Sudan's cholera crisis compounded by conflict, crowded camps

A renewed outbreak of cholera in Sudan is now endangering displaced populations across the nation, the United Nations Refugee Agency (UNHCR) has warned. The spread of the disease is particularly alarming in Kassala, Gedaref, and Jazirah states—regions that are sheltering not only refugees from neighboring countries but also thousands of internally displaced Sudanese seeking safety from the continuing violence.

Assadullah Nasrullah, Communications Officer for UNHCR Sudan, noted that this cholera outbreak is the second to occur since the onset of the ongoing conflict. He told The Media Line, “The cholera outbreak in Sudan, the second since the conflict began, is deeply concerning, especially for vulnerable communities displaced by the conflict.”

“Currently, there are 143 confirmed cases among refugees in Kassala state, and tragically, five lives have been lost.”

The conflict in Sudan, which began in April 2023 between the Sudan Armed Forces (SAF) and the Rapid Support Forces (RSF), has created one of the largest displacement crises in the world. Over 10 million people have been displaced internally, with an additional 2.1 million fleeing to neighboring countries such as Chad, South Sudan, Egypt, Ethiopia, and others. This conflict has intensified humanitarian needs, particularly in regions heavily affected by violence, where access to healthcare and basic necessities is severely limited.

Challenges faced by Sudan's civilian population

Ongoing conflict and severe humanitarian challenges, including overcrowded camps and gathering sites, exacerbate the recent cholera outbreak. The crisis is further worsened by the scarcity of medical supplies and healthcare workers, along with overburdened health, water, sanitation, and hygiene systems, significantly disrupted by the war.

“The overall situation is compounded by the ongoing conflict, displacement, heavy rains, and limited access to critical medical supplies, making the humanitarian situation extremely challenging,” Nasrullah explained.

Sita Caccioppe, Director of the Technical Unit at the international humanitarian aid organization IsraAid, shared insights from her extensive experience combating cholera outbreaks with The Media Line, noting, "Cholera is a waterborne disease. It originates from open sewers, overcrowded populations, and situations where people don't have access to clean water for washing their food, clothes, or themselves.”

“In such conditions, they can get contaminated and infected with cholera, which can be deadly," she said. "Once cholera is present within a water system, anyone is at risk, especially the most vulnerable—refugees, displaced people, children, even women washing clothes. Cholera outbreaks require a full setup including a community approach with rehydration points, a referral system, and isolation from other health clinics.”

"People need access to clean drinking water and should get assessed if they showed any signs of cholera,” she continued. “In Malawi, for instance, we opened community oral rehydration points (ORPs) near schools and markets, where people with diarrhea or vomiting could receive rehydration salts and be monitored for at least four hours. Those with severe cholera who had multiple instances of diarrhea and vomiting were referred to a special cholera hospital for treatment. Severe cases required hospitalization and intravenous fluids.”

"The time between getting cholera and potentially dying from it depends on several factors, including age, pre-existing conditions, and access to treatment. Cholera can kill in just a matter of hours in severe cases, particularly in older individuals. Dehydration can be fatal within a few days if left untreated," she explained.

Alongside the cholera outbreak, Sudan faced a troubling increase in other waterborne diseases, such as malaria and diarrhea. In states like Sennar, Blue Nile, Jazirah, White Nile, Darfur, and Kordofan—where over 7.4 million refugees and internally displaced people reside—war and heavy rainfalls have led to critical delays in the delivery of much-needed medicines and relief supplies.

In collaboration with the Ministry of Health, the World Health Organization (WHO), UNICEF, and UNHCR is intensifying efforts to prevent and respond to the cholera outbreak. UNHCR is implementing early warning systems and conducting contact tracing. The agency also provides crucial support to bolster local healthcare services and is actively running awareness campaigns to educate communities on recognizing and responding to potential outbreaks.

“We are focusing on strengthening disease surveillance, health worker training, and providing much-needed medical supplies in the most affected areas like Kassala, Gedaref, and White Nile states. Water chlorination and public health campaigns are also being carried out to reduce the spread of cholera and other waterborne diseases,” Nasrullah explained.

In Kassala, UNHCR supplies treatment facilities with patient beds, medications, and hygiene supplies while training healthcare workers—28 have been trained. Efforts to chlorinate water sources are underway, and the agency is expanding information campaigns to promote proper sanitation and hygiene practices. In White Nile state, which hosts ten refugee camps, Cholera Treatment Centers are being set up to facilitate the isolation and treatment of suspected and confirmed cases. Disease surveillance, testing, and staff training on cholera case management are ongoing.

“While we are making steps in controlling the outbreak and preventing further spread, the situation remains dire, and we anticipate that continued heavy rains and conflict may exacerbate the challenges,” he shared.