I first met my patient, whom I will call Halima, when she was referred to our hospital while suffering from advanced cervical cancer. In her mid-40s, she initially sought treatment in her home community, in the war-ravaged Darfur region, but the doctors there felt unable to treat her and referred her to the Juba Teaching Hospital in the capital city of South Sudan. There, as well, doctors felt they were ill equipped to handle the case, so they referred her to our Catholic mission hospital in the remote Nuba Mountains of Sudan.

We agreed with the diagnosis of advanced cervical cancer, started chemotherapy and then performed a radical hysterectomy after the second course of chemo. I saw her this week for a follow-up and another cycle of chemotherapy, and I’m happy to report she is recovering and doing well. 

This case highlights the fragility and brokenness of the health system in Sudan and South Sudan. Halima’s journey to care would be like a person from California being referred to Texas and then getting sent to rural Pennsylvania for treatment. The task to care for this woman fell to our relatively small hospital, a local project run by local staff.

Together with the late Bishop Macram Gassis of the El Obeid Diocese, I helped found Mother of Mercy Hospital almost 20 years ago. The hospital is rooted in the local church and community, and it will be here well into the future, through good times and bad. But despite broad promises from major donors to provide humanitarian aid to locally led projects, only a small percentage of previously pledged aid has reached those on the ground.

There is much room to improve: In 2016, major donor states and humanitarian aid agencies pledged to channel 25 percent of humanitarian funding to local organizations. Nine years later, this commitment has proven largely meaningless. According to the Overseas Development Institute, less than 2 percent of humanitarian aid goes directly to local organizations and assistance providers.

My experiences show that renewed commitment to supporting grassroots assistance from international donors, backed by people of faith around the world, is not just a bureaucratic target; it is a matter of life and death.

Since arriving here in 2008, I have treated hundreds of thousands of patients at Mother of Mercy Hospital—the only referral hospital for more than two million people, including hundreds of thousands displaced by ongoing civil war and civilians from South Sudan who cross the border to receive care. On any given day, alongside a dedicated team of Sudanese medical staff, I perform amputations with limited anesthesia, operate on newborn infants with congenital defects, and treat broken bones and shrapnel wounds with the most basic medical equipment.

The medical care and supply of basic necessities like food and water for millions now lies in the hands of a few grassroots humanitarian organizations. Over decades of conflict, warring parties in Sudan have demonstrated the utmost contempt for the laws of war and have routinely denied United Nations agencies and international humanitarian access to civilians ensnared by violence. And while previous civil wars have largely been confined to Sudan’s periphery, the current civil war has engulfed the entire country as combatants have laid waste to major urban centers—including the capital Khartoum and El-Fasher, the capital of North Darfur state. 

As a result, Sudan is now home to the world’s worst and most neglected humanitarian crisis. The warring parties have driven more than 12 million civilians from their homes, committed mass rape and ethnic cleansing, and pushed hundreds of thousands to the brink of starvation. Compounding the challenges facing anyone who tries to assist, parties to the conflict have systematically targeted health facilities. Mother of Mercy is among the fewer than 30 percent of the country’s health facilities still operating, and it is the only provider of cancer care not only for Nuba but for most of Sudan.

While large humanitarian organizations are cutting staff in response to debilitating funding cuts from the United States and other Western nations, and are unable to reach the tens of millions of Sudanese who need assistance to survive, many locally based aid providers continue to operate. Indeed, the most impactful humanitarian responders in Sudan right now are the so-called Emergency Response Rooms, or E.R.R.s—local mutual aid groups that run soup kitchens for the hungry and distribute medical supplies to the sick and wounded across the country. It’s also important to recognize other doctors and hospitals like mine, undaunted in the face of extreme violence. Dr. Jamal Eltaeb was awarded the Aurora Prize for Awakening Humanity on Nov. 6 in recognition of his courage in providing care at one of the last referral hospitals in the greater Khartoum area. He has said his work is not just about survival: “It is about hope that refuses to die.”

This unceasing determination resonates with me. I keep going because Jesus Christ calls us to help those in greatest need. This work has introduced me to humanitarians across the globe, from Sudan to Syria to Myanmar, who are putting their lives at risk to save others. Helping them continue their work has become an extension of my mission here in Sudan.

While grassroots aid providers like E.R.R.s and Mother of Mercy save lives every day, skeptics of the local humanitarian response argue that only large international agencies have the resources and reach to operate at scale. But my experience shows otherwise. When local leaders are equipped and trusted, their impact is immediate, cost-effective and lasting. They know who is most vulnerable, how to navigate cultural realities and how to build trust. And they have the ingenuity to find solutions when medicine and food stop arriving.

My hospital and other health care facilities in the region are almost always at capacity. We run on solar power with a backup generator and have running water thanks to a solar water pump, but there is no running water outside the hospital gates. We live a simple, busy life, but there is joy in helping others and saving lives. In 2022, we began the region’s first training school for physician assistants and midwives. This is an example of how donor funding can make a difference that boosts local capacity and starts communities on a path to healing.  

With the United States and other major donors scaling back their support for humanitarian response, U.N. agencies and large NGOs all acknowledge that they must do more with less. Agencies have cut staff and closed programs. While the collapse of this lifesaving system is both tragic and dire, the need to rebuild demands that we reconsider basic assumptions about the most effective way to deliver assistance in conflict zones.

Based on my experience in Sudan and the success of locally led mutual aid groups in reaching millions of vulnerable Sudanese, I believe this effort must be from the ground up. As a missionary who is integrated into the local community, I prioritize building local capacity. But there are real needs that we need more resources to address, and this is where international aid and coalitions come in. To take care of people, local humanitarian leaders need meaningful financial support that is consistent, not here today and gone tomorrow. 

Coming out of the U.N. General Assembly in September, donors should re-commit to directing at least 25 percent of humanitarian aid specifically through local organizations by 2030. And as Catholics dedicated to protecting human dignity, we must urge them to fully implement those commitments.

This aligns with the Catholic principle of solidarity, which is rooted in the teachings to love our neighbors across the world and the call from the Gospel to be peacemakers. Pope Francis said that what reigns today is “cool, comfortable and globalized indifference, born of deep disillusionment concealed behind a deceptive illusion: thinking that we are all-powerful, while failing to realize that we are all in the same boat.”

Investing in those who are already saving lives on the ground is a way of thinking and acting in terms of community, without restrictions on whom we consider brothers and sisters. It will allow dollars to stretch farther and, ultimately, save more lives. The alternative, to abandon the people around us at their most vulnerable, is a waste of humanity. 

[From 2024: “Catholic aid workers confront humanitarian crisis in Sudan as world looks away”]

Dr. Tom Catena is a Catholic missionary serving as the medical director of the Mother of Mercy Hospital in Sudan. He also works to catalyze and support the work of local humanitarians globally as Chairman of the Advisory Board of the Aurora Humanitarian Initiative.