Radiotherapy in Sudan: facing infrastructure, workforce and armed conflict challenges.

Abstract

Sudan, with a population of 50 million, faces a dual burden of communicable and non-communicable diseases, including a raising incidence of cancer. Despite the critical role of radiotherapy in cancer treatment, access remains limited due to inadequate infrastructure, workforce shortages, and the impact of the ongoing armed conflict. This study assesses the current status of radiotherapy services in Sudan, identify challenges, and propose strategies for improvement. A cross-sectional descriptive study was conducted across all five radiotherapy centers in Sudan (three public and two private). Data were collected via facility surveys in January 2023 regarding infrastructure, equipment functionality, source replacement, and human resources. Descriptive analysis was performed to assess services capacity in relation to IAEA benchmarks. A follow-up survey (Sept 2025) assessed operational status during April 2023 conflict. Since 1967, a total of 13 Cobalt-60 (Co-60) teletherapy units, eight linear accelerators (LINAC), and six High Dose Rate Brachytherapy (HDR) brachytherapy systems have been installed in Sudan. Prior to April 2023 conflict, only seven megavoltage (MV) units (four cobalt-60, three LINACs) are operational, corresponding to one MV unit per seven million people, far below the IAEA recommendation of one per 250,000. Several teletherapy Co-60 (30%) were dismantled prematurely due to inadequate maintenance and source replacement. Advanced technologies (IMRT/VMAT) available only in private centers. Of six HDR brachytherapy units installed, only two remain operational. The workforce includes 52 clinical oncologists and 27 medical physicists. Approximately 77% of the radiation oncologists are concentrated in the capital Khartoum, whereas medical physicists are more evenly distributed across the centers. Since April 2023 conflict, service availability has collapsed further, leaving Merwe Medical City as the sole functioning facility the entire nation. Radiotherapy in Sudan is critically under-resourced, with infrastructure gaps, workforce imbalances, and conflict-related service disruptions. Strengthening the sector requires a national program for equipment maintenance and securing radioactive source replacement, investment in workforce training and retention, equitable facility distribution, and international partnerships to restore and expand access.