Introduction
The 2023 conflict in Sudan has triggered a humanitarian crisis affecting millions, yet mental health remains evidently absent from the international response. Despite global frameworks such as the Sustainable Development Goals (SDGs 3.4, 3.5) and WHO’s Mental Health Gap Action Programme (mhGAP) that prioritize mental health in emergencies, translation into practice remains elusive in active conflict settings. Sudan exemplifies this implementation gap: with fewer than 100 psychiatrists for 45 million people and two-thirds of hospitals currently non-operational, the already fragile mental health infrastructure has collapsed precisely when psychological distress is escalating.Reference Khalil, Mohammed and Ahmed
1
, Reference Hussein, Saleeb and Tolba
2 Over 10 million people have been displaced, health care facilities have sustained more than 100 attacks, and pharmaceutical supply chains have disintegrated.
3 While infectious disease outbreaks, malnutrition, and displacement have received international attention, the mental health dimensions of this crisis have been largely overlooked.
4 Recent studies document high rates of post-traumatic stress disorder (PTSD), depression, and anxiety among refugees, internally displaced persons, and health care workers,Reference Khalil, Mohammed and Ahmed
1
, Reference Hussein, Saleeb and Tolba
2
, Reference Ahmed, Gasmalha and Ahmed
5 yet mental health programming remains peripheral to humanitarian operations. This commentary examines the mental health burden in Sudan’s conflict, synthesizes evidence from comparable crises, and proposes a practical framework for immediate integration of mental health into humanitarian response. The framework’s components draw directly on the IASC MHPSS Guidelines and WHO’s mhGAP; they are not new principles. Our contribution is their application to a setting most published IASC/mhGAP work does not address in combination: near-total infrastructure collapse, an active front line, and parallel SAF- and RSF-administered authorities. We further argue the implementation gap reflects not a lack of technical guidance but the near-absence of dedicated mental health financing in humanitarian appeals.
Background: The Mental Health Crisis in Sudan
Sudan’s mental health system was critically under-resourced even before the conflict. With a psychiatrist-to-population ratio of approximately 1:500,000, the country faced severe shortages of mental health professionals and limited service availability outside major urban centers.Reference Osman, Mohamed and Nashwan
6 The 2023 conflict has exacerbated these pre-existing deficiencies: hospital closures, supply chain disruptions, and attacks on health care facilities have effectively dismantled what limited infrastructure existed.
3
Recent epidemiological evidence highlights a substantial mental health burden among populations affected by armed conflict. High rates of post-traumatic stress disorder (PTSD) have been reported among both displaced and non-displaced individuals living in conflict-affected regions, alongside significantly reduced psychological well-being across diverse demographic groups.Reference Khalil, Mohammed and Ahmed
1
, Reference Hussein, Saleeb and Tolba
2 Individuals with chronic illnesses appear particularly vulnerable, experiencing compounded psychological distress during periods of instability and violence.Reference Ahmed, Gasmalha and Ahmed
5 These observations are consistent with global estimates indicating that conflict-affected populations experience PTSD prevalence rates of 15–30%, while depression affects more than 30% of individuals in these settings.Reference Tol, Barbui and Galappatti
7
Health care workers themselves constitute a critically affected population. Those remaining in conflict zones face dual burdens: delivering care under extreme conditions while experiencing their own psychological trauma. This workforce attrition threatens to deepen the crisis as experienced providers leave the system.Reference Osman, Mohamed and Nashwan
6
Three populations warrant explicit prioritization. Survivors of conflict-related gender-based violence (GBV) require case-management pathways linked directly to mental health referral systems rather than run in parallel. Children, an estimated three in 5 internally displaced Sudanese, need developmentally appropriate, school- and caregiver-based interventions. Persons with disabilities face additional access barriers and are named as a heightened-risk group in the 2026 Sudan Humanitarian Needs and Response Plan.
8 We integrate these groups into the framework below rather than treating them as an afterthought.
Global Lessons From Conflict Settings
Evidence from protracted conflicts demonstrates that mental health integration is feasible even amid active hostilities. Syria’s decade-long conflict has shown that tele-psychiatry can maintain specialist access when physical movement is restricted.Reference Jefee-Bahloul
9 Yemen’s humanitarian response has demonstrated that community-based psychological interventions can operate despite infrastructure destruction. Ukraine’s 2-year experience has documented both the rapid escalation of mental health needs during war and the potential for scalable service delivery through primary care integration.Reference Pinchuk, Yachnik and Goto
10
Three key lessons emerge from these contexts. First, task-shifting psychological interventions to non-specialists significantly expands service reach. Pakistan’s Problem Management Plus (PM+) trial demonstrated that lay health workers can effectively deliver psychological first aid, reducing distress and improving functioning in conflict-affected communities.Reference Dawson, Bryant and Harper
11 Qualitative systematic reviews confirm the feasibility and acceptability of lay health worker models across diverse crisis settings.Reference Shahmalak, Blakemore and Waheed
12
Second, telemedicine bridges critical access gaps. Systematic reviews of telemedicine interventions in WHO’s Eastern Mediterranean Region demonstrate that remote mental health delivery is feasible during conflict, though sustainability requires infrastructure investment.Reference Jefee-Bahloul
9 Syria’s experience specifically highlights tele-psychiatry’s role in extending specialist care to displaced populations when travel is impossible.Reference Parkes, Pillay and Bdaiwi
13
Third, primary care integration enhances both reach and acceptability. Post-conflict programs in Sri Lanka demonstrated that training primary health workers using WHO mhGAP materials improves early detection and management of mental disorders.Reference Siriwardhana, Adikari and Jayaweera
14 However, successful integration requires government commitment, community sensitization, and sustained supervision.
Despite these proof-of-concept experiences, fundamental challenges persist: resource competition with life-saving interventions, coordination gaps among multiple actors, and the difficulty of sustaining services through conflict transitions.
A Framework for Immediate Action
Drawing on global evidence and Sudan’s specific constraints, we propose 6 priorities for immediate mental health integration into the humanitarian response (Figure 1).
Figure 1.
A framework for immediate action: six priorities for integrating mental health into Sudan’s humanitarian response.
Figure 1. Long description
The infographic is organized into a header, six numbered panels in a two-by-three grid, and a footer.
Header: A Framework for Immediate Action. Subtitle: Six Priorities for Integrating Mental Health into Sudan’s Humanitarian Response.
Panel 1 (Top-Left): Task-Shifted Community-Based Support. Illustration shows a Community Health Worker (C H W) speaking with a woman. Bullet points: Train community health workers in Psychological First Aid; Establish supervision through remote specialist support; Create clear referral pathways for severe cases including G B V case-management services.
Panel 2 (Top-Center): Infrastructure Rehabilitation. Illustration shows a damaged building labeled Mental Health Care and an ambulance. Bullet points: Assess and rehabilitate psychiatric wards and outpatient facilities; Deploy mobile clinics for displaced populations; Protect remaining functional facilities.
Panel 3 (Top-Right): Protected Supply Chains. Illustration shows a green truck carrying Essential Medicines and boxes of Psychotropic Medication. Bullet points: Negotiate humanitarian corridors for essential medicines; Stockpile psychotropic medications in secure locations; Use simplified prescribing protocols for non-specialists.
Panel 4 (Bottom-Left): Tele-Psychiatry Expansion. Illustration shows a woman with a headset using a laptop for a video call with a doctor. Bullet points: Establish tele-psychiatry networks; Train primary care providers in remote consultation protocols; Educate patients on telehealth access.
Panel 5 (Bottom-Center): Primary Care Integration. Illustration shows two healthcare workers at a desk with m h G A P Guidelines. Bullet points: Train primary health workers using W H O m h G A P protocols; Integrate mental health indicators into routine assessments; Coordinate with existing general health services.
Panel 6 (Bottom-Right): Community Engagement and Stigma Reduction. Illustration shows a man presenting a poster that reads Mental Health is Essential for Survival and Recovery to a seated group. Bullet points: Conduct community mental health literacy campaigns; Involve religious and community leaders; Establish peer support networks for survivors.
Footer: Mental Health is Essential. Integrated, accessible, and community-centered care saves lives and supports recovery.
Implementation Challenges
Realizing this framework faces significant obstacles. These priorities must be weighed against Sudan’s constrained funding and access environment. The 2026 Sudan Humanitarian Needs and Response Plan sought USD 2.9 billion for 20.4 million people and was 41.1% funded as of late August 2026,
8
,
15 leaving a substantial gap even as funding has improved over the year. Access is further complicated by the need to negotiate separately with SAF- and RSF-aligned authorities, recurrent telecommunications blackouts that undermine telepsychiatry delivery, and banking-system collapse affecting worker payment and medication procurement.
Security constraints limit access to affected populations and health care facilities, requiring innovative remote and community-based delivery models. Resource competition means mental health programming competes with trauma care, infectious disease response, and malnutrition treatment for limited funding. Coordination gaps among UN agencies, international NGOs, and local organizations require aligned priorities and information-sharing mechanisms that remain underdeveloped in Sudan’s operational context.Reference Tol, Barbui and Galappatti
7
Sustainability concerns loom large: emergency interventions must eventually transition to sustained health system services as conflict stabilizes. This requires early investment in training, infrastructure, and supply chains that can persist beyond immediate crisis response.
Despite these challenges, the cost of inaction exceeds implementation costs. Untreated mental health conditions impede economic recovery, compromise social cohesion, and undermine peacebuilding efforts. The intergenerational transmission of trauma means delays today compound future burdens.
Call to Action
We urge decisive action on 3 fronts. First, donor governments and private foundations should designate a minimum of 10% of health-related humanitarian aid for mental health and psychosocial support. No WHO or Sphere standard currently sets such a benchmark; mental health has historically received under 1% of development assistance for health and under 2% of COVID-19-era humanitarian funding.Reference Tol, Barbui and Galappatti
7
, Reference Charlson, Dieleman and Singh
16
, Reference Gribble, Durham and Roy
17 We propose 10% as an original advocacy target reflecting the burden of disease, not an existing external standard.
Second, WHO and UNICEF should integrate mhGAP training into all emergency health responses, with explicit mental health indicators in humanitarian surveillance systems. Mental health must be treated as essential, not optional, to emergency response.
Third, the research and humanitarian communities should invest in rapid mental health needs assessments and outcome monitoring to enable adaptive, evidence-informed programming.
Failure to act now will compound the crisis, with mental health consequences persisting long after the conflict ends. Sudan represents both an urgent humanitarian emergency and a test of whether global mental health commitments can translate into action when and where they are most needed.
Conclusion
Sudan’s mental health crisis is neither inevitable nor intractable. The tools, evidence, and frameworks exist; what remains lacking is political will and operational prioritization. As the international community responds to Sudan’s humanitarian emergency, mental health must be recognized as fundamental to recovery, not peripheral to it. The cost of continued neglect will be measured not only in individual suffering but in prolonged instability and compromised post-conflict reconstruction. Sudan is a warning: without integrating mental health into humanitarian policy and practice, sustainable peace will remain unattainable.
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Introduction
The 2023 conflict in Sudan has triggered a humanitarian crisis affecting millions, yet mental health remains evidently absent from the international response. Despite global frameworks such as the Sustainable Development Goals (SDGs 3.4, 3.5) and WHO’s Mental Health Gap Action Programme (mhGAP) that prioritize mental health in emergencies, translation into practice remains elusive in active conflict settings. Sudan exemplifies this implementation gap: with fewer than 100 psychiatrists for 45 million people and two-thirds of hospitals currently non-operational, the already fragile mental health infrastructure has collapsed precisely when psychological distress is escalating.Reference Khalil, Mohammed and Ahmed 1 , Reference Hussein, Saleeb and Tolba 2 Over 10 million people have been displaced, health care facilities have sustained more than 100 attacks, and pharmaceutical supply chains have disintegrated. 3 While infectious disease outbreaks, malnutrition, and displacement have received international attention, the mental health dimensions of this crisis have been largely overlooked. 4 Recent studies document high rates of post-traumatic stress disorder (PTSD), depression, and anxiety among refugees, internally displaced persons, and health care workers,Reference Khalil, Mohammed and Ahmed 1 , Reference Hussein, Saleeb and Tolba 2 , Reference Ahmed, Gasmalha and Ahmed 5 yet mental health programming remains peripheral to humanitarian operations. This commentary examines the mental health burden in Sudan’s conflict, synthesizes evidence from comparable crises, and proposes a practical framework for immediate integration of mental health into humanitarian response. The framework’s components draw directly on the IASC MHPSS Guidelines and WHO’s mhGAP; they are not new principles. Our contribution is their application to a setting most published IASC/mhGAP work does not address in combination: near-total infrastructure collapse, an active front line, and parallel SAF- and RSF-administered authorities. We further argue the implementation gap reflects not a lack of technical guidance but the near-absence of dedicated mental health financing in humanitarian appeals.
Background: The Mental Health Crisis in Sudan
Sudan’s mental health system was critically under-resourced even before the conflict. With a psychiatrist-to-population ratio of approximately 1:500,000, the country faced severe shortages of mental health professionals and limited service availability outside major urban centers.Reference Osman, Mohamed and Nashwan 6 The 2023 conflict has exacerbated these pre-existing deficiencies: hospital closures, supply chain disruptions, and attacks on health care facilities have effectively dismantled what limited infrastructure existed. 3
Recent epidemiological evidence highlights a substantial mental health burden among populations affected by armed conflict. High rates of post-traumatic stress disorder (PTSD) have been reported among both displaced and non-displaced individuals living in conflict-affected regions, alongside significantly reduced psychological well-being across diverse demographic groups.Reference Khalil, Mohammed and Ahmed 1 , Reference Hussein, Saleeb and Tolba 2 Individuals with chronic illnesses appear particularly vulnerable, experiencing compounded psychological distress during periods of instability and violence.Reference Ahmed, Gasmalha and Ahmed 5 These observations are consistent with global estimates indicating that conflict-affected populations experience PTSD prevalence rates of 15–30%, while depression affects more than 30% of individuals in these settings.Reference Tol, Barbui and Galappatti 7
Health care workers themselves constitute a critically affected population. Those remaining in conflict zones face dual burdens: delivering care under extreme conditions while experiencing their own psychological trauma. This workforce attrition threatens to deepen the crisis as experienced providers leave the system.Reference Osman, Mohamed and Nashwan 6
Three populations warrant explicit prioritization. Survivors of conflict-related gender-based violence (GBV) require case-management pathways linked directly to mental health referral systems rather than run in parallel. Children, an estimated three in 5 internally displaced Sudanese, need developmentally appropriate, school- and caregiver-based interventions. Persons with disabilities face additional access barriers and are named as a heightened-risk group in the 2026 Sudan Humanitarian Needs and Response Plan. 8 We integrate these groups into the framework below rather than treating them as an afterthought.
Global Lessons From Conflict Settings
Evidence from protracted conflicts demonstrates that mental health integration is feasible even amid active hostilities. Syria’s decade-long conflict has shown that tele-psychiatry can maintain specialist access when physical movement is restricted.Reference Jefee-Bahloul 9 Yemen’s humanitarian response has demonstrated that community-based psychological interventions can operate despite infrastructure destruction. Ukraine’s 2-year experience has documented both the rapid escalation of mental health needs during war and the potential for scalable service delivery through primary care integration.Reference Pinchuk, Yachnik and Goto 10
Three key lessons emerge from these contexts. First, task-shifting psychological interventions to non-specialists significantly expands service reach. Pakistan’s Problem Management Plus (PM+) trial demonstrated that lay health workers can effectively deliver psychological first aid, reducing distress and improving functioning in conflict-affected communities.Reference Dawson, Bryant and Harper 11 Qualitative systematic reviews confirm the feasibility and acceptability of lay health worker models across diverse crisis settings.Reference Shahmalak, Blakemore and Waheed 12
Second, telemedicine bridges critical access gaps. Systematic reviews of telemedicine interventions in WHO’s Eastern Mediterranean Region demonstrate that remote mental health delivery is feasible during conflict, though sustainability requires infrastructure investment.Reference Jefee-Bahloul 9 Syria’s experience specifically highlights tele-psychiatry’s role in extending specialist care to displaced populations when travel is impossible.Reference Parkes, Pillay and Bdaiwi 13
Third, primary care integration enhances both reach and acceptability. Post-conflict programs in Sri Lanka demonstrated that training primary health workers using WHO mhGAP materials improves early detection and management of mental disorders.Reference Siriwardhana, Adikari and Jayaweera 14 However, successful integration requires government commitment, community sensitization, and sustained supervision.
Despite these proof-of-concept experiences, fundamental challenges persist: resource competition with life-saving interventions, coordination gaps among multiple actors, and the difficulty of sustaining services through conflict transitions.
A Framework for Immediate Action
Drawing on global evidence and Sudan’s specific constraints, we propose 6 priorities for immediate mental health integration into the humanitarian response (Figure 1).
A framework for immediate action: six priorities for integrating mental health into Sudan’s humanitarian response.
Figure 1. Long description
The infographic is organized into a header, six numbered panels in a two-by-three grid, and a footer.
Header: A Framework for Immediate Action. Subtitle: Six Priorities for Integrating Mental Health into Sudan’s Humanitarian Response.
Panel 1 (Top-Left): Task-Shifted Community-Based Support. Illustration shows a Community Health Worker (C H W) speaking with a woman. Bullet points: Train community health workers in Psychological First Aid; Establish supervision through remote specialist support; Create clear referral pathways for severe cases including G B V case-management services.
Panel 2 (Top-Center): Infrastructure Rehabilitation. Illustration shows a damaged building labeled Mental Health Care and an ambulance. Bullet points: Assess and rehabilitate psychiatric wards and outpatient facilities; Deploy mobile clinics for displaced populations; Protect remaining functional facilities.
Panel 3 (Top-Right): Protected Supply Chains. Illustration shows a green truck carrying Essential Medicines and boxes of Psychotropic Medication. Bullet points: Negotiate humanitarian corridors for essential medicines; Stockpile psychotropic medications in secure locations; Use simplified prescribing protocols for non-specialists.
Panel 4 (Bottom-Left): Tele-Psychiatry Expansion. Illustration shows a woman with a headset using a laptop for a video call with a doctor. Bullet points: Establish tele-psychiatry networks; Train primary care providers in remote consultation protocols; Educate patients on telehealth access.
Panel 5 (Bottom-Center): Primary Care Integration. Illustration shows two healthcare workers at a desk with m h G A P Guidelines. Bullet points: Train primary health workers using W H O m h G A P protocols; Integrate mental health indicators into routine assessments; Coordinate with existing general health services.
Panel 6 (Bottom-Right): Community Engagement and Stigma Reduction. Illustration shows a man presenting a poster that reads Mental Health is Essential for Survival and Recovery to a seated group. Bullet points: Conduct community mental health literacy campaigns; Involve religious and community leaders; Establish peer support networks for survivors.
Footer: Mental Health is Essential. Integrated, accessible, and community-centered care saves lives and supports recovery.
Implementation Challenges
Realizing this framework faces significant obstacles. These priorities must be weighed against Sudan’s constrained funding and access environment. The 2026 Sudan Humanitarian Needs and Response Plan sought USD 2.9 billion for 20.4 million people and was 41.1% funded as of late August 2026, 8 , 15 leaving a substantial gap even as funding has improved over the year. Access is further complicated by the need to negotiate separately with SAF- and RSF-aligned authorities, recurrent telecommunications blackouts that undermine telepsychiatry delivery, and banking-system collapse affecting worker payment and medication procurement.
Security constraints limit access to affected populations and health care facilities, requiring innovative remote and community-based delivery models. Resource competition means mental health programming competes with trauma care, infectious disease response, and malnutrition treatment for limited funding. Coordination gaps among UN agencies, international NGOs, and local organizations require aligned priorities and information-sharing mechanisms that remain underdeveloped in Sudan’s operational context.Reference Tol, Barbui and Galappatti 7
Sustainability concerns loom large: emergency interventions must eventually transition to sustained health system services as conflict stabilizes. This requires early investment in training, infrastructure, and supply chains that can persist beyond immediate crisis response.
Despite these challenges, the cost of inaction exceeds implementation costs. Untreated mental health conditions impede economic recovery, compromise social cohesion, and undermine peacebuilding efforts. The intergenerational transmission of trauma means delays today compound future burdens.
Call to Action
We urge decisive action on 3 fronts. First, donor governments and private foundations should designate a minimum of 10% of health-related humanitarian aid for mental health and psychosocial support. No WHO or Sphere standard currently sets such a benchmark; mental health has historically received under 1% of development assistance for health and under 2% of COVID-19-era humanitarian funding.Reference Tol, Barbui and Galappatti 7 , Reference Charlson, Dieleman and Singh 16 , Reference Gribble, Durham and Roy 17 We propose 10% as an original advocacy target reflecting the burden of disease, not an existing external standard.
Second, WHO and UNICEF should integrate mhGAP training into all emergency health responses, with explicit mental health indicators in humanitarian surveillance systems. Mental health must be treated as essential, not optional, to emergency response.
Third, the research and humanitarian communities should invest in rapid mental health needs assessments and outcome monitoring to enable adaptive, evidence-informed programming.
Failure to act now will compound the crisis, with mental health consequences persisting long after the conflict ends. Sudan represents both an urgent humanitarian emergency and a test of whether global mental health commitments can translate into action when and where they are most needed.
Conclusion
Sudan’s mental health crisis is neither inevitable nor intractable. The tools, evidence, and frameworks exist; what remains lacking is political will and operational prioritization. As the international community responds to Sudan’s humanitarian emergency, mental health must be recognized as fundamental to recovery, not peripheral to it. The cost of continued neglect will be measured not only in individual suffering but in prolonged instability and compromised post-conflict reconstruction. Sudan is a warning: without integrating mental health into humanitarian policy and practice, sustainable peace will remain unattainable.
Acknowledgment
None.
Author contribution
JA conceptualized the study, conducted the literature review, drafted the manuscript, and coordinated revisions. MNJ and KI contributed to literature synthesis and drafted the manuscript. All authors approved the final version of the manuscript.
Funding statement
No funding was provided.
Competing interests
None.
Ethical standards
This study did not involve human participants or the collection of identifiable private data and was based solely on analysis of published literature, publicly available reports, and secondary aggregated data. Therefore, it was exempt from Institutional Review Board (IRB) review in accordance with international research ethics guidelines.