Amid the all-encompassing war that has ravaged Sudan since April 2023, a handful of civic initiatives have emerged as the last line of defense against the total collapse of the country’s health sector. Among the most prominent of these is the Sudanese American Physicians Association (SAPA), which began as a modest network of Sudanese doctors in the United States supporting the healthcare workers’ strike during the December Revolution. Since then, it has grown into one of the most effective and visible organizations in Sudan’s humanitarian and medical landscape.
This in-depth interview with Dr Yasir Yousif, President of SAPA, offers a rare documentation of an organization that has expanded at a remarkable pace—from a solidarity initiative with a revolutionary cause to a complex network that operates hospitals and health centres and delivers aid in some of Sudan’s most challenging regions. The conversation traces SAPA’s path from inception to growth, delves into its administrative and financial structures, and explores the hurdles of navigating coordination with authorities, all while attempting to strike a balance between emergency responses and building a sustainable health system.
The discussion also addresses SAPA’s stance on sensitive issues such as neutrality and operational constraints amid shifting territorial control, as well as lessons learned from fundraising, engagement with Sudanese diaspora communities, its cholera response experience, and the organization’s long-term vision.
This dialogue not only captures the rise of one of the most impactful Sudanese diaspora-led initiatives, but also serves as a window into Sudan’s health and political realities from a seldom-seen perspective: a local actor operating from within the heart of the crisis, standing at the threshold between collapse and recovery, politics and humanity, the possible and the impossible.
1. To begin, let us talk about the origins. When was SAPA founded, and what motivated its creation?
SAPA was founded in 2019, during a time when most Sudanese abroad had grown disillusioned with public engagement, weighed down by a sense of despair over the situation back home. The December Revolution came as a surprise, and affected me personally. At the time, doctors in Sudan were on strike, and we began to ask ourselves: what could Sudanese in the United States do to support this strike and the broader popular movement?
We quickly ran into the reality that the organizational model here differs from that in Western Europe or the UK and Ireland, where strong and active Sudanese doctors’ unions already exist. In the US, no such framework was in place. It took a momentous event like the revolution to awaken people to the importance of organizing and collective action.
SAPA’s primary goal at the outset was to support the doctors’ strike and the revolution. It was a moment of genuine inspiration that brought people together in unprecedented numbers. We formed a founding committee, drafted a constitution, and held our first board elections, which now recur every two years.
Initially, our focus was purely on delivering financial support to the striking doctors, given that it was one of the longest medical strikes in Sudan’s history. Over time, our ties with the Resistance Committees deepened, and we began supporting them with printed materials and supplies for the sit-in. When the transitional government came to power, our focus partially shifted toward strengthening Sudan’s health system. Later, following the 2021 coup, we redirected our efforts back toward supporting Resistance Committees, until the war broke out in April 2023. That war has since redirected the majority of our work toward humanitarian relief.
2. How has the current war affected SAPA’s work? Has it changed your priorities or strategic vision?
Our original mission, as stated in our constitution, rests on three pillars: supporting human rights, promoting democracy, and strengthening Sudan’s health system. Humanitarian work was not among our initial priorities, nor was it part of any formal plan. But it was thrust upon us by necessity and by the rapidly shifting reality.
We found ourselves in a critical moment. International agencies had become largely immobilized within Sudan, and local organizations with experience were not equipped to handle a crisis of this magnitude. Because SAPA’s board operates from abroad, and because we already had a solid fundraising infrastructure, we were uniquely positioned to mobilize donations quickly. We also enjoyed a high level of credibility. To be candid, pivoting toward humanitarian relief was not a premeditated decision. It was a compelled response to the demands of the moment.
As the war escalated, our resources surged, and our budget expanded almost a thousand fold. In the early days of the war, most SAPA members were aligned with the spirit of the December Revolution. There was a prevailing belief that this war would be short-lived. But as it dragged on, diverging perspectives began to emerge within our ranks regarding the conflict. What ultimately held us together was humanitarian work.
A consensus took shape: this was the one area where we could genuinely make an impact, a space in which we could tangibly improve people’s lives. At the same time, there was a deep-seated determination to preserve our presence in the Sudanese public sphere, in whatever form possible.
In short, this shift was not the result of long-term strategic planning, but rather a necessary and urgent response to an unfolding catastrophe.
3. Amid the complexities of war, how do you navigate the shifting lines of control? Do you have any red lines when it comes to coordination or working in areas under the control of one side?
We try, as much as possible, to operate with full transparency with the authorities in control on the ground. We do not undertake any activity, whether it is opening communal kitchens, running clinics, or distributing food, without informing the responsible authorities in that area.
No matter how much we strive to maintain our independence, a degree of interference or control is inevitable. However, as an organization, we are always clear about what we accept and what we do not. For example, we may agree to have an authority inaugurate a site or carry out a routine inspection. But what we categorically reject is being dictated to or coerced into providing services to one group over another. In such cases, we simply refuse to comply.
What we prioritize, above all, is building direct communication with communities, and our deep understanding of Sudan, having studied and lived there, has been instrumental in this regard. Typically, those working in a particular location are from that very community. For example, our staff in Saraf Omra and in Al-Fashir are locals. This gives them a better capacity to navigate complexities and interact with whichever authority is in control.
The real challenge arises when control over an area changes hands. In such instances, the new authority often views us with suspicion, assuming we are aligned with the previous power. Over time, however, we have managed to build a minimum level of trust with all sides.
The greatest danger, in our view, lies in the overall chaos in Sudan. You may coordinate smoothly with a given authority at the local, state, or even national level, but due to the proliferation of weapons and lack of hierarchy, another group with no knowledge of prior agreements can suddenly pose a threat. This, in our view, is the most serious risk facing any humanitarian actor in Sudan.
We believe the best path forward is to strengthen communication with the controlling authorities and to rely as much as possible on local staff. Still, some of our team members have faced difficult situations, including having their phones and Facebook accounts searched, and being harassed by various groups.
Another painful reality we’ve had to come to terms with is the need to forgive. In the past, if any of our staff were mistreated, we would respond strongly and immediately. Today, however, amid war, we face unbearable violations, and yet remain silent. Not out of fear, but to prevent greater retaliation against our colleagues or beneficiaries. It is a bitter reality we live with every day.
We take pride in being perhaps the only nationally registered Sudanese organization that operates in a balanced and sustained manner across all territories.
4. How does SAPA determine its areas of operation? Do you work in some regions and avoid others?
There is a common perception that most of SAPA’s activities are concentrated in areas controlled by the Sudanese Armed Forces (SAF), but that is not entirely accurate. In reality, we have a strong presence in areas under the control of the Rapid Support Forces (RSF), though we do not publicize this work as openly as we might.
For example, we currently run Nyala Hospital in its entirety, along with another hospital and two health centres in the same city. We also conducted a large-scale food distribution campaign in Munawashi, Saraf Omra, and Al-La’ayit, and until quite recently, we were the sole provider of health services in those areas. This reflects our broad footprint across Darfur—even if we sometimes choose not to disclose the full extent of our work, to protect our teams and ensure continuity in a highly volatile environment.
Ultimately, we are a registered Sudanese civil society organization, committed to the Humanitarian Aid Commission (HAC) regulations. When we work in RSF-held areas, we notify HAC and obtain the necessary permits. However, publicizing such activities, given the current political polarization and fragmented control structures, could create serious problems, especially in the face of rising hostility toward any notion of humanitarian neutrality.
That said, we take pride in being perhaps the only nationally registered Sudanese organization that operates in a balanced and sustained manner across army-controlled areas, RSF territories, and even in regions under the control of Abdel Wahid Mohamed Nour’s faction. In Tawila, for instance, we have been among the largest service providers for more than a year and a half.
Maintaining this balance is not easy, but it is essential. We do our utmost to preserve our independence and continue delivering humanitarian services without becoming a party to the conflict—or a tool in the hands of any faction.
Openness, as a work ethic, was central to our development.
5. Tell us about the administrative and financial journey of SAPA. How has it evolved, and what factors have contributed to its success compared to other experiences?
I don’t want to sound overly romantic, but I truly believe the moment in which SAPA was founded played a major role in its success. It was a time of passion and ambition. I still remember the overwhelming sense of purpose at our founding conference in late August 2019, although SAPA was officially established in January that same year. Even before the conference, we were already fundraising, sending donations to Sudan, and engaging with US legislators. At the time, the discussions revolved around developing the health system and exploring how members of the diaspora could contribute to supporting their country. That moment sparked a strong sense of motivation among people and inspired a genuine desire to learn from the experiences of others.
We drafted our organization’s constitution by drawing on the models of other diaspora organizations, whether from Sudanese who had preceded us or from other communities like Indians, Pakistanis, and Syrians, groups with rich experience and budgets in the hundreds of millions of dollars. We adapted those models and improved our own processes, especially when it came to fundraising. Today, we have one of the most efficient systems in that regard, and we have learned a great deal from American and Canadian organizations we have partnered with. In fact, some of them now jokingly say we have become better than they are!
For instance, American Muslims donate nearly four billion dollars annually, and competition among charities for that support is intense. During the last Ramadan, we ranked at the top of fundraising charts during the first three days, surpassing even campaigns for Gaza, despite Sudan often being overlooked. I believe diversifying our funding sources and building a good reputation have both played key roles. I can’t pinpoint a single lesson or reason for our success, but I do think passion and ambition, combined with a genuine willingness to learn from others, were critical elements.
I also cannot overlook the contributions of Sudanese professionals working in the UN system, in companies, or in the U.S. Department of Health. They were looking for ways to give back, and they found SAPA to be the right vehicle. I remember how they helped us learn to write funding proposals, which had a huge impact on the scale of support we received. One of our projects received funding ten times greater than what UNICEF typically provides for a first grant. Similar things happened with the WHO and IOM. Even Sudanese working at major tech firms like Google helped channel donations for Sudan through us.
I believe openness, as a work ethic, was central to our development. When we prepared our most recent strategic plan, most of the contributors were actually outside SAPA’s membership, including former health ministers and academics from prestigious institutions like Oxford. They shared ideas and helped push the project forward. This openness inspired many to get involved and support us. In contrast to some civil society organizations that predated the revolution, many of which adopted a culture of isolation due to years of conflict with the former regime, we were born in a new moment, and our spirit was far more open and collaborative.
6. How were you able to transfer this experience to your engagement with initiatives like the Grassroots Coordination Council and Emergency Response Rooms?
We had high hopes for these initiatives, but to be frank, our role could have been more significant. We have very strong relationships with neighbourhood resistance committees and emergency rooms, and we could have contributed more deeply to the coordination council experience.
We did try to share some of our organizational and administrative expertise with them, and they, in turn, possess skills and knowledge that far exceed ours in many areas. The relationship was mutually beneficial: we learned from them, and they learned from us. I believe one of the most important roles SAPA can play in this space is to serve as a bridge, between international donors and local organizations, and also between official institutions and grassroots groups like emergency rooms or transitional trade unions.
At the start of the war, we were highly engaged and worked closely with them. But with the organization’s rapid and unexpected expansion, coordination decreased, and we were no longer working together as effectively as before. This is something we need to revisit and improve in the future.
We uphold one non-negotiable principle: the neutrality of healthcare services.
7. What is SAPA’s long-term strategy? Can it strike a balance between emergency relief and building sustainable healthcare infrastructure?
SAPA’s long-term strategy is grounded in a profound understanding that crises, even protracted ones, are ultimately temporary, and that the road to recovery begins even in the darkest phases of war. From this perspective, SAPA’s efforts were never limited to emergency response alone. Strategic thinking was present from the outset, even amid the peak of health system collapse.
At one stage of the war, approximately 70 per cent of health facilities had ceased operations, leaving a large number of medical professionals, mostly still within Sudan, without employment. This reality presented an opportunity to swiftly hire new staff, offering salaries higher than those paid by the government, though still lower than wages in the diaspora. SAPA capitalized on this situation by adopting a dual approach: direct employment and support for the existing healthcare system. At one point, SAPA was paying salaries or incentives to some 4000 health workers, even though they were officially affiliated with the Ministry of Health. Today, it continues to support around 1300 personnel.
In addition, some of SAPA’s staff are employed full-time, particularly in clinics and health centres it fully manages, such as in Dongola. In other facilities, like the intensive care unit in Port Sudan, staff are administratively under the Ministry but receive their salaries from SAPA. This hybrid model enabled the continuity of healthcare delivery in the absence of government funding and fostered mutual trust between SAPA and official institutions.
In terms of sustainability, SAPA anticipates that Sudan’s health sector will remain chronically underfunded, even after the war ends. Therefore, the organization sees partnerships with the state and international agencies as essential. While the WHO initially described SAPA’s salary support initiative as “non-scalable,” it later backed the project financially, and even replicated the model in other areas.
As for infrastructure, SAPA has sought a balance between emergency response and long-term recovery. It didn’t settle for temporary service provision; it took the initiative to repair and reopen essential health facilities, such as the Saudi Maternity Hospital, which later became the largest hospital in Sudan. Its interventions have also included establishing intensive care units and opening new hospitals. These steps were deliberate and carefully planned, not ad hoc reactions.
Operationally, management models vary. Some field clinics are fully run by SAPA, while others, such as the ICU in Port Sudan and Al-Buluk Hospital, remain under Ministry control despite being funded by SAPA. In places like Dongola and Madani, SAPA assumes direct management. Across all settings, however, SAPA upholds one non-negotiable principle: the neutrality of healthcare services. All medical interventions must be guided strictly by humanitarian need and the availability of security, regardless of who controls the area. SAPA considers the classification of locations as off-limits purely based on military control maps to be a betrayal of humanitarian principles and medical neutrality in times of war.
Regarding access to medicines, the experience has been complex. While U.S.-based organizations sent over 65 tons of medications early in the war, logistical challenges—including port and licensing complications, impeded the process. SAPA increasingly turned to the local market, where procurement is faster and more practical, despite higher costs. In some cases, local pharmaceutical networks, including drug traders, played a key role in distribution and even donated entire warehouses of supplies. Although SAPA still imports medicine, reliance on the local market is growing, especially with informal community support.
Medicine quality remains a concern, but SAPA has established quality control mechanisms. Shipments arriving in Port Sudan are inspected by the Pharmacy and Poisons Board, while locally sourced drugs are tested based on their type, especially life-saving medications. However, the lack of a comprehensive regulatory system during wartime continues to pose a major challenge for any actor working in the sector.
8. How has SAPA responded to the current cholera outbreak in Sudan? What obstacles are hindering epidemic control efforts?
With the onset of cholera season, the situation in Sudan worsened significantly due to the collapse of water and electricity services and the deteriorated health system, which was unprepared for such crises. Khartoum State, particularly areas like Al-Salha and Al-Qi’ah, has been among the hardest hit due to chronic water issues. Despite the escalating crisis, the Ministry of Health and humanitarian organizations have begun attempting to coordinate their response.
Cholera, at its core, is a social disease. In its early stages, it requires access to clean water and proper sanitation; in later phases, treatment with IV fluids and antipyretics becomes necessary. As epidemiological history shows, outbreaks typically rise and eventually decline after reaching a peak. Our responsibility is to reduce the human toll, and we hope the current wave will begin to subside soon.
For our part at SAPA, we previously had a high capacity for rapid emergency response, thanks to flexible decision-making and quick budget allocation. However, as the organization expanded and began focusing more on primary healthcare, a fundamental question arose: Should we continue allocating resources to emergency response? The answer is not straightforward. It depends on whether we can achieve meaningful impact.
In crises like cholera, humanitarian imperatives and public expectations push us to act, and we do, despite the challenges. We currently maintain a strong presence in Khartoum State and are capable of mounting an effective response. That said, the cholera crisis has evolved into an issue where health and politics intersect.
There is an official emergency coordination mechanism—Sudan’s Federal Emergency Operations Centre, which is supposed to meet daily, as well as the Health Cluster led by the United Nations, which includes WHO and UNICEF. Typically, the Ministry coordinates these meetings with WHO, but in this crisis, it has taken on full responsibility, including publishing the case numbers.
The outbreak has significantly affected our daily operations. We are not a large organization that can absorb a crisis of this scale without consequences. Administrative and coordination burdens have doubled. Responding to a cholera outbreak requires full attention and forces us to continuously ask: Are we truly capable of managing an emergency in this complex?
9. What are SAPA’s short-term plans? And how do the challenges differ between operating in the absence and presence of the state?
SAPA’s experience shows that humanitarian work in emergencies, especially during times of weakened state institutions, can sometimes be more straightforward than during periods when governmental structures are more present. For instance, the organization was able to expand in Khartoum during the early months of the war, benefiting from the absence of some bureaucratic hurdles that tend to accompany the reemergence of formal institutions. As certain government frameworks have reappeared, additional challenges have emerged, particularly around coordination and regulatory procedures, an understandable development given the country’s complex circumstances. In some cases, official entities approach civil society organizations with caution due to historical tensions and previous experiences, even though there have been commendable efforts by certain officials to facilitate cooperation and foster complementarity.
In this context, the organization notes that operating in areas with a limited official presence often provides more flexibility to deliver services, such as in the current expansion taking place in Tawila, where the environment is relatively conducive for healthcare provision and humanitarian response.
Looking ahead, SAPA places primary healthcare at the forefront of its priorities, viewing it as the essential foundation for saving lives. The aim is for every mother to have a safe pregnancy, for every child to receive timely vaccinations, and for these services to remain accessible under all circumstances. Yet the vision does not stop there. SAPA also aspires to contribute to the development of national health policy in Sudan. Recently, the organization participated in an international meeting in Kigali, Rwanda, on the future of the health system. One of the main recommendations from the meeting was the establishment of an independent health policy institute. SAPA has committed to providing seed funding for this initiative, which will operate entirely independently from the state. The institute is expected to launch soon and will offer a significant contribution to strategic health thinking in Sudan.
In parallel, SAPA continues to provide direct healthcare services, fully aware that the recovery phase, despite its high cost, is no less important. The organization seeks to strike a balance between immediate emergency response and contributing to the development of a more sustainable health infrastructure, within the limits of available resources.
10. How does SAPA view the role of community awareness and training alongside direct healthcare services?
This is one of the least costly interventions, yet its impact is enormous, as it is essentially about sharing knowledge. SAPA tries to focus on topics that align with its services—such as workshops on community-based management of severe acute malnutrition, how individuals without medical backgrounds can respond to such cases, maternal and child health, and gender-based violence. All of this is naturally contingent on what the relevant institutions permit. It’s a low-cost, high-impact area of work.
