Task-Sharing Anaesthesia in Conflict Zones: A Cross-Sectional Study of Safety Gaps and Systemic Failures in Sudan

Abstract BackgroundIn Sudan—where physician anaesthesiologists are critically scarce (0.47/100,000 population)—non-physician anaesthesia providers (NPAPs) deliver most perioperative care, especially amid conflict-driven health system collapse. Despite global evidence supporting task sharing, NPAP safety outcomes in fragile settings remain unquantified.MethodsCross-sectional audit of 1,559 surgical cases across four Sudanese referral hospitals (2022–2023), assessing provider roles, supervision, and adverse events using adapted WHO/ASA tools.ResultsNPAPs independently managed 46% of cases (718/1,559), performing 82% of intubations and 91% of spinal anaesthetics. Adverse events were 2.8× more frequent under unsupervised NPAP care (34% vs. 12% supervised; RR 2.8, 95% CI 1.9–4.1), dominated by cardiovascular (58%) and airway crises (41%). Systemic failures included 94% underreporting of adverse events and 0% NPAP access to continuing education.ConclusionNPAPs sustain surgery in Sudan’s crisis but face lethal safety gaps. Urgent reforms require: (1) legislated scope-of-practice guidelines (e.g., Ethiopia’s model), (2) mobile supervision platforms (e.g., WhatsApp consults), and (3) NPAP integration into national surgical plans. These findings inform WHO strategies for conflict-affected states.