Three cluster randomised controlled trials in Portugal, Czechia and the United Kingdom to test the effectiveness and cost-effectiveness of an augmented social play intervention in schools to support r

Healthcare delivery in any country is influenced by availability of appropriately trained (local and overseas) manpower. Any interruption in training, undoubtedly has serious repercussions on current and future manpower needs of the country. This is more so in low and middle-income countries where the ratio of healthcare provider to patients is much lower. In Sudan for example the ratio of physicians to the population was 2.1/10,000 population in 2021 (significantly lower than the recommended 134/10,000) [, ]. Manpower planning to meet healthcare needs of any country are determined by the health of the communities - how stable it is and the prevalence of factors that increase morbidity and mortality. Where there is stability, such planning is an iterative process influenced to an extent by health indicators such as the pattern of diseases and mortality and morbidity. In conflict zones, there is a shift from factors that promote good health and manpower training to a dominance of factors that promote and sustain poor health and thus significantly affect any prospective healthcare manpower planning. In Sudan where medical training started in 1924, there has been an exponential increase in the number of medical schools and students (both from Sudan and overseas) []. As of 2008, there were more than 70 medical schools producing over 5000 graduates yearly, a significant number of who came from other African countries. It was estimated that Sudan had up to 23% of medical schools in Sub-Sahara Africa [, ]. Disruption in this setting is therefore likely to have significant consequences not only on health care delivery in Sudan but in the wider region. Several studies have shown that with outbreak of conflict there is often significant disruption in training and furthermore there is deterioration in health driven by the impact of the conflict on displacement of people, famine, and poor living conditions. Tekulu et al. [] showed that extensive damage to healthcare facilities in the Eastern Tigay Zone led to total collapse of the healthcare system. The outbreak of the Sudanese Civil War in April 2023 has destabilized the medical education system and the civilian society. This war which quickly swept through the capital to other areas of the country has vastly changed the country’s landscape in every conceivable way. None more so than its Education and Healthcare systems. According to a 2024 report by Doctors Without Borders, up to 80% of people in the capital (Khartoum) have fled for safety []. Mahgoub et al. [] reported that of 58 universities involved in their study (a few months after the onset of the conflict), 58.6% had been vandalized and occupied.