The widespread use of rape and other sexual violence as a weapon of war in Sudan has spurred a massive mental health crisis, United Nations agencies and local aid groups warned.
The Sudanese army and the paramilitary Rapid Support Forces (RSF) have been locked in a brutal conflict since April 2023 that has killed tens of thousands and displaced around 11 million people.
Medical charity Doctors Without Borders last month said at least 3,396 survivors of sexual violence -- nearly all of them women and girls -- sought treatment at facilities it supports in North and South Darfur between January 2024 and November 2025.
But the World Health Organization said Tuesday that the high numbers were likely just the "tip of the iceberg".
"Accessing services when you are raped is very, very challenging," Avni Amin, head of WHO's gender-based violence unit, told an event at the UN in Geneva, focused on Sudan's humanitarian and health emergency.
She pointed to a lack of security and difficulty reaching functioning healthcare establishments, and notably not enough health workers trained to deal with victims of sexual violence.Â
The huge stigma for survivors was also a major barrier, said Amin.
"For every woman who discloses, there are probably eight or nine women who've been raped and who will suffer in silence," she warned.
- 'No safety' -
Niemat Ahmadi, of the Darfur Women Action Group, described horrific conditions for victims seeking care after violent gang rapes that have left them with complications, such as fistula, an incontinence-causing tear in the wall between the vagina and bladder or rectum.
Even in peace time, there were few doctors in Darfur to help with such cases. "Now, that is non-existent," she said.
Victims who had been abducted and raped were wary of seeking treatment at hospitals that had not been destroyed, since they were often controlled by the fighting forces.
At one Darfur hospital, she described how RSF fighters had marched in and shot and raped a health worker.
"There was a woman in delivery at the time, she died," she said.
The withdrawal of international aid organisations due to security concerns and deep cuts to humanitarian funding were exacerbating the situation, she said.
Small women-led organisations like hers were left to do the work, scrambling for resources as "people die", she warned.
- 'A lot of suicide' -
UNFPA, the UN Population Fund, said the lack of services had dire implications.
Shoko Arakaki, head of UNFPA's humanitarian response division, stressed that it was "very, very important" for victims of sexual violence to receive clinical treatment within 72 hours.
"But we don't have services, we don't have medicines," she said.
In particular, she stressed the need to provide psychosocial support, as a growing number of victims are laden with severe mental health issues.
"A lot of suicide is happening," she said.
It is difficult to come by official numbers but Ahmadi also said she was aware of a large number of women in Al-Jazira who die by suicide "to avoid rape".
Amin said there needed to be far bigger emphasis on mental health support in Sudan, alongside the focus on saving lives.
"We have to integrate support for mental health," she said, stressing the "long-term consequences" both for victims and for those witnessing the horrors unfolding on the ground.
"We know from other conflicts that the impacts last not just long term but inter-generationally," she said.
"We have to be prepared for that."
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