The impact of the Sudan conflict on urological surgical training: a national study of challenges, adaptations, and trainee-led pathways to resilience

Abstract

BACKGROUND: Armed conflicts pose severe challenges to healthcare workforce pipelines, with specialized surgical training being particularly vulnerable. The war in Sudan, which began in April 2023, has led to a complex humanitarian crisis, damaging health infrastructure and displacing medical professionals. The impact on postgraduate urological surgical training requires detailed assessment. METHODS: A national, descriptive quantitative cross-sectional study was conducted from September to December 2024. A structured online questionnaire was distributed to the complete national cohort of urology specialty trainees (n = 40, 100% census) and to surgical trainees in general and pediatric surgery programs who undertake mandatory urology rotations (high-response sub-cohorts, n = 60). Data on demographics, displacement, mental health, training quality, resource access, and adaptations were collected. Descriptive statistics were analyzed using SPSS v26.0. RESULTS: Among 100 trainees in the urological training pipeline-representing all current urology specialists-in-training in Sudan and a majority of surgical trainees with urology exposure-the majority (68%) were displaced to Port Sudan. A profound psychological burden was evident: 57% reported significant war-related mental health impacts, and 72% described severe training-related stress. Critically, only 24% accessed mental health services. Surgical training experienced major disruptions, with 84% reporting a decline in procedural participation and 86% a reduction in case diversity. Resource shortages affected 68%, and while 67% of programs underwent curriculum changes, remote learning was deemed ineffective by 51% of trainees. Confronting these systemic challenges, trainees proposed actionable solutions, prioritizing enhanced remote education (71%), secure funding for supplies (69%), and curriculum modification (66%). CONCLUSION: The Sudan conflict has profoundly disrupted urological surgical education, creating a mental health crisis and threatening future surgical capacity. Trainees are not passive victims but architects of a potential hybrid-resilience model. Their insights point to the urgent need for a collaborative, internationally supported "Surgical Training Support Framework" that integrates psychological support, a structured blended-learning curriculum, and guaranteed resource funding.