In Sudan, one of the hottest countries on earth, people are complaining that it’s not hot enough. “Corona”, they are hoping, will be unable to survive temperatures above 40°C, which are the norm here for much of the year. The science behind this assumption is slim and as yet far from definitive, but in a country whose health system has collapsed, clutching at straws is inevitable.
Estimates of Covid-19 mortality rates range from less than 1% of those infected in countries that are deemed well prepared for the outbreak, to almost 5% in countries that are ill-prepared. The well-prepared countries include Italy. With a population of 60-million, Italy has 3 000 of the ventilators that are critical for keeping people with severe coronavirus alive. This has been nowhere near enough to cope with the epidemic.
Government data in Sudan, which has a population of 44-million, is hard to come by, but a senior administrator in a private hospital in Khartoum reports that there are no more than 80 ventilators in the whole country. His own hospital, one of Sudan’s best, has three. Khartoum’s top private hospital has 18.
Most Sudanese cannot afford private healthcare. Their only option in the event of illness is to queue outside public hospitals. Even during normal times, the streets outside these hospitals are strewn day and night with people waiting for an appointment. Tea ladies and falafel vendors do a brisk trade as would-be patients and their families bed down for a long wait on mats or bits of cardboard.
Dr Salma Abdelaziz Mohamed has worked as a clinician in a number of Sudan’s public hospitals. “Yesterday I read an article saying that the UK was unprepared for coronavirus because it only has 4 000 critical care beds,” she tells me. “I almost cried. Do you know how many there are in Sudan? Less than 200 — and only 40 in public hospitals.” But it’s not just a question of beds and ventilators. “We don’t have treatment,” Mohamed says. “We don’t have personal protective equipment for hospital staff. We don’t have sterilisation standards. We don’t have enough nurses. We don’t have electricity to keep the hospitals running. It’s like the Titanic not having enough rescue boats. If the country is hit, it will definitely sink.”
Effects of dictatorship
Sudan’s ill-preparedness is partly deliberate. Under dictator Omar al-Bashir’s 30-year rule, public health services were left to wither so that his cronies — the likes of Mamoun Homeida, former health minister of Khartoum State — could build and make vast profits from private hospitals. Public funds were invested not in health, but in the military and security services that were needed to prop up the regime or fight its many internal wars.
When the revolution which would eventually unseat al-Bashir began in December 2018, he withheld medical supplies from hospitals to force people to stop demonstrating. Healthcare personnel were targeted by his secret police — two hospital managers I spoke to in Khartoum, still scarred by years of repression, asked me not to mention them by name.
In the absence of any means of treating Covid-19, preventing its spread is crucial. Schools, ports and borders have been closed since early March, restaurants and cafés since last weekend, and a night-time curfew was announced on Monday. The ministry of health gives daily press briefings in which it emphasises the importance of handwashing and social distancing.
Cellphone service providers deliver prevention messages to callers before connecting them. The neighbourhood resistance committees that helped to organise the uprising against al-Bashir have been making their own hand sanitisers using alcohol normally reserved for making illegal liquor. They distribute them without charge in their communities.
Sudan’s medical community is mobilising, too. Sudanese health experts at home and in the diaspora have made videos for social media explaining what the virus is and how to avoid infection. The Sudan Twitter Union, a campaigning group, is pressuring the ministry of health to act faster and spend more money to stem the disease’s spread. Pharmacists are asking people not to throw away empty hand sanitiser bottles and they are refilling them free of charge. Question and answer sessions are delivered on Facebook, with the aim of dispelling myths such as US President Donald Trump’s widely shared claim that the virus is a hoax, or that having fended off so many other diseases in their lives, Sudanese are immune to Covid-19’s worst effects.
The messages are beginning to get through. In Khartoum, the price of face masks has increased tenfold, while commercially made hand sanitisers are no longer available in the shops. But in a country where large families often live in cramped spaces and where great offence is caused if you refrain from shaking hands whenever you bump into an acquaintance, some social mores are harder to shift.
At the time of writing (March 24), Sudan had only two confirmed Covid-19 cases. The first was a 52-year-old Khartoum man who had returned from Egypt and died a few days after showing symptoms. The second was a Spanish aid worker. The Khartoum man’s family has threatened to sue the government, claiming that he tested negative for the virus (his first test came up negative, but a later one was positive). The family is desperate to escape the stigma that it believes will surround the first person to have brought the virus into the country.
The family members may be less worried now. Two weeks ago, a junior doctor returned home to Sudan from Morocco, where his wife had tested positive for Covid-19 and was in isolation. The doctor took paracetamol so that temperature checkers at Khartoum airport wouldn’t detect a fever, and went to work the next day in his hospital. After a few days he began coughing, and complained to work colleagues that he had a fever. When his colleagues realised he had been in contact with someone infected with the virus, he fled.
He is now being held while the ministry of health awaits the results of his test. His colleagues — 22 doctors, nurses and other medical staff — are in isolation. The Sudan Doctors Association described this as the country’s “Patient 31 moment”, referring to the gregarious South Korean woman whose failure to self-isolate triggered a chain reaction, creating thousands of infections in that country.
The true number of coronavirus cases in Sudan may be much higher than the official figure. The ministry of health has only a few dozen testing kits. After news of the first infection broke out in Khartoum, hospitals were mobbed by people who thought they had a fever, the crowds a potential petri dish for the virus. Hadeel Abdelrazag, senior procurement officer at Royal Care, a private hospital used by diplomats and politicians that itself has only 14 critical care beds, is better placed than most to detail the country’s needs. “We need antiviral drugs,” she says. “We need more ventilators, more ambulances, more hand sanitisers and more personal protective equipment for health workers. We really are not prepared if this virus spreads.”
While they await the results of tests on the young doctor and his colleagues, Sudanese cling to other sources of hope. Only one in 50 of the country’s population is aged 70 or above, the age group worst affected by Covid-19. In hard-hit Italy, one in six falls into this age group. Outside Khartoum, the population is sparsely spread — an urbanisation rate less than half of that in most European countries may help to slow transmission. The temperature, meanwhile, has begun slowly to rise, with maximums of 42°C expected this week. Never has the hot weather been more eagerly awaited.
Mark Weston is the author of African Beauty and The Ringtone and the Drum. He lives in Khartoum