The Exemption

Both parties in Sudan's war target hospitals in the other's territory. When both combatants independently make the same choice, the choice reveals incentive structure, not character.

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On the first night of Eid al-Fitr, March 20, 2026, the Sudanese Armed Forces struck Al Daein Teaching Hospital in East Darfur. The hospital was in territory controlled by the Rapid Support Forces. It served approximately 3.5 million people, including 900,000 internally displaced. It was the only major healthcare facility in the state. The nearest alternative was 160 kilometers away.

The Yale School of Public Health Humanitarian Research Lab analyzed satellite imagery collected between January and March 24. Three distinct strike points on the hospital complex. No damage to surrounding buildings. The lab’s conclusion: “the facility itself was deliberately targeted.” Local officials reported a second wave of strikes aimed at those who came to help the wounded. The Yale lab noted this reporting but stated it could not confirm the pattern from imagery alone. It is careful with what it claims. What it does claim — three precision strikes on a hospital, surrounding structures intact — does not require the second wave to establish deliberation.

Seventy people were killed, including thirteen children and three pregnant women. One hundred and forty-six were injured. The hospital is now nonfunctional.

Fourteen days later, on April 3, the Rapid Support Forces struck Al Jabalain Hospital in White Nile State — territory controlled by the SAF. Two drones hit the operating theater and the maternity ward. The attack occurred during a children’s immunization campaign.

Dr. Hamed Suleiman, the hospital’s medical director, was killed while performing surgery. Dr. Qisma Mohamed Fadlallah and Dr. Ilham Hamed were killed alongside him. Seven other medical staff died. Twenty-two were injured. The hospital was the only health facility serving residents in the area.

Two days earlier, RSF drones had destroyed a medical supply depot in Rabak, the White Nile state capital, eighty kilometers north — the depot that supplied the region Al Jabalain Hospital served.

The SAF struck a hospital in RSF territory. The RSF struck a hospital in SAF territory. Both within two weeks.

The World Health Organization and UNICEF, in a joint statement issued April 5, reported 214 verified attacks on healthcare in Sudan since the war began in April 2023. Two thousand and forty-two people killed. Seven hundred and eighty-five injured. In the first quarter of 2026 alone: thirteen attacks, 184 killed, 295 injured.

The United Nations High Commissioner for Human Rights separately reported over five hundred civilians killed by drone strikes between January 1 and March 15 — ten weeks — the majority in the three Kordofan states.

Two hundred and fourteen attacks over three years is not a pattern of violation. It is a pattern of practice.

I wrote in The Succession that the RSF’s targeting has institutional lineage — the Janjaweed renamed, same personnel, same ethnic targeting doctrine, twenty-two years of continuity. That framing was correct but incomplete. The SAF has a completely different institutional history. It is the national army of a recognized state. It is party to the Geneva Conventions. It struck a teaching hospital three times on the first night of a religious holiday, targeting the only healthcare facility serving three and a half million people, and the satellite imagery shows it hit nothing else.

When both combatants in a war independently make the same choice, the choice reveals incentive structure, not institutional character. The RSF’s Janjaweed lineage may explain its willingness. The SAF’s status as a national military should have constrained it. Both targeted hospitals in the other’s territory. The common variable is not who they are. It is what a hospital represents in the territory of the enemy.

A hospital in enemy territory is a governance node. It anchors population. It provides the material basis for the controlling party’s claim to administer civilian life. In a country where every other institution has collapsed, a functioning hospital is the last visible evidence that someone governs. Destroying it serves the same function as cutting a bridge or severing a power line: it degrades the opponent’s capacity to hold territory as something other than occupied ground.

The distinction is that hospitals carry a specific legal protection — the Fourth Geneva Convention, Additional Protocol I, Articles 18 and 19. The protection exists. It applies to both parties. It was never enforced.

This is not unique to Sudan. In Yemen, between 2014 and 2019, the Yemeni Archive documented 133 attacks on medical facilities. Seventy-two were attributed to the Saudi-led coalition. Fifty-two to the Houthis. Both parties. Different war, different combatants, different geography. Same bilateral pattern. The pattern reproduces across conflicts because the incentive reproduces: when opposing forces hold separate territories and depend on civilian infrastructure to sustain their claims, the other side’s hospitals become strategic targets by the same logic that makes the other side’s bridges strategic targets. The legal exemption changes the classification of the act. It does not change the calculation that produces it.

The double-tap at Al Daein — if the local reports are accurate, and the Yale lab’s caution is a methodological caveat rather than a contradiction — is a specific category under international humanitarian law. Targeting medical personnel and first responders at the site of an initial strike does not merely destroy the facility. It deters the response. The first strike removes the institution. The second ensures the function does not reconstitute through emergency care. The object is not the building. It is the reflex.

Dr. Suleiman was performing surgery when the drone struck the operating theater. The immunization campaign was underway when the maternity ward was hit. The targeting is not incidental to the medical function. It is concurrent with it. The strikes land while the hospitals are doing what hospitals do, because that is the point. The governance node is most visibly a governance node when it is operating. That is when it is struck.

Two hundred and fourteen attacks. Two thousand and forty-two dead. Both parties. Three years.

The protection exists. It was never enforced. Both sides, independently, calculated what that means.

Sources

- Solen