A Diaspora-Led Telehealth Response to the Sudan Conflict: A Six-Month Analysis of the SUDAQ Initiative

A Diaspora-Led Telehealth Response to the Sudan Conflict: A Six-Month Analysis of the SUDAQ Initiative | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Diaspora-Led Telehealth Response to the Sudan Conflict: A Six-Month Analysis of the SUDAQ Initiative Abdelrahman Hamad, Amani Khalifa, Mohamed O Eltahir, Mohammed Elbadri, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8003993/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background: The armed conflict in Sudan, which began on April 15, 2023, led to the systemic collapse of the healthcare system, necessitating innovative care delivery methods. This report details the rapid implementation and six-month outcomes of a diaspora-led telehealth service launched by the Sudanese Doctors Association in Qatar (SUDAQ). Methods : A descriptive, retrospective analysis of the SUDAQ Telehealth Service (17 April–17 October 2023). The volunteer-run program offered remote consultations via a dedicated hotline and WhatsApp. The service adhered to a privacy-by-design framework, ensuring that all detailed clinical interactions took place solely between the patient and their assigned physician. Data from clinical chats were manually transcribed into an anonymous electronic log. Results: Over the course of six months, the service delivered 1,480 consultations across 36 specialities to patients in 13 of Sudan’s 18 states. Demand was highest in the first two months (1,085 consultations, 73%), coinciding with the peak conflict intensity. The most frequent reasons for consultation were internal medicine (32%), paediatrics (25%), obstetrics and gynaecology (15%), psychiatry (10%), and dermatology (8%). In direct response, a dedicated mental health hotline was established. The model utilised 143 volunteer doctors and chemists to facilitate access to medication. Conclusion : The SUDAQ initiative demonstrates that a diaspora-led telehealth model, utilising inexpensive and accessible technology, can be rapidly deployed and adapted to deliver essential medical advice during active conflict. This approach represents a scalable, ethical crisis response that highlights the critical role of professional diaspora networks. Telemedicine Humanitarian response Conflict Mental health Diaspora Sudan Figures Figure 1 Figure 2 Figure 3 Introduction On April 15, 2023, widespread armed conflict erupted in Sudan, leading to the destruction of hospitals, the displacement of medical staff, and the cessation of basic healthcare services [ 1 ]. In this context of danger and shattered infrastructure, obtaining even basic medical advice became exceedingly difficult, creating an urgent imperative for new healthcare delivery channels, particularly through remote, technology-enabled services. This crisis has catalysed a range of innovative, ad-hoc health initiatives, as documented in recent analyses of the humanitarian response [ 2 ]. Globally, telehealth has emerged as a critical modality for sustaining healthcare during emergencies [ 3 ]. Evidence from active conflict zones, such as Ukraine, confirms the rapid adoption and vital role of this approach when traditional systems collapse [ 4 ]. Furthermore, studies have highlighted both the potential and challenges of implementing telemedicine in war zones, especially in reaching vulnerable populations [ 5 ]. Beyond institutional programs, diaspora professional networks often play a crucial role in facilitating cross-border medical care during emergencies [ 6 ]. However, comprehensive evaluations of such diaspora-led telehealth initiatives remain scarce. The Sudanese Doctors Association in Qatar (SUDAQ), a non-profit organisation of Sudanese doctors, recognised this gap and established a volunteer-based telehealth program within 48 hours of the conflict’s onset. This report details the establishment, workflow, and six-month outcomes of the SUDAQ Telehealth Service, contributing to the evidence base on scalable, diaspora-led telemedicine models in conflict environments. Methods Study Design and Setting This retrospective report describes the operations of the SUDAQ Telehealth Service. This volunteer initiative employs a low-tech, high-touch model reliant on human coordination rather than complex digital infrastructure. The service launched on April 17, 2023, and provided continuous support until October 17, 2023. Operational Model and Workflow The service operated through a structured workflow summarised in Figure 1. Hotline Access & Automated Response: A dedicated mobile number, disseminated via social media and community networks, served as the single point of entry. An automated WhatsApp reply clarified the service’s scope and instructed users to specify the required medical speciality or main complaint. Triage: Incoming messages were handled by a member of the SUDAQ steering committee (all licensed doctors) on a rotating 24-hour schedule. Consultation Tasking: The on-call physician triaged the specialist selection, choosing the most suitable specialist from a pool of volunteers based on their shared availability on a secure internal communication platform. The on-call physician then shared the name, speciality, and contact details of the assigned doctor with the service requester (patient or caregiver). Consultation: The service requester subsequently contacted the assigned physician directly via WhatsApp for the medical consultation, with the chat serving as the primary medical record. Referral: For complex cases, the consulting doctor could seek input from another specialist within a closed professional WhatsApp group. Privacy-Conscious Model A key feature was the strict separation of triage and clinical care to protect patient privacy. All detailed clinical discussions, including sensitive health information and patient images, took place exclusively in direct chats between the patient and their assigned treating physician. Data Collection and Analysis Consultation data were gathered retrospectively from the WhatsApp records. After each consultation, the physician manually transcribed non-identifiable information into a central electronic log, and the original chats were then deleted. Follow-up interactions occurring within the same chat thread were counted as a single consultation. The anonymised log included the following variables: date of consultation, patient state, age group, sex (when available), presenting complaint, assigned speciality, and type of consultation (patient or peer-to-peer). Data were analysed descriptively using Microsoft Excel (counts and percentages) to summarise consultation volume, geographic distribution, demographic patterns, and speciality breakdown. Volunteers and Ethics The service involved 143 licensed doctors residing in Qatar, covering 36 medical specialities. Several clinical chemists volunteered to assist with sourcing medications through local networks. This project was conducted as a humanitarian medical response. Verbal consent for remote consultation and use of anonymised data was obtained. The privacy-by-design approach was an integral part of the ethical principle. As only aggregated, anonymised data were analysed, the project was exempt from formal institutional ethics review. Results Consultation Trends The SUDAQ Telehealth Service handled 1,480 consultations over a six-month period. The first two months (April 17–June 17, 2023) saw the highest activity, with 1,085 consultations (73% of the total), coinciding with the most intense period of conflict. Consultation volume steadily declined thereafter (Figure 2). Distribution by Speciality and Service Evolution The most common reasons for consultation were Internal Medicine (32%), Paediatrics (25%), Obstetrics and Gynaecology (15%), Psychiatry (10%), and Dermatology (8%). This distribution indicates a high demand for chronic disease management, primary care, and mental health support during the conflict (Figure 3). In response to the increasing number of psychiatric consultations, SUDAQ established a dedicated mental health hotline in parallel with the leading service. This hotline was managed by trained volunteers under the supervision of consultant psychiatrists. To build local capacity, one of the senior psychiatry consultants organised a full-day in-person training workshop in May 2023 for general practitioners and psychologists on basic psychological first aid and crisis response, guided by established Psychological First Aid principles [7]. The mental health hotline operated as a paid international number, where individuals in distress could initiate contact by sending a brief text message or a missed call, and would then receive a return call from trained staff offering psychological support. This branch of the service formed the foundation for a distinct mental health tele-support initiative. Consultation Type and Source The majority of consultations were initiated by patients or family members seeking advice for acute or chronic conditions. Notably, twenty-eight consultations were undertaken by junior doctors within Sudan seeking specialist support for complex cases. The majority of these peer-to-peer consultations were for specialised surgical disciplines—including vascular surgery, neurosurgery, and radiology—highlighting the critical gap in specialist coverage and the service’s role in providing remote clinical guidance to frontline providers. These peer-to-peer requests represent an important early indicator of the model’s capacity-building potential, which is further explored in the Discussion. Geographic and Demographic Reach Patients originated from 13 of Sudan's 18 states, with the highest volume from Khartoum (40%), Al Jazirah (18%), the five states of Darfur (collectively 14%), North Kordofan (8%), Kassala (7%), and White Nile (7%). The remaining consultations were distributed across three other states. Demographically, approximately 60% of patients were adults, while 40% were children under the age of 18. Among adult patients, 59% were female and 41% were male. Volunteer Composition The program was sustained by 143 licensed doctors and several clinical chemists. The chemists played a crucial role in leveraging their professional networks to locate vital medications within Sudan's fragmented supply chains. Discussion This initiative demonstrates that a diaspora-led telemedicine service can be rapidly established and dynamically adapted to provide essential medical assistance during conflict. Our findings are consistent with recent evidence from other conflict areas, where telemedicine has proven vital for maintaining healthcare delivery [8]. The high demand for internal medicine, paediatric, and obstetric consultations underscores the collapse of both acute and chronic care pathways, a pattern reflected in other conflict settings [5]. The significant proportion of psychiatric cases (10%) highlights the severe psychosocial stress endured by civilians, aligning with the identified need to tailor services to the mental health needs of vulnerable populations in war zones [5]. The program's responsiveness in establishing a dedicated mental health hotline, complete with specialised training based on evidence-based Psychological First Aid [7], represents a model for tiered, sustainable psychological support in humanitarian crises. This evolution from a generalist to a specialist service based on real-time data is a key strength of agile, diaspora-led models. The model's strengths included its rapid scalability, cultural and linguistic competence, and the high level of trust between providers and patients—a 'diaspora advantage' that likely improved engagement in a context where official health structures had collapsed. A key operational and ethical strength was the privacy-conscious design, which confined sensitive clinical discussions to the direct channel between the patient and the treating specialist. Beyond direct patient care, the service inadvertently evolved into a platform for remote mentoring and capacity-building. The twenty-eight consultations initiated by junior doctors in Sudan, predominantly for complex surgical and radiological cases, underscore a critical gap in specialist coverage and demonstrate the model's utility in supporting the remaining healthcare workforce on the ground. This peer-to-peer support component adds another dimension to the diaspora's role, extending its impact from civilian care to professional solidarity and knowledge transfer. Challenges included the inability to issue formal prescriptions universally, limited diagnostic testing capacity, and intermittent internet connectivity, all well-documented barriers in conflict-zone telemedicine [3,5]. Furthermore, the gradual decline in consultations after the initial peak is multifactorial. It likely reflects not only population displacement and the widespread telecommunications blackouts imposed in Sudan—highlighting a critical vulnerability of digital health in modern warfare—but also the gradual establishment of patient populations in safer areas, both within Sudan and abroad, where they regained access to local, in-person healthcare services. An additional internal challenge was the reliance on self-reporting by volunteers, which may have led to under-recording, underscoring the broader challenge of maintaining 24/7 services that rely on volunteer labour. Additionally, the retrospective nature of the dataset meant that follow-up and clinical outcome data were largely unavailable, limiting our ability to assess patient improvement. Despite these limitations, the program maintained a steady communication link between patients and healthcare providers during the acute phase of the conflict. The critical role of diaspora networks, as highlighted in other humanitarian contexts [6], was clearly manifested in this initiative. Conclusion and Recommendations The SUDAQ Telehealth Service served as a vital humanitarian lifeline, providing timely medical advice to civilians during the conflict in Sudan. This initiative demonstrates how diaspora-based professional groups can rapidly mobilise and deliver scalable, ethical, and sustainable telemedicine models in emergencies. Based on this experience, we recommend the following: For Diaspora Groups: Pre-emptively establish communication protocols, volunteer registries, and readiness frameworks that enable rapid activation in the event of crises. For Humanitarian Agencies: Integrate vetted diaspora telehealth networks into emergency response plans, and ensure support for secure data handling, digital communication infrastructure, and medication supply pathways. For Future Research: Prioritise studies examining patient-reported outcomes, cost-effectiveness, and the long-term management of chronic diseases delivered through telehealth in conflict settings. For system strengthening, focus on formalising these networks, standardising prescribing pathways, enhancing triage protocols, and establishing reliable follow-up mechanisms for patients. Declarations Ethics approval and consent to participate: This project was conducted as a humanitarian medical response by the Sudanese Doctors Association in Qatar (SUDAQ) to support patients affected by the 2023 conflict in Sudan. It did not involve patients or data from Hamad Medical Corporation or any Qatari institution. The study consisted of a retrospective analysis of anonymised service data and voluntary feedback from participating physicians. According to institutional and national guidelines, this type of activity did not require formal ethics approval. All participating volunteer physicians provided informed consent for their inclusion in the evaluation, and verbal informed consent was obtained from all patients (or their guardians) before teleconsultations. The project adhered to the ethical principles outlined in the Declaration of Helsinki (2013 revision), and privacy-by-design principles were applied throughout the service to ensure data confidentiality and anonymity. Consent for publication: Not applicable. Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: This initiative received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. It was conducted entirely by volunteers. Author Contributions A.H. conceived the study, led the data analysis, and wrote the main manuscript text. A.H. is the sole author of this manuscript. A.K., M.O.E., M.E., O.E., S.I. and S.G. contributed to data validation, case review, and manuscript revision. All authors reviewed and approved the final version of the manuscript. Acknowledgements: The authors wish to acknowledge the immense dedication of all 143 SUDAQ volunteer doctors and clinical chemists. We also extend our gratitude to the communities in Sudan who placed their trust in us. The authors specifically thank Sami Omer for leading the establishment and supervision of the dedicated mental health service. The authors also gratefully acknowledge the other members of the SUDAQ executive committee for their vital coordination and triage duties, including Hatim Abdelrahman, Ibnouf Sulieman, and Khalid Mohamed. References Médecins Sans Frontières (2023) Sudan crisis update. Available at: https://www.msf.org/sudan-crisis-update-2023 (Accessed: 10/11/2025) Campbell, A.C., Baleela, R.M., Mude, W. and Sulaiman, S., 2025. Innovation in health and humanitarian aid: lessons from Sudan. The Lancet, 406(10502), pp.442-443. Merrell RC, Cone SW, Rafiq A. Telemedicine in extreme conditions: disasters, war, remote sites. Stud Health Technol Inform. 2008;131:99-116. Poberezhets V, Demchuk A, Mostovoy Y. How Russian-Ukrainian war changed the usage of telemedicine: a questionnaire-based study in Ukraine. Ankara Med J. 2022;22(3). Haimi M. Telemedicine in war zones: prospects, barriers, and meeting the needs of special populations. Front Med. 2024;11:1417025. Bowsher G, et al. eHealth for service delivery in conflict: a narrative review. J Public Health Policy. 2021; Online First. Ruzek, J.I., Brymer, M.J., Jacobs, A.K., Layne, C.M., Vernberg, E.M. and Watson, P.J., 2007. Psychological first aid. Journal of Mental Health Counseling, 29(1), pp.17-49. Sberro-Cohen S, Ellen ME. From Conflict to Care-Telemedicine Utilisation During Wartime: A Retrospective Cohort Study. J Med Syst. 2025;49(1):83. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 20 Jan, 2026 Reviews received at journal 28 Dec, 2025 Reviewers agreed at journal 19 Dec, 2025 Reviewers agreed at journal 19 Dec, 2025 Reviewers agreed at journal 17 Dec, 2025 Reviewers invited by journal 12 Dec, 2025 Editor assigned by journal 08 Dec, 2025 Editor invited by journal 17 Nov, 2025 Submission checks completed at journal 14 Nov, 2025 First submitted to journal 14 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8003993","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":561032063,"identity":"ba04b2fb-bb86-4d26-aeb7-b180159f8e31","order_by":0,"name":"Abdelrahman Hamad","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYFAC5gYGxgYJBgb2HjCPGC2MUC08Z0jTAqQlcojUwt9+sPkz7w4LOfOZbw9+ulFjzcB3/AB+LRJnEhuMec9IGMvczkuWzjmWziB5JoGANQcSG5J52yQSZ0jnGEjnsB1mMDhAQIv8+YcNh4Fa6mdInjH+nfMPqOX8A/xaDG4kNjYDtSRISPCYSee2AbXcIGCL4Y2HzYxzz0gYzuDJMbPO7UvnkbxBwBa588mHP7zdUScvwX7G+HbON2s5vvMEbMEAPAwHSNQBBGRoGQWjYBSMguENAB+BRUGOpBinAAAAAElFTkSuQmCC","orcid":"","institution":"Hamad General Hospital, Hamad Medical Corporation","correspondingAuthor":true,"prefix":"","firstName":"Abdelrahman","middleName":"","lastName":"Hamad","suffix":""},{"id":561032064,"identity":"76d4821c-2fe5-4250-99f6-0a7ee8358b58","order_by":1,"name":"Amani Khalifa","email":"","orcid":"","institution":"Hamad General Hospital, Hamad Medical Corporation","correspondingAuthor":false,"prefix":"","firstName":"Amani","middleName":"","lastName":"Khalifa","suffix":""},{"id":561032065,"identity":"f71e9bae-ed92-4d1b-afad-ca3a23a7e4d2","order_by":2,"name":"Mohamed O Eltahir","email":"","orcid":"","institution":"Hamad General Hospital, Hamad Medical Corporation","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"O","lastName":"Eltahir","suffix":""},{"id":561032066,"identity":"d8f893f9-4971-4c1b-924a-7f9d4482e8d3","order_by":3,"name":"Mohammed Elbadri","email":"","orcid":"","institution":"Hamad General Hospital, Hamad Medical Corporation","correspondingAuthor":false,"prefix":"","firstName":"Mohammed","middleName":"","lastName":"Elbadri","suffix":""},{"id":561032067,"identity":"ff4e1ffe-73ac-4f15-b5e4-39bd191aceea","order_by":4,"name":"Osama Elnour","email":"","orcid":"","institution":"Hamad General Hospital, Hamad Medical Corporation","correspondingAuthor":false,"prefix":"","firstName":"Osama","middleName":"","lastName":"Elnour","suffix":""},{"id":561032070,"identity":"8988bd2b-5262-4d30-9837-65da1a63bf90","order_by":5,"name":"Shahd Ibrahim","email":"","orcid":"","institution":"Hamad General Hospital, Hamad Medical Corporation","correspondingAuthor":false,"prefix":"","firstName":"Shahd","middleName":"","lastName":"Ibrahim","suffix":""},{"id":561032072,"identity":"e0dc325b-c2c2-4e14-be0f-0234303a1fbc","order_by":6,"name":"Sohel Gamal","email":"","orcid":"","institution":"Hamad General Hospital, Hamad Medical Corporation","correspondingAuthor":false,"prefix":"","firstName":"Sohel","middleName":"","lastName":"Gamal","suffix":""}],"badges":[],"createdAt":"2025-11-01 08:08:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8003993/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8003993/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98751637,"identity":"5fdf8fb0-c7c1-45ee-a30b-dd9c1d922d4d","added_by":"auto","created_at":"2025-12-22 09:12:10","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":274107,"visible":true,"origin":"","legend":"","description":"","filename":"FinalTelehealthSUDAQ.docx","url":"https://assets-eu.researchsquare.com/files/rs-8003993/v1/1182b93ddc52e8ded65f0abf.docx"},{"id":98751634,"identity":"211d5433-e943-4c9a-bd70-34b852c10fa8","added_by":"auto","created_at":"2025-12-22 09:12:10","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":8323,"visible":true,"origin":"","legend":"","description":"","filename":"0e446374f5894499b32718be27686456.json","url":"https://assets-eu.researchsquare.com/files/rs-8003993/v1/3c14ac924ccbcf2b3d00491d.json"},{"id":98751636,"identity":"d73fcf1c-8f78-4f6c-98f4-3eddb9499e16","added_by":"auto","created_at":"2025-12-22 09:12:10","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":39160,"visible":true,"origin":"","legend":"","description":"","filename":"0e446374f5894499b32718be276864561enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8003993/v1/f2feeaaa35e76ce8c8ee3faf.xml"},{"id":98777235,"identity":"3b84f995-2fe1-47f0-9abb-42a6af5aabc5","added_by":"auto","created_at":"2025-12-22 12:26:08","extension":"png","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":54008,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8003993/v1/16f37bd0ee5ae104077a8126.png"},{"id":98751639,"identity":"3498a985-b84c-4276-8f46-4ccff10b1d5a","added_by":"auto","created_at":"2025-12-22 09:12:10","extension":"png","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":89100,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8003993/v1/8193f59ffa25a95519a2deee.png"},{"id":98751640,"identity":"bfed4d42-e9cc-4f07-912d-eb4740baaf42","added_by":"auto","created_at":"2025-12-22 09:12:10","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":86008,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8003993/v1/1a3c9e0baa1596ad86c22ff3.png"},{"id":98751644,"identity":"1ceabae2-1149-4f7d-8692-e177a1ae3be9","added_by":"auto","created_at":"2025-12-22 09:12:10","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":22177,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8003993/v1/eadd25a895ffe511937477c8.png"},{"id":98777596,"identity":"f1240d89-4bc9-4982-985d-46b5905b12c6","added_by":"auto","created_at":"2025-12-22 12:28:09","extension":"png","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":23802,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8003993/v1/8e95259c7d8298b1b8b77c61.png"},{"id":98778624,"identity":"40b5889b-a70a-488a-90e4-88d6667e1fb5","added_by":"auto","created_at":"2025-12-22 12:29:28","extension":"png","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":35816,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8003993/v1/cf0d3d3e9b1a6fd3ebfba8ec.png"},{"id":98751645,"identity":"a2bae9a4-ad95-439e-80bb-b444960e51c2","added_by":"auto","created_at":"2025-12-22 09:12:10","extension":"xml","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":36822,"visible":true,"origin":"","legend":"","description":"","filename":"0e446374f5894499b32718be276864561structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8003993/v1/dd4498918a56c3dd110bcae1.xml"},{"id":98778230,"identity":"27f066d3-5301-4211-90da-a3c8d0fb795a","added_by":"auto","created_at":"2025-12-22 12:29:02","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":46417,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8003993/v1/3aa431cfe5e2265765dfdc8e.html"},{"id":98751631,"identity":"b9698e74-598a-499d-9d48-f607f0ac1de5","added_by":"auto","created_at":"2025-12-22 09:12:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":54008,"visible":true,"origin":"","legend":"\u003cp\u003eOperational Workflow of the SUDAQ Telehealth Service.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8003993/v1/a6d9e45b706584a6b809325c.png"},{"id":98777139,"identity":"469d969d-324a-4f92-b4d2-5853f8575f40","added_by":"auto","created_at":"2025-12-22 12:25:28","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":89100,"visible":true,"origin":"","legend":"\u003cp\u003eMonthly Consultation Volume (April–October 2023). The volume peaked in the first two months and then gradually declined.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8003993/v1/d639842b2b19516ccb3c7bb4.png"},{"id":98751633,"identity":"ec44e927-24cc-4aa1-9428-0175e9be4d91","added_by":"auto","created_at":"2025-12-22 09:12:10","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":86008,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of Consultations by Speciality (n = 1,480).\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8003993/v1/6d9c1bfbca448a3e995643f2.png"},{"id":98785789,"identity":"f837089d-157e-467e-9701-195cefa990e8","added_by":"auto","created_at":"2025-12-22 12:43:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":613216,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8003993/v1/56b57739-ff74-460e-84d9-57e6e0e41002.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Diaspora-Led Telehealth Response to the Sudan Conflict: A Six-Month Analysis of the SUDAQ Initiative","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOn April 15, 2023, widespread armed conflict erupted in Sudan, leading to the destruction of hospitals, the displacement of medical staff, and the cessation of basic healthcare services [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In this context of danger and shattered infrastructure, obtaining even basic medical advice became exceedingly difficult, creating an urgent imperative for new healthcare delivery channels, particularly through remote, technology-enabled services. This crisis has catalysed a range of innovative, ad-hoc health initiatives, as documented in recent analyses of the humanitarian response [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGlobally, telehealth has emerged as a critical modality for sustaining healthcare during emergencies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Evidence from active conflict zones, such as Ukraine, confirms the rapid adoption and vital role of this approach when traditional systems collapse [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Furthermore, studies have highlighted both the potential and challenges of implementing telemedicine in war zones, especially in reaching vulnerable populations [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBeyond institutional programs, diaspora professional networks often play a crucial role in facilitating cross-border medical care during emergencies [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, comprehensive evaluations of such diaspora-led telehealth initiatives remain scarce. The Sudanese Doctors Association in Qatar (SUDAQ), a non-profit organisation of Sudanese doctors, recognised this gap and established a volunteer-based telehealth program within 48 hours of the conflict\u0026rsquo;s onset. This report details the establishment, workflow, and six-month outcomes of the SUDAQ Telehealth Service, contributing to the evidence base on scalable, diaspora-led telemedicine models in conflict environments.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective report describes the operations of the SUDAQ Telehealth Service. This volunteer initiative employs a low-tech, high-touch model reliant on human coordination rather than complex digital infrastructure. The service launched on April 17, 2023, and provided continuous support until October 17, 2023.\u003c/p\u003e\n\u003ch3\u003eOperational Model and Workflow\u003c/h3\u003e\n\u003cp\u003eThe service operated through a structured workflow summarised in Figure 1.\u003c/p\u003e\n\u003cp\u003eHotline Access \u0026amp; Automated Response: A dedicated mobile number, disseminated via social media and community networks, served as the single point of entry. An automated WhatsApp reply clarified the service\u0026rsquo;s scope and instructed users to specify the required medical speciality or main complaint.\u003c/p\u003e\n\u003cp\u003eTriage: Incoming messages were handled by a member of the SUDAQ steering committee (all licensed doctors) on a rotating 24-hour schedule.\u003c/p\u003e\n\u003cp\u003eConsultation Tasking: The on-call physician triaged the specialist selection, choosing the most suitable specialist from a pool of volunteers based on their shared availability on a secure internal communication platform. The on-call physician then shared the name, speciality, and contact details of the assigned doctor with the service requester (patient or caregiver).\u003c/p\u003e\n\u003cp\u003eConsultation: The service requester subsequently contacted the assigned physician directly via WhatsApp for the medical consultation, with the chat serving as the primary medical record.\u003c/p\u003e\n\u003cp\u003eReferral: For complex cases, the consulting doctor could seek input from another specialist within a closed professional WhatsApp group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrivacy-Conscious Model\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA key feature was the strict separation of triage and clinical care to protect patient privacy. All detailed clinical discussions, including sensitive health information and patient images, took place exclusively in direct chats between the patient and their assigned treating physician.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection and Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsultation data were gathered retrospectively from the WhatsApp records. After each consultation, the physician manually transcribed non-identifiable information into a central electronic log, and the original chats were then deleted. Follow-up interactions occurring within the same chat thread were counted as a single consultation.\u003c/p\u003e\n\u003cp\u003eThe anonymised log included the following variables: date of consultation, patient state, age group, sex (when available), presenting complaint, assigned speciality, and type of consultation (patient or peer-to-peer).\u003c/p\u003e\n\u003cp\u003eData were analysed descriptively using Microsoft Excel (counts and percentages) to summarise consultation volume, geographic distribution, demographic patterns, and speciality breakdown.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVolunteers and Ethics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe service involved 143 licensed doctors residing in Qatar, covering 36 medical specialities. Several clinical chemists volunteered to assist with sourcing medications through local networks.\u003c/p\u003e\n\u003cp\u003eThis project was conducted as a humanitarian medical response. Verbal consent for remote consultation and use of anonymised data was obtained. The privacy-by-design approach was an integral part of the ethical principle. As only aggregated, anonymised data were analysed, the project was exempt from formal institutional ethics review.\u003c/p\u003e"},{"header":"Results","content":"\u003ch3\u003eConsultation Trends\u003c/h3\u003e\n\u003cp\u003eThe SUDAQ Telehealth Service handled 1,480 consultations over a six-month period. The first two months (April 17\u0026ndash;June 17, 2023) saw the highest activity, with 1,085 consultations (73% of the total), coinciding with the most intense period of conflict. Consultation volume steadily declined thereafter (Figure 2).\u003c/p\u003e\n\u003ch3\u003eDistribution by Speciality and Service Evolution\u003c/h3\u003e\n\u003cp\u003eThe most common reasons for consultation were Internal Medicine (32%), Paediatrics (25%), Obstetrics and Gynaecology (15%), Psychiatry (10%), and Dermatology (8%). This distribution indicates a high demand for chronic disease management, primary care, and mental health support during the conflict (Figure 3).\u003c/p\u003e\n\u003cp\u003eIn response to the increasing number of psychiatric consultations, SUDAQ established a dedicated mental health hotline in parallel with the leading service. This hotline was managed by trained volunteers under the supervision of consultant psychiatrists. To build local capacity, one of the senior psychiatry consultants organised a full-day in-person training workshop in May 2023 for general practitioners and psychologists on basic psychological first aid and crisis response, guided by established Psychological First Aid principles [7]. The mental health hotline operated as a paid international number, where individuals in distress could initiate contact by sending a brief text message or a missed call, and would then receive a return call from trained staff offering psychological support. This branch of the service formed the foundation for a distinct mental health tele-support initiative.\u003c/p\u003e\n\u003ch3\u003eConsultation Type and Source\u003c/h3\u003e\n\u003cp\u003eThe majority of consultations were initiated by patients or family members seeking advice for acute or chronic conditions. Notably, twenty-eight consultations were undertaken by junior doctors within Sudan seeking specialist support for complex cases. The majority of these peer-to-peer consultations were for specialised surgical disciplines\u0026mdash;including vascular surgery, neurosurgery, and radiology\u0026mdash;highlighting the critical gap in specialist coverage and the service\u0026rsquo;s role in providing remote clinical guidance to frontline providers. These peer-to-peer requests represent an important early indicator of the model\u0026rsquo;s capacity-building potential, which is further explored in the Discussion.\u003c/p\u003e\n\u003ch3\u003eGeographic and Demographic Reach\u003c/h3\u003e\n\u003cp\u003ePatients originated from 13 of Sudan\u0026apos;s 18 states, with the highest volume from Khartoum (40%), Al Jazirah (18%), the five states of Darfur (collectively 14%), North Kordofan (8%), Kassala (7%), and White Nile (7%). The remaining consultations were distributed across three other states. Demographically, approximately 60% of patients were adults, while 40% were children under the age of 18. Among adult patients, 59% were female and 41% were male.\u003c/p\u003e\n\u003ch3\u003eVolunteer Composition\u003c/h3\u003e\n\u003cp\u003eThe program was sustained by 143 licensed doctors and several clinical chemists. The chemists played a crucial role in leveraging their professional networks to locate vital medications within Sudan\u0026apos;s fragmented supply chains.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis initiative demonstrates that a diaspora-led telemedicine service can be rapidly established and dynamically adapted to provide essential medical assistance during conflict. Our findings are consistent with recent evidence from other conflict areas, where telemedicine has proven vital for maintaining healthcare delivery [8]. The high demand for internal medicine, paediatric, and obstetric consultations underscores the collapse of both acute and chronic care pathways, a pattern reflected in other conflict settings [5].\u003c/p\u003e\n\u003cp\u003eThe significant proportion of psychiatric cases (10%) highlights the severe psychosocial stress endured by civilians, aligning with the identified need to tailor services to the mental health needs of vulnerable populations in war zones [5]. The program\u0026apos;s responsiveness in establishing a dedicated mental health hotline, complete with specialised training based on evidence-based Psychological First Aid [7], represents a model for tiered, sustainable psychological support in humanitarian crises. This evolution from a generalist to a specialist service based on real-time data is a key strength of agile, diaspora-led models.\u003c/p\u003e\n\u003cp\u003eThe model\u0026apos;s strengths included its rapid scalability, cultural and linguistic competence, and the high level of trust between providers and patients\u0026mdash;a \u0026apos;diaspora advantage\u0026apos; that likely improved engagement in a context where official health structures had collapsed. A key operational and ethical strength was the privacy-conscious design, which confined sensitive clinical discussions to the direct channel between the patient and the treating specialist.\u003c/p\u003e\n\u003cp\u003eBeyond direct patient care, the service inadvertently evolved into a platform for remote mentoring and capacity-building. The twenty-eight consultations initiated by junior doctors in Sudan, predominantly for complex surgical and radiological cases, underscore a critical gap in specialist coverage and demonstrate the model\u0026apos;s utility in supporting the remaining healthcare workforce on the ground. This peer-to-peer support component adds another dimension to the diaspora\u0026apos;s role, extending its impact from civilian care to professional solidarity and knowledge transfer.\u003c/p\u003e\n\u003cp\u003eChallenges included the inability to issue formal prescriptions universally, limited diagnostic testing capacity, and intermittent internet connectivity, all well-documented barriers in conflict-zone telemedicine [3,5]. Furthermore, the gradual decline in consultations after the initial peak is multifactorial. It likely reflects not only population displacement and the widespread telecommunications blackouts imposed in Sudan\u0026mdash;highlighting a critical vulnerability of digital health in modern warfare\u0026mdash;but also the gradual establishment of patient populations in safer areas, both within Sudan and abroad, where they regained access to local, in-person healthcare services. An additional internal challenge was the reliance on self-reporting by volunteers, which may have led to under-recording, underscoring the broader challenge of maintaining 24/7 services that rely on volunteer labour.\u003c/p\u003e\n\u003cp\u003eAdditionally, the retrospective nature of the dataset meant that follow-up and clinical outcome data were largely unavailable, limiting our ability to assess patient improvement.\u003c/p\u003e\n\u003cp\u003eDespite these limitations, the program maintained a steady communication link between patients and healthcare providers during the acute phase of the conflict. The critical role of diaspora networks, as highlighted in other humanitarian contexts [6], was clearly manifested in this initiative.\u003c/p\u003e"},{"header":"Conclusion and Recommendations","content":"\u003cp\u003eThe SUDAQ Telehealth Service served as a vital humanitarian lifeline, providing timely medical advice to civilians during the conflict in Sudan. This initiative demonstrates how diaspora-based professional groups can rapidly mobilise and deliver scalable, ethical, and sustainable telemedicine models in emergencies.\u003c/p\u003e\n\u003cp\u003eBased on this experience, we recommend the following:\u003c/p\u003e\n\u003cp\u003eFor Diaspora Groups: Pre-emptively establish communication protocols, volunteer registries, and readiness frameworks that enable rapid activation in the event of crises.\u003c/p\u003e\n\u003cp\u003eFor Humanitarian Agencies: Integrate vetted diaspora telehealth networks into emergency response plans, and ensure support for secure data handling, digital communication infrastructure, and medication supply pathways.\u003c/p\u003e\n\u003cp\u003eFor Future Research: Prioritise studies examining patient-reported outcomes, cost-effectiveness, and the long-term management of chronic diseases delivered through telehealth in conflict settings.\u003c/p\u003e\n\u003cp\u003eFor system strengthening, focus on formalising these networks, standardising prescribing pathways, enhancing triage protocols, and establishing reliable follow-up mechanisms for patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate:\u003c/p\u003e\n\u003cp\u003eThis project was conducted as a humanitarian medical response by the Sudanese Doctors Association in Qatar (SUDAQ) to support patients affected by the 2023 conflict in Sudan. It did not involve patients or data from Hamad Medical Corporation or any Qatari institution.\u003c/p\u003e\n\u003cp\u003eThe study consisted of a retrospective analysis of anonymised service data and voluntary feedback from participating physicians. According to institutional and national guidelines, this type of activity did not require formal ethics approval.\u003c/p\u003e\n\u003cp\u003eAll participating volunteer physicians provided informed consent for their inclusion in the evaluation, and verbal informed consent was obtained from all patients (or their guardians) before teleconsultations.\u003c/p\u003e\n\u003cp\u003eThe project adhered to the ethical principles outlined in the Declaration of Helsinki (2013 revision), and privacy-by-design principles were applied throughout the service to ensure data confidentiality and anonymity.\u003c/p\u003e\n\u003cp\u003eConsent for publication: Not applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials:\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding: This initiative received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. It was conducted entirely by volunteers.\u003c/p\u003e\n\u003cp\u003eAuthor Contributions\u003c/p\u003e\n\u003cp\u003eA.H. conceived the study, led the data analysis, and wrote the main manuscript text. A.H. is the sole author of this manuscript.\u003c/p\u003e\n\u003cp\u003eA.K., M.O.E., M.E., O.E., S.I. and S.G. contributed to data validation, case review, and manuscript revision.\u003c/p\u003e\n\u003cp\u003eAll authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements:\u003c/p\u003e\n\u003cp\u003eThe authors wish to acknowledge the immense dedication of all 143 SUDAQ volunteer doctors and clinical chemists. We also extend our gratitude to the communities in Sudan who placed their trust in us.\u003c/p\u003e\n\u003cp\u003eThe authors specifically thank Sami Omer for leading the establishment and supervision of the dedicated mental health service.\u003c/p\u003e\n\u003cp\u003eThe authors also gratefully acknowledge the other members of the SUDAQ executive committee for their vital coordination and triage duties, including Hatim Abdelrahman, Ibnouf Sulieman, and Khalid Mohamed.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eM\u0026eacute;decins Sans Fronti\u0026egrave;res (2023) Sudan crisis update. Available at: https://www.msf.org/sudan-crisis-update-2023 (Accessed: 10/11/2025)\u003c/li\u003e\n \u003cli\u003eCampbell, A.C., Baleela, R.M., Mude, W. and Sulaiman, S., 2025. Innovation in health and humanitarian aid: lessons from Sudan. The Lancet, 406(10502), pp.442-443.\u003c/li\u003e\n \u003cli\u003eMerrell RC, Cone SW, Rafiq A. Telemedicine in extreme conditions: disasters, war, remote sites. Stud Health Technol Inform. 2008;131:99-116.\u003c/li\u003e\n \u003cli\u003ePoberezhets V, Demchuk A, Mostovoy Y. How Russian-Ukrainian war changed the usage of telemedicine: a questionnaire-based study in Ukraine. Ankara Med J. 2022;22(3).\u003c/li\u003e\n \u003cli\u003eHaimi M. Telemedicine in war zones: prospects, barriers, and meeting the needs of special populations. Front Med. 2024;11:1417025.\u003c/li\u003e\n \u003cli\u003eBowsher G, et al. eHealth for service delivery in conflict: a narrative review. J Public Health Policy. 2021; Online First.\u003c/li\u003e\n \u003cli\u003eRuzek, J.I., Brymer, M.J., Jacobs, A.K., Layne, C.M., Vernberg, E.M. and Watson, P.J., 2007. Psychological first aid. Journal of Mental Health Counseling, 29(1), pp.17-49.\u003c/li\u003e\n \u003cli\u003eSberro-Cohen S, Ellen ME. From Conflict to Care-Telemedicine Utilisation During Wartime: A Retrospective Cohort Study. J Med Syst. 2025;49(1):83.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Telemedicine, Humanitarian response, Conflict, Mental health, Diaspora, Sudan","lastPublishedDoi":"10.21203/rs.3.rs-8003993/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8003993/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e The armed conflict in Sudan, which began on April 15, 2023, led to the systemic collapse of the healthcare system, necessitating innovative care delivery methods. This report details the rapid implementation and six-month outcomes of a diaspora-led telehealth service launched by the Sudanese Doctors Association in Qatar (SUDAQ).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A descriptive, retrospective analysis of the SUDAQ Telehealth Service (17 April–17 October 2023). The volunteer-run program offered remote consultations via a dedicated hotline and WhatsApp. The service adhered to a privacy-by-design framework, ensuring that all detailed clinical interactions took place solely between the patient and their assigned physician. Data from clinical chats were manually transcribed into an anonymous electronic log.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Over the course of six months, the service delivered 1,480 consultations across 36 specialities to patients in 13 of Sudan’s 18 states. Demand was highest in the first two months (1,085 consultations, 73%), coinciding with the peak conflict intensity. The most frequent reasons for consultation were internal medicine (32%), paediatrics (25%), obstetrics and gynaecology (15%), psychiatry (10%), and dermatology (8%). In direct response, a dedicated mental health hotline was established. The model utilised 143 volunteer doctors and chemists to facilitate access to medication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The SUDAQ initiative demonstrates that a diaspora-led telehealth model, utilising inexpensive and accessible technology, can be rapidly deployed and adapted to deliver essential medical advice during active conflict. This approach represents a scalable, ethical crisis response that highlights the critical role of professional diaspora networks.\u003c/p\u003e","manuscriptTitle":"A Diaspora-Led Telehealth Response to the Sudan Conflict: A Six-Month Analysis of the SUDAQ Initiative","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 09:12:05","doi":"10.21203/rs.3.rs-8003993/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-01-20T13:21:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-28T10:46:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"313875160560298884486015015344624347635","date":"2025-12-19T14:56:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"298761026837455459138173694038834751240","date":"2025-12-19T12:08:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"191458234180794720497353872568983990472","date":"2025-12-17T12:49:42+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-12T10:46:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-08T12:48:23+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-17T06:13:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-14T17:13:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-11-14T17:11:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9277d788-4924-4d0d-bae0-d2ee82a60227","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-22T09:12:06+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-22 09:12:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8003993","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8003993","identity":"rs-8003993","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}