Sudan’s Economic Struggles & Conflict Dynamics

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): The Good Men Project

Publication Date (yyyy/mm/dd): 2025/02/15 (Unpublished)

Eddie Thomas, a researcher specializing in Sudan and South Sudan, discusses the transition from subsistence farming to market economies, the impact of conflict, and healthcare inequalities. He examines how wars have disrupted traditional kinship networks, pushing people into market dependency. South Sudan’s caloric intake has dropped, leading to malnutrition. Sudan’s healthcare disparities stem from colonial-era spatial inequalities and privatization. Border conflicts like Kafia-Kingi influence economic dynamics, and kinship networks are under pressure. Thomas advocates for universal healthcare and decommodification as solutions to economic instability and conflict. He acknowledges Sudanese revolutionaries striving for systemic change.

Scott Douglas Jacobsen: Today, we are here with Eddie Thomas. He is a researcher specializing in Sudan and South Sudan. He has previously been affiliated with the Rift Valley Institute and XCEPT. Currently, he works with the ATAR Network. He has two decades of experience as a teacher, human rights worker, and researcher. He examines border conflicts, healthcare inequalities, and economic transformation. He has authored South Sudan: A Slow Liberation and reports such as Moving Towards Markets and The Future of Sudan’s Shattered Health System. His research, previously supported by the XCEPT program and the Rift Valley Institute, explored the consequences of market dependence, conflict-driven social shifts, and healthcare privatization in Sudan’s shifting and evolving political landscape. 

Thank you for joining me today. My first question is: How has the transition from subsistence farming to market dependence in South Sudan affected local economies and social structures?

Eddie Thomas: Subsistence is a term many people still use to describe agriculture in South Sudan. It is a peculiar term that arose during the Enlightenment and was the opposite of a new concept: improved agriculture, capitalist agriculture, agriculture for profit and high yield. Subsistence was used to describe forms of agriculture that were not oriented toward maximizing yield but rather toward managing consumption.

The subsistence systems in South Sudan were long-lived. They have only started to decline over the past 20 or 30 years. Even now, they are not defunct but are deteriorating. Before this shift, people primarily produced food for consumption or exchange within their social networks. They organized production around social relationships rather than markets.

This meant that people did not necessarily seek to maximize surplus or yield but considered other factors now recognized as equally important—such as sustainability, climate and ecological adaptation, and flavour and nutrition. These factors influenced agricultural production decisions.

However, South Sudan has experienced near-continuous conflict since the 19th century, particularly during the Turco-Egyptian rule and later under British colonial administration. It has had only brief periods of peace. War is a significant reorganizer of society and production. It is also an effective means of instilling a profit motive in people, as it introduces intense coercion to reshape society.

That is what happened in South Sudan. Wars gradually detached people from the land where they produced food, grew grain, kept livestock, or fished in rivers. These conflicts transformed them into something different. Initially, they might have become enslaved persons or military recruits—who were not much different from enslaved persons—or what are now referred to as displaced people, those forced off their land and compelled to live in unsuitable and uncomfortable conditions.

And all of these factors limited the ability of kinship networks and other social structures to survive and organize production. At the same time, people’s ability to manage their production was being undermined.

Other factors were coming into play. New groups of people were not interested in market commodities a hundred years ago. People didn’t seek to save money to buy available goods. Basic commodities such as soap or fishhooks were available but not central to people’s lives. However, the allure of commodities has grown significantly. Now, people desire handbags, stylish shoes, fashionable clothing, and smartphones.

People are increasingly drawn into market economies and commodities while facing new threats to their ability to remain on the land. Climate change has severely affected South Sudan, which is ecologically sensitive. The levels of flooding along major rivers and waterways are alarming. Some individuals are forced to reconsider their home locations due to the risk of flooding. Others must reconsider their livelihoods, as they can no longer sustain farming or herding. As a result, many are switching to fishing as a means of survival, adapting to the climate-induced displacement they are experiencing.

What has happened is that an older system—one not designed for maximizing profit or yield but rather focused on maintaining social and kinship networks—has been disrupted. This traditional system provided multiple layers of meaning to life through production. Work was once deeply tied to one’s sense of family, home, and even cultural traditions, such as the songs people sang while working.

I’m not trying to sentimentalize the past or suggest it was the only way of life. There were negative aspects to the “good old days.” However, the kinship-based and socially networked production systems helped hold society together. Today, many pressures on South Sudanese people are forcing them apart, breaking down social cohesion, and pushing them into fragmented, often antagonistic, enclaves.

One of the things I examined was how conflict is as much tied to these ongoing agrarian changes as it is to ethnicity or other cultural explanations sometimes given for violence. The countryside is undergoing a massive transformation, and this upheaval has become entangled with the conflict, potentially fueling its continuation.

Let me explain why. The first scientific nutrition studies in South Sudan were conducted in the 1950s by Gertrude Culwick, an English researcher employed by the colonial government. She conducted multiple studies in different parts of Sudan. Her work in the floodplains—vast, flat, muddy lands on the east and west of the Jebel, where the White Nile flows through South Sudan on its way north—revealed interesting findings. She found that people consumed between 2,000 and 3,500 calories per day, a substantial intake. However, the measures she used then differed from the ones we use today.

Because today, caloric intake would be averaged out, considering age differences and other factors. Gertrude Culwick may have used specific measurement criteria. However, adults in her studies still consumed a substantial amount of food.

Some studies suggest that people in South Sudan consume an average of 1,500 to 1,800 calories per day in the 21st century. This marks a dramatic reduction in caloric intake over the past 60 to 70 years. One key aspect of this transition is that it is a hungry transition. It may eventually lead to obesity, as market-based food systems have in many other countries, but at present, it is leading to undernourishment and malnutrition.

There is no direct link between marketization and better food systems. On the contrary, marketization—alongside war, displacement, and other disruptions—is not resulting in better nutrition. Instead, it is driving an increased demand for cash. In the past, many South Sudanese lived with minimal reliance on money, and it wasn’t easy during the colonial period to get people to work for wages because they simply did not need cash. Additionally, they did not wear clothes with pockets, making it impractical to carry money.

The colonial administration introduced money taxes to compel people to work for wages. As a result, people would perform a few days of labour annually to pay their taxes. Over time, market dependence increased, and people needed money not just for taxes but also for new necessities such as modern education and healthcare, both of which required cash. Additionally, they began to need money for food as they transitioned from solely producing food to selling portions and later repurchasing food from merchants once their stocks ran low. Essentially, their food supplies were becoming commodities.

I found an interesting trend in household surveys—though they are infrequent in South Sudan and must be interpreted cautiously. Surveys conducted during the peace years from 2006 to 2013 suggested that while many areas shifted toward market-based economies, many people reported that they had not used cash in the past seven days. This indicates a growing reliance on cash without consistent access to it.

In the areas where hunger was most prevalent, people needed money to buy food but often did not have it. These were the same areas where militia groups were gaining strength, and young men increasingly turned to alternative forms of work that provided access to cash or coercive means of obtaining resources they could no longer produce themselves. The militia system played a crucial role in dismantling traditional production methods and was instrumental in sustaining this economic transition. As workers defected from productive labour to military employment, money circulated more through soldiers than through conventional economic activity.

As hunger intensified, the need for money grew, pushing people into new methods of obtaining it, including selling labour and sending their sons to fight. This transformation perpetuated economic instability and reinforced the cycle of displacement and market dependence.

People also invested heavily in educating their children because they believed education was essential for navigating the emerging economy. Even families with very little money would sell their labour to afford school fees, hoping that education, even in under-resourced schools, could provide their children with a better future.

South Sudan’s progression toward a market economy is an important study area because it sheds light on how the rural crisis underpins many ongoing challenges. This rural crisis is sometimes misrepresented as a conflict between antagonistic ethnic groups, as that provides a simplistic explanation. However, the reality is more complex. The government, unable to adequately serve its people, often exacerbates divisions by taking resources away in a discriminatory manner rather than providing for its citizens. This creates friction among communities and pushes individuals into armed groups.

Focusing less on the military and more on the agricultural sector would help me better understand South Sudan’s challenges.

Jacobsen: What are the key drivers behind Sudan’s healthcare inequalities? Are these comparable to those of other countries, or are their causes and characteristics unique?

Thomas: Sudan’s inequalities are well known and have multiple dimensions. One of the most significant factors is spatial inequality. Some regions benefit from Sudan’s merchant and trade systems, where the wealthier populations reside and have access to services. Then, some regions generate wealth for these merchant systems—through agriculture, gold mining, oil extraction, and food production—yet remain significantly disadvantaged.

Most of this wealth-generating activity occurs far from the centers of trade. Historically, Sudan’s economic hub has been around Khartoum. At the same time, peripheral areas have suffered from lower life expectancy, higher child mortality rates, and other indicators of material disadvantage. These disparities were entrenched during the 19th century due to colonial aggression and the arbitrary drawing of colonial borders, which heavily favoured the central regions.

The healthcare system that emerged under these conditions had serious shortcomings. There was a strong bias toward providing better healthcare in wealthier regions, with greater access to medical personnel and facilities. In contrast, poorer regions suffered from stark disparities in mortality rates, particularly infant and child mortality.

Furthermore, Sudan’s healthcare system has historically been skewed towards curative rather than preventative care. Those living in the capital could access expensive medical procedures. At the same time, those in remote areas often lacked access to vaccines or basic preventative medicine. This structural imbalance has persisted, reinforcing the country’s deep-seated healthcare access and outcomes inequalities.

After the end of the colonial period, there was a global movement toward primary healthcare, aiming to expand medical services to poor and marginalized communities. The goal was to provide the best possible healthcare for all, leading to the development of some health facilities in underserved peripheral regions. There was also an effort to improve healthcare access for economically disadvantaged populations. Sudan had significant social inequalities, with rich and poor people living side by side in cities. This movement gained momentum in the 1970s and 1980s.

However, by the 1980s, a global financial crisis caused a significant shift in the financial landscape. One of the outcomes was a severe debt crisis across Africa. Many governments have been encouraged to take out loans to build productive infrastructure and social welfare services, including healthcare. Right-wing economic policies advocating for privatization gained prominence when the debt crisis struck. These policies argued that people should not expect free healthcare, leading to declining public health services.

During this period, Sudan initially experienced some growth in healthcare access, and free services were available in many places. When I first visited Sudan, one could walk into a healthcare facility and receive basic treatment, such as a bandage, without charge. However, this changed drastically in the 1990s when a new military government took over. Adopting hyper-privatization and austerity measures, they systematically cut back public health services.

A weak, developing healthcare system came under immense strain. Additionally, the government initiated conflicts in many regions where they imposed austerity, as such policies often required coercion and repression. This further eroded the health system. By the early 21st century, Sudan’s healthcare had become highly privatized and heavily concentrated in Khartoum, which retained the majority of medical personnel.

Most Sudanese doctors sought better opportunities abroad, particularly in Saudi Arabia or the UK. Those who remained in Sudan preferred working in private hospitals in major cities, where they could earn a livable wage, rather than in underfunded public hospitals in rural areas, where salaries ranged between $50 and $200 per month—insufficient for someone who had endured the rigorous training required for a medical career.

As a result, Sudan developed a highly centralized healthcare system focused on Khartoum, making access to medical services in other regions extremely difficult. When Khartoum fell in April 2023, this unequal system was effectively decapitated. Most specialist hospitals, clustered around the presidential palace where intense fighting occurred, were forced to shut down, leaving only a few operational facilities.

Healthcare provision then shifted into two main spheres. On one hand, private actors relocated their services outside of Khartoum. On the other hand, grassroots emergency response groups emerged during the 2018–2019 revolution and stepped in to provide urgent medical care. These mutual aid organizations had pioneered self-help models, running emergency rooms nationwide. However, they were ill-equipped to handle the massive healthcare crisis. Their resources were scarce, medical buildings were destroyed, and doctors were arrested and tortured.

Despite their efforts, these groups faced overwhelming challenges and became key targets of government repression during this turbulent period.

Jacobsen: How have cross-border conflicts and territorial disputes, such as the Kafia-Kingi enclave, shaped some of the political-economic dynamics of the region?

Thomas: I worked on Kafia-Kingi a few years ago but am unaware of recent developments except through friends and other contacts. However, Sudan and South Sudan have a relatively unique set of border conflicts because they are both recent and unresolved. Border disputes exist across Africa—there is a contested triangle on the Egypt-Sudan border and another between South Sudan and Kenya, where different interpretations exist regarding ownership.

Often, the more powerful state maintains control over disputed enclaves. This has been the case along much of the Sudan-South Sudan border, where Sudan, with its larger population, military, and financial resources, has retained its presence in key border areas.

Not all border disputes are resolved through war. Most are long-term disputes that gradually get negotiated. Sudan has maintained control over Kafia-Kingi, a mineral-rich enclave South of Darfur, which, by legal standards, should have been ceded to South Sudan in 2011. The rules established that areas administered by southern provinces in 1936 would remain part of South Sudan. However, Kafia-Kingi was the largest land area transferred from South Sudanese to North Sudanese provincial administration, an early post-independence decision.

There were several reasons for this transfer. Kafia-Kingi was sparsely populated, making it a difficult area to govern. Additionally, its mineral wealth made it highly valuable, prompting authorities in Khartoum to exercise greater control over the region.

When South Sudan gained independence, border enclaves became one of the many unresolved issues negotiators had to address. Other complex matters included national debt allocation, ownership of embassies such as the one in Nairobi, and South Sudanese citizens’ status in Sudan. These were sensitive topics requiring significant compromise.

As a result, negotiations on border enclaves were indefinitely postponed, and it is likely to take a long time before any resolution is reached.

Kafia-Kingi is particularly significant because it borders the Central African Republic and Chad. Despite being a remote and sparsely populated area, it has become a hotbed of activity due to arms trafficking, gold smuggling, and the presence of various outlaw groups.

It is now a highly contested zone, as one of the major gold mines fueling the war in Sudan is located within the enclave. The ongoing conflict between the Rapid Support Forces, the military, and their respective allies is partly driven by control over these gold resources.

Unfortunately, this beautiful and remote forested region has been brutally drawn into the turmoil of modern geopolitics, with its resources becoming central to an increasingly violent conflict.

Jacobsen: What are the major challenges foreign-funded healthcare initiatives face in Sudan? Supply chains, delivery, application, things of this nature.

Thomas: Foreign funding does not constitute a significant portion of Sudan’s healthcare economy. The most recent national health accounts, published about six years ago, estimated that foreign funding accounted for approximately 5% of the country’s total healthcare costs. Much of this funding came from global philanthro-capitalist organizations, such as the Gates Foundation and Gavi, which focused on vertical programs.

Vertical programs allocate funds for specific interventions—such as vaccines or malaria nets—rather than supporting comprehensive healthcare systems. While these programs can lead to progress on urgent public health challenges, they are limited in scope. Effective healthcare requires addressing multiple needs simultaneously, and vertical programs do not always integrate well with broader health initiatives. For example, malaria nets alone are insufficient in communities facing malnutrition, infectious diseases, and epidemic outbreaks.

Most foreign-funded healthcare in Sudan was channelled through the Ministry of Health, which managed the distribution of funds and resources. However, with the government’s collapse, these funds’ status remains uncertain. Efforts have been made to transition toward UN funding mechanisms. However, coordination with the Ministry of Health is still necessary at some level, as it maintains connections across the country.

The volume of foreign aid has likely contracted, given the logistical challenges of transferring funds, purchasing medical supplies, and distributing goods within Sudan. Though I do not have precise figures, I suspect foreign funding has not increased. An increasingly significant element of foreign-funded healthcare is diaspora remittances, which support emergency rooms providing critical care across Sudan.

Jacobsen: What about kinship networks in Sudan and South Sudan’s economies? Are these scaled in a way that helps at least some of the population and mitigates healthcare gaps?

Thomas: Kinship networks exist everywhere, don’t they? Powerful figures like Mr. Trump have kinship networks even in the United States. They are an integral part of social organization.

Economic and social life was historically structured around kinship-based production systems in many places. However, not all social orders were strictly kinship-based. Production was sometimes organized around alternative social networks, such as age groups. These networks were not necessarily based on family ties but on individuals coming of age together in a specific place—a pattern seen in many societies worldwide.

You see these types of networks everywhere—think of school reunions. People still attend them as useful networking events. For example, Harvard alums often connect with fellow graduates to secure job opportunities.

These networks have always existed, but previously, labour was not mobilized through markets. Instead, it was organized through reciprocal obligations that weren’t formally tracked or bartered. Let’s say, Scott, that you invite me for dinner tomorrow, then again the following week, and a couple of weeks later, a third time. I wouldn’t write you a check saying I owe you a dinner, but after the third invitation, I would likely feel an implicit obligation to return the favour. You, too, might expect that I reciprocate in some way.

That is a better way of understanding how these economies function than the concept of barter, which is largely an invention of right-wing economists who misunderstand social reciprocity. If you’ve invited me multiple times, I should contribute something. If you are significantly wealthier than me, I may not invite you back to my home out of embarrassment. Still, I will find another way to reciprocate—perhaps by helping you in some other manner.

These networks, however, are under immense pressure as people increasingly need money. Many are forced to relocate, live in refugee camps, or seek safety in displacement camps. In such environments, individuals must sell their labour and endure harsh conditions. The freedom to choose is greatly diminished, and they must adhere to external demands rather than act according to their social obligations.

Jacobsen: To move into a more constructive discussion, what policy recommendations could mitigate economic commodification and conflict in Sudan’s healthcare system or South Sudan?

Thomas: If you want a policy recommendation, why not aim for a global free healthcare system modelled after Canada or Cuba? If discussing real solutions, why not advocate for a universal healthcare system?

People are under tremendous pressure to access healthcare and education, enduring significant hardships to obtain these basic needs. Nearly everyone would prefer free healthcare and education. Suppose wealthy countries do not want people migrating across their borders. Why not invest in comprehensive social services in their home countries? By fully decommodifying healthcare and education, you incentivize people to remain in their communities rather than seek opportunities elsewhere.

That is a genuine policy recommendation. There are other policy approaches, but I often see them as non-solutions. For example, some propose micro-enterprise programs to empower women—yet these initiatives often result in marginal economic gains, with individuals earning just a few dollars a month. These approaches fail to address the root causes of economic disparity and healthcare inequity.

Those are the policy prescriptions of the aid industry, but they have been tried before.

Jacobsen: Do you have any comments on Omer Al-Bashir’s impact on healthcare access or medical services, particularly in rural areas?

Thomas: He was an arch-neoliberal, managing healthcare in rural areas accordingly.

Jacobsen: Who do you think is leading, organizationally or individually, a positive collective movement toward a better future for Sudan? Who is working towards reducing human rights abuses, improving healthcare, and ensuring people’s needs are met?

Thomas: Sudan has undergone a revolution. Brilliant revolutionaries have eloquently articulated Sudan’s crisis and proposed practical solutions. They have devised models of decommodified healthcare in a highly commodified healthcare environment. These individuals and movements are leading the way, and people should pay attention to what they have to say.

Jacobsen: Excellent. Eddie, I have no more questions. Thank you very much for your time today. It was nice to meet you. 

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