to ongoing emotional turmoil. It forces people to endure chronic behavioural and physiological distress. Both combatants and civilians experience the physical and psychological effects of war. The most severe physical consequences include death, injury, sexual violence, malnutrition, disease, and disability. Meanwhile, the mental impacts encompass anxiety, despair, and post-traumatic stress disorder (PTSD) [5]. The most common mental disorders in conflict-affected children are PTSD and depression, with symptoms often including helplessness, withdrawal, sleep disturbances, and aggression. These mental health issues can impair daily functioning and family interactions and present both immediate and long-term risks. Beyond the initial effects, armed conflict severely disrupts brain development, educational progress, social skills, and emotional regulation in children, leaving enduring consequences for their overall growth and well-being [6].

Bendavid and his co-authors in 2021 focused their study on the direct and indirect health effects of armed conflict on women and children worldwide. They discovered that the morbidity and mortality rates among women and children significantly increase due to these conflicts [7].

A study conducted by Assefa and his colleagues in 2022 revealed that armed conflict and education have a reciprocal influence on each other in various regions worldwide. For instance, Sub-Saharan Africa has historically been the region most impacted by armed conflict, which significantly affects education on a global scale [8]. Another devastating impact of the ongoing conflict in Sudan has been on education. Currently, over 2.5 million girls, accounting for 74% of school-age girls, are not enrolled. This puts them at a greater risk of engaging in harmful practices such as female genital mutilation and child marriage [9]. The ongoing war has created significant uncertainty and insecurity, leading to the destruction of many universities, colleges, and institutions. Some have been burned down, while others have become targets for kidnappers seeking ransom money, and some are simply inaccessible. The negative impact of armed conflict on educational systems disrupts the learning of children and young people. This situation poses a significant obstacle to providing education for all, as outlined in human rights legislation [10]. Learning can deteriorate even without significant disruptions to education during a crisis. Conflict may lead to inadequate learning environments, a shortage of educational resources, and psychological trauma that affects children’s ability to learn [11].

Healthcare issues have worsened due to the ongoing military conflict in Sudan, which has destroyed hospitals and clinics, disrupting medical supply systems [12]. At the individual level, war and displacement have negatively affected mental health, social interactions, and physical well-being. Many individuals experience poorer health outcomes due to the trauma associated with these circumstances. Common chronic conditions among refugees include high rates of hypertension, type 2 diabetes, cardiovascular diseases, chronic obstructive pulmonary disease, and musculoskeletal pain [13]. According to a UN report released on September 24, 2024, at least 80% of internally displaced women are unable to access clean water due to issues related to affordability, safety concerns, and distance [14]. The ongoing lack of safe, accessible, and affordable water, sanitation, and hygiene disproportionately impacts women and girls. In addition, 1.63 million women of reproductive age lack sufficient healthcare services, despite an expected 54,000 childbirths in the upcoming three months [14]. Children in Sudan are enduring severe hardships due to the ongoing conflict. Millions of people have been displaced both within the country and across international borders because of forced migration. Currently, approximately 50% of the total population, over 24.7 million people, need humanitarian assistance. This includes nearly 14 million children. Since April 2023, approximately 4.6 million children have been forced to leave their homes, with around one million crossing into neighbouring countries such as South Sudan, Egypt, and Chad. As a result, Sudan is facing the largest child displacement crisis in the world [15]. According to UNICEF’s report, approximately 3.7 million children under five are expected to experience malnutrition, with 730,000 of those cases projected to involve life-threatening severe malnutrition. Recurrent disease outbreaks, including measles and malaria, continue to impact a significant number of children, and the routine immunisation rate has rapidly declined, leaving one in six children completely unprotected. Additionally, 11 million people, nearly one-third of the population, are in urgent need of water, sanitation, and hygiene (WASH) interventions. At the same time, WASH-related diseases, such as diarrhoea and cholera, remain a high risk due to a lack of safe water and inadequate sanitation [15].

Several studies have shown that countries experiencing armed conflict tend to have higher rates of death and disability [6], as well as an increased prevalence of illnesses and mental disorders that manifest in various ways. Specifically regarding mental health, there remains a continuous risk of developing psychiatric illnesses during such conflicts [16]. A study conducted in Syria reported that the ongoing conflict and violence back then had directly impacted the country’s healthcare facilities and workers. The health sector suffered severely during the war, with up to 50% of healthcare facilities destroyed and approximately 70% of healthcare providers fleeing the country in search of safety [17]. The ongoing conflict in Yemen has displaced millions and severely damaged health infrastructure, resulting in the largest humanitarian disaster in the world. As of 2023, Yemen continues to have one of the highest maternal mortality rates [18]. The conflict in northern Ethiopia is another example that has resulted in widespread destruction of health systems and severe atrocities against civilians [19]. In Tigray, only about 27.5% of hospitals, 17.5% of health centres, and 11% of ambulances remained functional after just six months of fighting. Over 50% of health facilities in the Amhara region have been damaged or looted, and many in rural areas are particularly affected, with limited access to alternative care [20].

The aim of this study was to assess the impact of armed conflict on women and children in Sudan, with a focus on the psychological, educational, and health-related consequences.

Materials and methods

Study design and sampling

An online cross-sectional survey was conducted among a Sudanese population from December 1, 2023, to October 31, 2024. We adopted this method because it was quick, economical, and enabled us to reach a diverse group of participants, considering the constraints imposed by the ongoing conflict. Snowball sampling was utilised in our study to access hard-to-reach communities by leveraging trusted social networks, thereby helping overcome prevalent fear, mistrust, and logistical challenges. Given the non-probability sampling strategy, the sample may not reflect the underlying target population, and the results are exploratory and not intended to be generalized.

Study group

The study included 243 women and 122 of their children from all selected states in Sudan during the period of the military conflict. Our research participant recruitment strategy began with clearly defining the target population (women and children in Sudan who lived through the armed conflict), followed by the strategic use of online channels, particularly through social media, to reach and engage participants randomly. Not all questions were mandatory; therefore, the total number of responses varied across questions.

Data collection method and instrument

Data collection was conducted through a web-based approach to maximise accessibility and reach a diverse group of participants. A semi-structured questionnaire was developed by the authors, informed by an extensive review of the literature and aligned with the study’s objectives. The questionnaire was designed in English and translated into Arabic to ensure inclusivity and comprehension. The instrument included a consent form and five distinct sections. The first section gathered sociodemographic data relevant to the participants. The second section examined the impact of the conflict on participants’ education, detailing disruptions and the coping mechanisms employed. The third section focused on the psychological effects of the armed conflict on women, addressing emotional, mental, and behavioural responses. The fourth section examined the conflict’s impact on health, with a particular emphasis on women’s health issues, including access to healthcare and management of chronic conditions. The final section investigated the effects of the conflict on children, covering educational disruptions, mental health challenges, and physical well-being.

Arabic numbers (e.g., 1, 2, and 3) were used to label each questionnaire obtained from participants to ensure anonymity and confidentiality during the reporting of qualitative data. Using numeric codes instead of personal identifiers is a standard practice in research to protect participant identity and maintain privacy. For children under the age of 18, consent to participate in research is provided by one of the parents or legal guardians.

Data management and analysis

Data were initially entered using Microsoft Excel. The dataset was then imported into the Statistical Package for the Social Sciences (SPSS), version 20, for analysis. Descriptive statistics were employed to summarise the data, with categorical variables presented as frequencies (n) and percentages (%).

The significance of differences between groups was calculated using chi-square tests.

Ethical considerations ethics approval and consent to participate

This research protocol was approved by the Ethics Committee of Nile University, Khartoum, Sudan (http://www.nileuniversity.edu.sd). Informed consent was designed to ensure the confidentiality of each participant’s personal information.

All expected ethical concerns and processes were followed when collecting and reporting the acquired data, including safeguarding the confidentiality of all respondents and assigning them pseudonyms to protect their privacy. The researchers paid extra attention to properly obtaining informed consent from all participants.

Results

A total of 243 participants were admitted to our study during the study period. There was variation in the number of participants who answered each question on the survey. Some respondents intentionally or unintentionally skipped questions, resulting in incomplete survey responses and variations in the number of respondents who answered each question. Of these, 11.6% were aged 18–23 years, while 15.9% were between 24 and 29 years. The age group of 30–35 constituted 23.7%, and the majority (48.8%) were 36 years or older. 34.5% were single, and 57.8% were married. Most participants had graduated from college (48.3%), while 40.9% had completed postgraduate studies (Table 1). Fig. 1 shows that 41.8% of participants were employed, while 58.2% (n = 232) were unemployed. Furthermore, the data revealed that 90.1% of participants lived in Sudan, primarily in Khartoum, while 9.9% resided abroad (Figure S1, supplementary). 75% of the participants were residing in conflict zones with direct exposure to violence, 53.5% had relatives or friends injured in the conflict, and 45.8% had experienced the loss of relatives or friends due to armed violence. Additionally, 81.1% have been displaced or forced to migrate from their homes, with 45% facing displacement for a second time. Among the displaced, 48% moved to another state, 8.9% relocated to a different city within the same state, and 43.1% displaced outside the country (Table 2). Furthermore, 78% of families have been separated due to repeated displacements, while 22% remained together (Figure S2, supplementary).

Table 1.

Participant’s characteristics

Characteristics (n = 232)	Variables	Number (%)
Age group (years)	18–23	27 (11.6)
	24–29	37 (15.9)
	30–35	55 (23.7)
	≥ 36	113 (48.8)
Marital status	Single	80 (34.5)
	Married	134 (57.8)
	Divorced	11 (4.7)
	Widow	7 (3)
Qualifications	Postgraduate	95 (40.9)
	Graduate	112 (48.3)
	Others	25 (10.8)

Fig. 1.

Employment status of the participants

Table 2.

Difficulties and events that participants faced during the conflict

	Yes (%)	No (%)
Living in a conflict zone with direct exposure to violence (n = 204)	153 (75% )	51 (25%)
Relatives or friends injured during the conflict (n = 200)	107 (53.5%)	93 (46.5%)
Loss due to armed conflict (n = 203)	93 (45.8%)	110 (54.2%)
Displaced or forced migrated from home (n = 211)	171 (81.1% )	40 (18.9%)
Displaced to another state	108 (48%)
Displaced outside Sudan	97 (43.1%)
Displaced to another city in the same state	20 (8.9%)
Second displaced (n = 202)	91 (45%)	111 (55%)

Figure 2 illustrates the impact of conflict on education (n = 177). About 9% of participants chose to continue their studies within Sudan, while an equal percentage of women opted to study abroad; additionally, 8% pursued online education. Meanwhile, 74% are still undecided, with most women (73%) who wish to continue their education indicating they struggle to cope with the challenges posed by the war compared to 27% who have managed to overcome these challenges. Table 3 summarises the psychological effects related to PTSD and changes in sleep patterns. Participants in Fig. 3 identified various types of fear. Depression symptoms emerged as an arising issue from the war; women reported that approximately 48% experienced a loss of interest, 25.2% faced a reduction in appetite leading to significant weight loss, 34.3% lost their jobs, 47.8% reported a loss of energy, 38.3% experienced cognitive concentration issues, and 5.2% had suicidal thoughts (Fig. 4). Many women who participated in research studies often began experiencing unexplained symptoms. Headaches were reported by 33.6%, back pain by 26.2%, and abdominal pain by 9.2% (Table S1, supplementary). Additionally, 27.4% of participants suffered from chronic illnesses, including diabetes mellitus 16.1%, hypertension 33.9%, asthma 26.8%, and thyroid disease 14.3%. The armed conflict worsened their conditions as demonstrated in Table 4, with 56.3% noting a decline in disease management, 53.5% citing the lack of health centres, and 69.8% noting that many specialists have been displaced outside Sudan. Some women, 31.2% reported interruptions in their medication for various reasons: 58.7% faced drug supply disruptions, 41.3% switched medications, and 21.7% received a reduced dose. Regarding their gynaecological health, 56.9% of study participants reported irregular menstrual cycles, while 18.3% were pregnant or had conceived after April 15. Additionally, 36.4% experienced miscarriage or stillbirth for various reasons: 44.4% for unknown causes, 27.8% due to psychological factors, 11.1% due to insufficient chronic disease medications, 5.6% due to inadequate access to hospitals and antenatal care, and 11.1% due to prolonged travel during displacement (Table 5). Many women reported living in displacement shelters (n = 27), where most are deficient in essential services. Specifically, 63% lack adequate water, while 40.7% suffer from poor sanitation, and 63% face extreme weather conditions. When asked about their feelings regarding the war, 74. 2% expressed reluctance to discuss it, leading to a sense that they could not return to their pre-war lives (Table 6). The study also revealed that most children present during the war’s early days exhibited various depressive symptoms (n = 121). Specifically, 9.1% displayed aggression, 19.8% felt sad or had a negative mood, and 10.7% encountered concentration difficulties. Additionally, 1.7% experienced isolation, 10.7% showed frequent crying and changes in sleep patterns, 4.1% withdrew socially, another 1.7% lost interest in activities, and 16.4% were irritable or angry. Furthermore, 81.8% (n = 121) began using phrases related to the conflict in their daily conversations, while 85.2% (n = 104) expressed a desire to discuss ending the war and returning home (Fig. 5).

Fig. 2.

Depression among children typically presents with a range of symptoms

Table 3.

Shows the most common symptoms of psychological effects, which may occur in the form of sleep disturbances and symptoms of post-traumatic stress disorder (PTSD) [21]

Symptoms of post-traumatic stress disorder ( n = 227)	Yes (%)	Symptoms of sleep disturbance ( n = 229)	Yes (%)
flashbacks of the war events	30 (13.2%)	Insomnia	136 (59.4%)
Repetitive and distressing images	15 (6.6%)	Narcolepsy	37 (16.2%)
Avoiding people	39 (17.2%)	Urge to move the legs while trying to fall asleep	13 (5.7%)
Avoiding situations associated with the events	105 (46.3%)	Suffering from nightmares	28 (12.2%)
They didn’t suffer from anything	38 (16.7%)	They didn’t suffer from anything	15 (6.5%)

Fig. 3.

The most common depression symptoms among female participants

Fig. 4.

Participants' fear manifests in a number of symptoms

Table 4.

The effect of conflict on women’s health, particularly chronic illness

	Yes (%)
They suffer from chronic diseases (n = 223)		61 (27.4%)
Diabetes mellitus	9 (14.8%)
Hypertension	21 (34.4%)
Asthma	17 (27.9%)
Thyroid diseases	9 (14.8%)
Others*	5 (8.1%)
Interruption of obtaining chronic diseases medications (n = 109)		34 (31.2%)
Due to the interruption of the drug supply (n = 46)	27 (58.7%)
The medication was changed to another type (46)	19 (41.3%)
The dose was reduced (n = 46)	10 (21.7%)
Interruption of disease follow-up (n = 112) due to		49 (43.8%)
Absence of health centres (n = 43)	23 (53.5%)
Displacement of a large number of specialists (n = 43)	30 (69.8%)

*Heart diseases, Cancer, End-stage renal diseases, and mental health

Table 5.

Armed conflict disrupts women’s gynaecological and reproductive health through psychological distress, leading to increased rates of many complications

	Yes (%)
Gynaecological health
Disturbance of the menstrual cycle (n = 204)	116 (56.9%)
Types of menstrual cycle disturbances (n = 145)
It became irregular	50 (34.5%)
Associated with severe pain	24 (16.6%)
More days than usual	22 (15.2%)
Less days than usual	13 (9%)
It stopped since the beginning of the war	10 (6.8%)
None of the above	26 (17.9%)
Pregnant or has become pregnant after 15 April,2023 (n = 180)		33 (18.3%)
The baby was delivered alive and mature (n = 33)	21 (63.6%)
Had a miscarriage/still birth (n = 33)	12 (36.4%)
The loss of the fetus was due to (n = 18)
Psychological state	5 (27.8%)
Shortage of chronic diseases medications	2 (11.1%)
Traveling for a long time during displacement	2 (11.1%)
There is no hospitals and lack of antenatal care	1 (5.6%)
Unknown reason	8 (44.4%)

Table 6.

Participants' perspectives on the displacement shelters, discussion on the conflict’s events, and returning to everyday life

	Yes	P  < .05
Displacement shelters problems (n = 27)
Lack of adequate water	17 (63%)
Lack of sanitation	11 (40.7%)
Exposure to cold and hot weather	17 (63)
The possibility of discussing the events of the conflict and its consequences (n = 221)		0.007703
Yes	52 (25.8%)
No	151 (74.2%)
Ability of returning to everyday life before the war (n = 221)
Yes	86 (38.9%)
No	135 (61.1%)

Fig. 5.

The impact of armed conflict on the educational process for women

The armed conflict significantly exposed children to a wide range of psychological problems, according to mother’s observations (Fig. 6). 57.6% (n = 191) of the children involved in the study were under 18 and attending schools. A notable 87.6% (n = 121) had witnessed an act of armed conflict. Of those, 7% (n = 113) continued their studies within Sudan, 42.5% are studying outside the country, 13.3% enrolled in online classes, and 37.2% were still awaiting educational opportunities. There is a statistically significant difference (p = .000639) between the outcomes of children who witnessed armed conflict and those trapped within the country who were unable to resume their education (Table 7). Many children were self-reported by their mothers to suffer from malnutrition for various reasons (n = 36): 44.4% of mothers reported that due to reduced food intake, 19.4% because of limited access to nutritious food, and 36.1% owing to both factors for their children. Furthermore, 14.6% (n = 96) suffered from diarrhoea or other infectious diseases. The results also indicated that approximately 21.1% (n = 114) of children began wetting the bed after the conflict, while 10.5% (n = 114) complained of headaches and 11.4% (n = 114) reported stomach pain (Fig. 7). These results are based on self-reported data and should not be interpreted as population prevalence rates.

Fig. 6.

The impact of war on children's health as evidenced by various symptoms

Table 7.

Children who witnessed the armed conflicts and how war affected their educational process

	Yes (%)
Children who witnessed armed conflict (n = 121)		106 (87.6%)
Current educational status (n = 113)
Continue studying outside Sudan	48 (42.5%)
Continue studying inside Sudan	8 (7%)
Continue studying online	15 (13.3%)
Still waiting	42 (37.2%)
p-value < 0.05		0.000639

Fig. 7.

Psychological changes observed in children who were exposed to armed conflict showed a significant association (P < .05)

Discussion

This study’s findings emphasise the devastating effects of the ongoing war on women and children who participated, reflecting how it affected their psychological well-being, education, and health. The participant demographic data indicate that most participants were middle-aged, with nearly half aged 36 or older, and many were married and possessed a college education. This profile indicates that respondents are primarily individuals with significant family and educational responsibilities, making them especially vulnerable to the turmoil caused by armed conflict.

Health impact

Among surveyed participants, the conflict was associated with substantial psychological distress. It has imposed a profound psychological impact on women, with nearly 50% showing symptoms of depression, including reduced interest and energy, difficulty concentrating, and significant weight loss. Alarmingly, about 5.2% have reported thoughts of suicide. These findings are consistent with earlier research on the mental health effects of warfare in Sudan [22] and among refugees from other conflict-affected countries like Syria and Ukraine [23, 24]. A study among Ukrainian refugees in Germany revealed that 46% of women suffered from severe psychological distress, compared to 20% of men, as per the 12-Item General Health Questionnaire (GHQ-12) results [23]. Another study conducted by Kheirallah et al., focusing on female Syrian refugees in Jordan, found that a significant proportion reported distress symptoms, with 90.5% identified as being at high risk for depression, anxiety, and PTSD [24].

Additionally, the conflict worsened physical symptoms, such as headaches, back pain, and stomach pain, reflecting common physical manifestations linked to psychological distress, trauma, and chronic stress experienced during and after armed conflict. Many women participating in the study suffered from chronic conditions, including hypertension, asthma, and diabetes, and the disruption of healthcare services, like medication shortages and the displacement of medical professionals, has made disease management significantly worse. For instance, the collapse of cancer services in Sudan due to the ongoing conflict has severely exacerbated the challenges faced by individuals suffering from the disease, as highlighted by Hammad et al. While decentralised centres located in relatively safe cities, such as Merowe, Shendi, Port Sudan, and El Gadarif, have attempted to meet the rising demand, resource shortages and unsafe travel routes limit their effectiveness [25]. This disruption not only worsens physical health conditions but also heightens psychological distress, underscoring the urgent need for support to restore healthcare services and address the compounded mental health burden of the conflict.

When designing the questionnaire for the study, the focus was on identifying symptoms and signs indicative of the onset of psychological disorders due to war trauma. The aim was to capture early mental health indicators such as symptoms of PTSD, depression, anxiety, and insomnia, which are common among conflict-affected populations in Sudan and similar contexts. It was recognised that while the questionnaire could screen for these symptoms, the final diagnosis must be made by psychological specialists when available. This approach ensures that appropriate treatments and interventions are tailored to each case, taking into account the complexity of mental health conditions and the need for professional assessment and support. This process acknowledges the challenges in war-affected regions like Sudan, where access to mental health specialists is limited. Yet, early identification through symptom-focused screening can help in prioritising care and referrals for those most in need. The questionnaire, therefore, serves as a practical tool for preliminary assessment, feeding into a more comprehensive diagnostic and treatment pathway when specialist resources are accessible.

Educational and social disruptions

The educational pursuits of the surveyed women have been severely disrupted by the conflict, with 74% of participants undecided about their educational future. Challenges such as displacement, lack of access to resources, and psychological stress impede progress for many. While some have sought alternative solutions, such as online education or studying abroad, the majority struggle to cope with the demands of continuing education amid war. These barriers not only limit personal growth but also hinder the socioeconomic recovery of affected regions.

The social fabric of communities has been deeply fractured, as evidenced by the high displacement rates (81.3%) and widespread family separations (78.3%). Many participants experienced repeated displacements, with some fleeing to other countries. Displacement shelters, often lacking basic necessities such as adequate water and sanitation, exacerbate the hardships faced by women and their families. This precarious living environment contributes to a sense of despair, with many women reluctant to discuss their experiences and fearing they will never regain their pre-war lives.

At the end of 2023, the Rapid Support Forces (RSF) took control of Al-Jazeera State, the second-largest state after Khartoum. Consequently, around 90% of those displaced from Khartoum experienced displacement again, severing communication with them. A third state was taken over by the Rapid Support Forces (RSF) during the course of the study. This resulted in another displacement, leading to the loss of contact with several other participants. Moreover, many participants were unable to engage due to trauma. The most significant obstacle was the complete disruption of internet services in these three states, resulting in a notable decrease in participant numbers from them.

Reproductive health crisis

The results also highlight the impact of armed conflict on the reproductive health of female participants. More than half of them reported irregular menstrual cycles, and many pregnant women experienced miscarriages or stillbirths due to psychological stress, limited healthcare access, and insufficient treatment for chronic diseases [26]. The reproductive health challenges faced by women during the Sudan conflict are further illuminated by findings from recent studies on maternal health in conflict-affected areas. One study in Sudan revealed that 86.6% of women lacked access to healthcare services, with nearly a quarter experiencing adverse outcomes such as complications during pregnancy and delivery [27]. Key factors contributing to these outcomes included limited access to healthcare, advanced gestational age, and the severity of conflict. Another retrospective study conducted at Jiblah Referral Hospital in Yemen highlighted how conflict exacerbates maternal mortality, with 88.5% of maternal deaths involving women who lacked regular antenatal care and 86.5% being referred cases [18]. The primary causes of death, including severe bleeding, pre-eclampsia, and eclampsia, were often associated with delays in seeking care, reaching health facilities, and receiving adequate treatment. These findings share striking similarities with the high rates of miscarriages and stillbirths reported in our study, where psychological stress, inadequate access to antenatal care, and disrupted chronic disease management were identified as major contributors. Together, these studies emphasise the urgent need to prioritise maternal healthcare in conflict settings to mitigate the compounded risks to reproductive health.

Impact on children

Mothers explained that child participants have disproportionately borne the burden of the conflict, showing notable psychological distress reflected in aggression, sadness, irritability, and social withdrawal. Many of those affected by the conflict have started using war-related language in their daily conversations, highlighting the profound psychological impact of the violence they’ve experienced. The psychological changes and distress experienced by mothers during and after armed conflict are strongly influenced by the trauma their children sustain. Witnessing children’s suffering, such as anger, sadness, irritability, and withdrawal, intensifies mothers’ feelings of helplessness, anxiety, and emotional pain. In addition, mothers experiencing higher levels of distress may have been more likely to report difficulties related to their children, which could have introduced a reporting bias in estimates of maternal distress. Educational disruptions have been severe among the participants, with many children either waiting for school opportunities or trying to learn through online platforms and foreign institutions. These challenges, along with the physical consequences of malnutrition signs, infectious diseases, and psychosomatic issues like bedwetting and abdominal pain, paint a grim picture of the long-term effects of the war on Sudan’s youth. Our findings regarding the effects of armed conflict on children among the study group closely resemble broader trends observed in the Middle East, which underscore the psychological and emotional impacts of war on young individuals [28]. Common psychological responses noted in our study, including nightmares, sleep difficulties, headaches, bedwetting, withdrawal, and concentration issues, align with those found in other regions affected by conflict. Although many children show a “natural” recovery over time, prolonged exposure to violence and a lack of a safe environment can obstruct complete recovery, leaving lasting psychological scars. The UN Security Council identifies six grave violations against children in armed conflict, with significant and lasting impacts on their mental health and psychological well-being. Mental health and psychological trauma are key effects resulting from exposure to violence, fear, lack of services, and family separation, often leading to PTSD, depression, anxiety, and persistent emotional distress [6]. In Sudan, the breakdown of family structures due to displacement and conflict also mirrors what is seen throughout the Middle East, where the loss of relatives, separation, and lack of psychosocial support disrupt children’s fundamental coping mechanisms [28]. Furthermore, the psychological exhaustion experienced by women, often the primary caregivers, heightens children’s emotional distress, emphasising the interconnectedness of family and child well-being during times of conflict. These similarities highlight the urgent need for integrated psychosocial interventions for both children and their caregivers in conflict-affected areas.

The psychological symptoms, such as symptoms of PTSD in children, often include flashbacks, nightmares, severe anxiety, and uncontrollable thoughts about the traumatic event [21], with each child displaying unique combinations of these symptoms. The impact on mental health and development can be profound, sometimes manifesting as additional disorders like anxiety and depression, particularly in war-affected environments. Due to the lack of psychological specialists and general practitioners in host states and refugee shelters, questions were specifically designed to provide clear indications of both the psychological and physical health of participants without clinical assessments.

Our study was based on a self-selected online sample, which may have overrepresented women with internet access, higher education, and relative stability, while underrepresenting displaced and rural populations. Information was entirely self- or proxy-reported without clinical verification, meaning that conditions such as depression, malnutrition, or chronic illness reflect perceived experiences rather than confirmed diagnoses. Moreover, most questions were binary (yes/no), limiting the ability to assess the severity or frequency of symptoms. As such, the results should be viewed as indicative signals of distress among participants rather than as prevalence estimates for the broader Sudanese population. This study aimed to examine the largest group of displaced women and children across all Sudanese states affected by conflict. Nonetheless, the authors faced several limitations, resulting in a relatively small sample size, which in turn limited the generalisability of the findings. Information bias, where participants may misinterpret questions, is another factor that could have reduced the accuracy of our data. Another notable limitation in our study was not using graded scales, such as the GHQ-12, to measure the extent of impact. Yet, we intend to utilise this in a follow-up study.

Implications and recommendations

This study offers early signals of an emerging crisis and highlights the importance of a comprehensive approach to assess the magnitude of the impact and mitigate the effects of armed conflict on women and children in Sudan. To address extensive mental health issues, NGOs and policymakers should prioritise deploying mobile teams to provide trauma counselling and establish safe spaces for psychological support. Using tools such as Refugee Health Screener-15 (RHS-15), Harvard Trauma Questionnaire (HTQ), Hopkins Symptom Checklist-25 (HSCL-25), and Screening Tool for Asylum-seeker and Refugee Mental Health (STAR-MH), which are accessible to non-specialists, can ensure that essential screening is possible even in resource-limited environments like the affected Sudanese states. Improving healthcare infrastructure and ensuring reliable access to medications are also essential for managing chronic conditions and providing reproductive health services. Moreover, mobile clinics are vital for delivering crucial maternal and child healthcare, including vaccinations and treatment for signs of malnutrition. The distribution of dignity kits and the development of women-friendly health services are key to addressing their specific needs. Collaborative efforts in peacebuilding and investment in health infrastructure are fundamental for restoring and maintaining essential services and achieving better outcomes in conflict-affected regions. Additionally, it is essential to improve living conditions in displacement shelters by addressing shortcomings in water, sanitation, and other fundamental needs. Prioritising efforts to reunite families and rebuild community connections will help promote resilience and recovery among affected individuals.

Ensuring the adoption of agreements like the Safe Schools Declaration (SSD) is central to protecting children’s educational rights during wars. Integrating these psychosocial, health, and education interventions is vital for fostering resilience and supporting the recovery of our Sudanese community.

Conclusion

This study provides preliminary, self-reported evidence of the psychological, educational, and health impacts among participating women and children, and it offers indicative signals of crisis conditions rather than population-level estimates. It underscores the need for collaboration among local and global stakeholders to address these issues. By prioritising mental health care, improving healthcare access, ensuring educational stability, and enhancing living conditions, we can alleviate suffering and promote long-term resilience for those affected by the conflict.

These results mirror the broader reality across Sudan, where the population of displaced women and children continues to rise, maternal and child mortality rates are escalating, and psychosocial trauma is deepening. The study’s findings highlight urgent humanitarian needs and underscore the profound vulnerability and resilience of these groups amid protracted conflict.

Despite sampling or access limitations, this study provides the first systematic quantitative evidence from Sudanese women and children during the 2023–2024 conflict.

Abbreviations

SAF

Sudanese Armed Forces

RSF

Rapid Support Forces

PTSD

Post-traumatic stress disorder

WASH

Water, sanitation, and hygiene

GHQ-12

The 12-Item General Health Questionnaire

SPSS

Statistical Package for the Social Sciences

SSD

Safe Schools Declaration

Authors’ contributions

All authors contributed significantly to the publication, whether through designing the questionnaire, conducting data analysis, or writing the manuscript. They have agreed to the content of the manuscript and declared no conflict of interest. TAMI conceptualised the study, contributed to data analysis, and wrote and revised the final manuscript. SAMI revised the questionnaire questions and wrote the manuscript. RSA contributed to data analysis, redesigning tables and figures, and writing and revising the final manuscript.

Funding

We did not receive any funds to conduct the study.

Data availability

All data generated or analysed during this study are included in this published article.

Declarations

All methods were carried out in accordance with relevant guidelines and regulations.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.