How conflict created the conditions for Sudan’s deadly cholera crisis

Special How conflict created the conditions for Sudan’s deadly cholera crisis
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Updated 28 January 2025
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How conflict created the conditions for Sudan’s deadly cholera crisis

How conflict created the conditions for Sudan’s deadly cholera crisis
  • War has displaced 12 million people, forcing many into overcrowded camps with poor sanitation and unsafe water
  • Sudan has reported more than 50,000 cholera cases and 1,300 deaths since August 2024, with the true toll likely far higher

LONDON: From displacement camps in Gedaref to overwhelmed hospitals in Al-Jazirah, Sudan’s ongoing cholera epidemic, exacerbated by its brutal civil war, has created a humanitarian crisis of staggering proportions.

Since the cholera outbreak was declared in August 2024, Sudan has recorded at least 50,000 cases and some 1,300 deaths. These numbers are likely an underestimate, however, due to challenges in accessing remote areas and gathering accurate data.

Mohamed Ahmed, the operational deputy head of mission for Medecins Sans Frontieres in Sudan, whose team has been working on the cholera response, described the realities on the ground, the fatigue audible in his voice.

“It’s exhausting,” he told Arab News, shortly after returning from Gedaref, where a 117 percent increase in cholera cases was recorded between October and November 2024, and where a fresh wave of displacement threatens further outbreaks.




People collect clean water provided by a charity organisation to people in Gedaref in eastern Sudan. (AFP/File)


“It’s exhausting because you have to deal with this every single day. It is exhausting to beg to reach the populations that are in need, to speak about it, to advocate for these populations that are in need.”

Cholera’s resurgence in Sudan is far from an isolated event. Historically, the country’s rainy seasons have fueled similar outbreaks, but this latest crisis has been exacerbated by unprecedented levels of displacement and a collapsing healthcare system.

The cholera epidemic currently ravaging Sudan is a grim testament to the devastating impact of protracted conflict on public health. “It is at a scale that we don’t see in many other conflict settings,” said Ahmed.

“The whole of the humanitarian response system in Sudan today is struggling. We are speaking about a magnitude of a crisis that we have not seen in other parts of the world, even including Gaza.”

Sudan has been engulfed in conflict for almost two years, severely limiting access to clean water, sanitation, and medical care. The nation’s healthcare system was fragile even before the conflict between the Sudanese Armed Forces and the Rapid Support Forces erupted in April 2023.




Cholera patients are treated at a clinic in Sudan's Red Sea State. (AFP/File)

The war has decimated medical infrastructure, leaving health workers unpaid for months and facilities devoid of essential supplies. “The healthcare facilities are near collapse,” said Ahmed. “Seventy to 80 percent of health facilities are non-functional.”

The outbreak’s epicenter includes the states of Al-Jazirah, Gedaref, and Kassala — areas already grappling with repeated waves of displacement.

“The ongoing conflict has displaced 12 million people,” said Ahmed. “In Gedaref, where I came from just now, we have 1 million internally displaced persons, straining an already broken system.”

These displaced populations often find refuge in overcrowded schools, bus stations, and abandoned government buildings, where basic sanitation is virtually non-existent.

“In one bus station in Gedaref, we had 17,000 families staying in a makeshift area that is really in a very bad state,” said Ahmed. “There’s a lack of latrines, so people are defecating outside, with a lack of safe drinking water.

“Cholera is largely spread from hand to mouth, so you come in with no food, no water to drink, and the situations they are in, staying in open buildings, crowded gathering sites that absolutely then propagate these kinds of epidemic diseases including cholera.

“And it is not only cholera that is spreading in these conditions. There are many preventable diseases. We are speaking about measles, we are speaking about other vaccine-preventable diseases.”

Christian Lindmeier, a spokesperson for the World Health Organization, highlighted the outbreak’s geographical spread.

“Fueled by heavy rains and flooding, destruction of health facilities, overcrowding and lack of access to clean water in displacement sites and within communities, this new wave of cholera quickly spread to 84 localities in 11 states, with over 51,203 cases and 1,356 deaths reported as of Jan. 13, 2025,” Lindmeier told Arab News.

“The cholera outbreak is occurring at a time when Sudan’s health system is severely weakened by the conflict that has been raging in Sudan for 21 months, causing severe access constraints and security risks where neither health workers nor patients can safely access health facilities or emergency health response can reach the people in need.”

Humanitarian organizations, including the MSF, the WHO, and the UN children’s fund UNICEF, have scrambled to respond to the crisis despite severe logistical and security challenges.

The MSF has established cholera treatment centers and oral rehydration points in hotspots such as Gedaref, which have saved the lives of countless people who would otherwise have quickly succumbed to dehydration.




A health worker wears a protective outfit at a hospital where Cholera patients are treated in Sudan's Red Sea State. (AFP/File)


Eva Hinds, a spokesperson for UNICEF based in Port Sudan, underscored the difficulties faced by aid agencies operating in this complex environment.

“The ongoing conflict makes transporting vaccines and health supplies throughout the country challenging and often tremendously time consuming as permit approvals, checkpoints and consignment inspections can delay the journeys by days or even weeks,” she told Arab News.

“Traveling across this sizable country, particularly during the rainy season, can also be taxing as roads get flooded and infrastructure gets washed away.”

Despite these obstacles, UNICEF has spearheaded vaccination campaigns, reaching 7.4 million people in eight states between August 2024 and January 2025.

However, Hinds warned: “There are limits to what assistance can achieve without meaningful peace and security for both humanitarian workers and the children they serve.”

Bureaucratic red tape and active conflict zones delay the movement of life-saving supplies and medical personnel. Ahmed recounted one particularly harrowing situation in Khartoum state, where clashes between the SAF and RSF have been particularly fierce.

“We had a really quite emotional situation with one of the sites, a hospital that we were supporting but did not have teams on the ground, and we have not been able to send in supplies,” he said.

“We had supplies in our warehouse that we wanted to send but were not able to because it is an intense conflict zone. And of course we have bureaucracies along the way. And in a single day we lost 30 patients.

“The frustrations within my team in not being able to go and not being able to respond or even responding from a distance because the security and the access doesn’t allow us to be there was really super difficult.”

INNUMBERS

• 12m People internally and externally displaced by conflict.

• 70-80% Sudanese health facilities knocked out of action.


Sudan’s health workers have not been spared amid the violence, forced to work in impossible circumstances, with health facilities regularly coming under attack.

“Since the start of the conflict on April 15, 2023, 141 attacks on health (facilities) have been verified causing 240 deaths and 216 among health workers, patients and patient caretakers,” said the WHO’s Lindmeier.

On Jan. 25, around 70 people were killed in a drone attack on the Saudi Teaching Maternal Hospital in the besieged city of Al-Fasher in Sudan’s North Darfur state.




Since the cholera outbreak was declared in August 2024, Sudan has recorded at least 50,000 cases and some 1,300 deaths. (AFP/File)

The assault has been attributed by local officials to the RSF, which is yet to acknowledge responsibility.

Saudi Arabia’s Foreign Ministry has condemned the attack, calling it “a violation of international law.”

Lindmeier called on all parties to respect the sanctity of healthcare and allow safe access to aid workers. “The WHO calls for cessation of hostilities by all parties in Sudan,” he said.

“Peace is overdue for Sudan. Without peace, lives, livelihoods, health and other social service systems will continue to be severely disrupted in the face of the rapidly deteriorating situation with transgenerational effects on the nation.

“We appeal for increased funding from the international community to enable us to support the provision of urgent lifesaving healthcare and outbreak response as we support and rebuild Sudan’s health system, which has been devastated by the conflict.”

The toll on Sudan’s displaced populations has been severe. Children, in particular, bear the brunt of the crisis, accounting for more than 70 percent of cholera cases. Older adults, especially those over 70, have the highest mortality rates.




A man disinfects a rural isolation centre where patients are being treated for cholera in Wad Al-Hilu in Kassala state in eastern Sudan. (AFP/File)

“It’s the image of all the children that we see in these treatment centers as well — malnutrition, cholera — that keeps on hanging on our minds,” said Ahmed, his voice breaking. “And every time we speak to people about this crisis, we see these images.”

The current Case Fatality Rate of 2.6 percent far exceeds the WHO’s recommended threshold of 1 percent, underscoring the dire need for intervention.

Although aid agencies are confident the outbreak can be brought under control, international support remains critical to addressing Sudan’s wider humanitarian crisis. Ahmed highlighted the need for sustained funding and access.

“We are approaching very challenging times, especially for the humanitarian community in 2025, with the magnitude of what we are seeing and as well the changes that we see in global dynamics,” he said.

“Donors must honor their promises and prioritize Sudan. We cannot turn a blind eye.”

 


Israel’s Netanyahu says Trump plan for Gaza ‘revolutionary’

Israel’s Netanyahu says Trump plan for Gaza ‘revolutionary’
Updated 10 February 2025
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Israel’s Netanyahu says Trump plan for Gaza ‘revolutionary’

Israel’s Netanyahu says Trump plan for Gaza ‘revolutionary’
  • Washington on Friday announced the approval of the sale of more than $7.4 billion in bombs, missiles and related equipment to Israel

JERUSALEM: Israeli Prime Minister Benjamin Netanyahu on Sunday praised a proposal from President Donald Trump for US control of Gaza and the displacement of its population as “revolutionary,” following his return to Israel from Washington.
Trump sparked global outrage by suggesting on Tuesday, during a week-long visit by the Israeli premier to the United States, that Washington should take control of the Gaza Strip and clear out its inhabitants.
On his return to Israel, addressing his cabinet, Netanyahu said the two allies agreed on war aims set out by Israel at the start of its 15-month war against Hamas including “ensuring Gaza no longer poses a threat to Israel.”
“President Trump came with a completely different, much better vision for Israel — a revolutionary, creative approach that we are currently discussing” the Israeli prime minister said, referring to the president’s Gaza plan.
“He is very determined to implement it and I believe it opens up many, many possibilities for us,” Netanyahu added.
Despite criticisms from international allies and Arab states in particular, Trump on Thursday doubled down on the plan, saying the “Gaza Strip would be turned over to the United States by Israel at the conclusion of fighting.”
“No soldiers by the US would be needed! Stability for the region would reign!!!” he wrote in social media post.
Israeli Defense Minister Israel Katz later on Thursday ordered the army to prepare for “voluntary” departures from Gaza.
“This visit, and the discussions we had with President Trump, carry with them tremendous achievements that could ensure Israel’s security for generations,” Netanyahu said.
Washington on Friday announced the approval of the sale of more than $7.4 billion in bombs, missiles and related equipment to Israel.
The State Department signed off on the sale of $6.75 billion in bombs, guidance kits and fuses, in addition to $660 million in Hellfire missiles, according to the US Defense Security Cooperation Agency (DSCA).
Israel launched a hugely destructive offensive against Hamas in Gaza in October 2023 in response to the Palestinian militant groups October 7 attack.
The war has devastated much of the Gaza Strip — a narrow coastal territory on the eastern Mediterranean — but a ceasefire has been in effect since last month that has brought a halt to the deadly conflict and provides for the release of hostages seized by Hamas.


UN chief welcomes formation of new Lebanon government

UN chief welcomes formation of new Lebanon government
Updated 10 February 2025
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UN chief welcomes formation of new Lebanon government

UN chief welcomes formation of new Lebanon government
  • New Prime Minister Nawaf Salam now faces the daunting task of overseeing the fragile Israel-Hezbollah ceasefire and rebuilding the country

UNITED NATIONS, United States: UN chief Antonio Guterres has welcomed the formation of a new government in Lebanon, affirming the international body’s commitment to that country’s “territorial integrity, sovereignty and political independence,” a spokesman said Sunday.
“The United Nations looks forward to working in close partnership with the new government on its priorities, including the consolidation of the cessation of hostilities,” said a statement from spokesman Stephane Dujarric.
Dujarric was referring to a ceasefire agreement between Lebanon and Israel signed on November 27, with Beirut’s military due to deploy in the country’s south alongside UN peacekeepers as Israel withdraws from those areas over 60 days.
Fighting between Israeli forces and long-dominant Hezbollah since October 2023 has weakened the group, helping bring a new Lebanese government to power after almost two years of caretaker authorities being in charge.
New Prime Minister Nawaf Salam now faces the daunting task of overseeing the fragile Israel-Hezbollah ceasefire and rebuilding the country.
Salam said Saturday that he hoped to head a “government of reform and salvation,” pledging to rebuild trust with the international community after years of economic collapse blamed on corruption and mismanagement.
Long the dominant force in Lebanese politics, Hezbollah suffered staggering losses in a war with Israel that saw its leader Hassan Nasrallah killed in a massive air strike in September.
Hezbollah suffered another seismic blow with the ouster on December 8 of Bashar Assad in Syria, which it had long used as its weapons lifeline from Iran.
After more than two years of political stalemate, the weakening of Hezbollah allowed former army chief Joseph Aoun, widely believed to be Washington’s preferred candidate, to be elected president and Salam approved as his premier.
 

 


Brother says freed Israeli hostage suffered ‘hardest blow’ learning wife killed

Brother says freed Israeli hostage suffered ‘hardest blow’ learning wife killed
Updated 10 February 2025
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Brother says freed Israeli hostage suffered ‘hardest blow’ learning wife killed

Brother says freed Israeli hostage suffered ‘hardest blow’ learning wife killed
  • “Einav, his beloved wife, was murdered on that cursed day

JERUSALEM: Freed Israeli hostage Or Levy suffered the “hardest blow” upon his release from Gaza when he learned that his wife was killed by Hamas militants in the 2023 attack in which he was abducted, his brother said Sunday.
On Saturday, Hamas militants released Levy along with two other hostages, Eli Sharabi and Ohad Ben Ami, as part of an ongoing ceasefire in Gaza.
“The hardest blow awaited Or when he was freed — his greatest fear was confirmed,” Michael Levy told journalists at a hospital where his brother is being treated.
“Einav, his beloved wife, was murdered on that cursed day. For 491 days, he held on to the hope that he would return to her. For 491 days, he didn’t know she was no longer alive,” Michael Levy added.
Or and Einav Levy had attended the Nova music festival when Hamas militants stormed it during their October 7, 2023, attack on Israel.
They had left their son Almog, two years old at the time, with his grandparents.
The usually inseparable couple, who met at school, tried to hide from the attackers along Route 232, the only path away from the festival.
According to the Hostages and Missing Families Forum, an Israeli campaign group, Einav was killed in the attack while Or was abducted along with other young men.
Until now, it had been unclear whether Or knew of his wife’s fate.
“He only found out yesterday,” said Michael Levy.
“Or is alive. He is here. But this happiness is mixed with an immense sadness, a pain that cannot be described.”
“After everything he went through, he finally met Mogi, his little son. A three-year-old boy who hadn’t seen his father for 16 months!” the brother added.
 

 


Palestinians say Israeli forces kill 3 in West Bank raid

Israeli soldiers conduct a raid in the Nur Shams camp for Palestinian refugees near Tulkarem in the occupied West Bank.
Israeli soldiers conduct a raid in the Nur Shams camp for Palestinian refugees near Tulkarem in the occupied West Bank.
Updated 10 February 2025
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Palestinians say Israeli forces kill 3 in West Bank raid

Israeli soldiers conduct a raid in the Nur Shams camp for Palestinian refugees near Tulkarem in the occupied West Bank.
  • A pregnant woman was dead when she arrived at a local hospital
  • At least 70 Palestinians have been killed by Israeli fire in the West Bank in 2025

TULKAREM: The Palestinian health ministry reported that Israeli forces in the occupied West Bank shot dead three people on Sunday, including a woman who was eight months pregnant.
Israeli forces launched an operation in the Nur Shams refugee camp, on the outskirts of Tulkarem in the northern West Bank, at dawn on Sunday, as part of an ongoing offensive in nearby camps, the military said.
The Palestinian health ministry said 23-year-old Sundus Jamal Muhammad Shalabi was killed in a pre-dawn incident, with her husband Yazan Abu Shola critically injured.
The mother-to-be was dead when she arrived at a local hospital, the ministry said.
“Medical teams were unable to save the baby’s life due to the (Israeli) occupation preventing the transfer of the injured to the hospital,” it added.
When asked by AFP about the shooting of the pregnant woman in Nur Shams, the Israeli military said “following the incident an investigation was opened by the Military Police Criminal Investigation Division."
Murad Alyan, a member of the popular committee in the Nur Shams camp, told AFP that the couple was “trying to leave the camp before the occupation forces advanced into it. They were shot while they were inside their car.”
The Palestinian foreign ministry condemned what it described as “a crime of execution committed by the occupation forces,” accusing Israeli forces of “deliberately targeting defenseless civilians.”
The health ministry later said a second woman, 21-year-old Rahaf Fouad Abdullah Al-Ashqar was killed in a separate incident in Nur Shams.
A source in the camp’s popular committee said she was killed and her father wounded when the “Israeli forces used explosives to open the door of their family house.”
And late on Sunday the health ministry announced that a third Palestinian, Iyas Adli Fakhri Al-Akhras, 20, had been killed “after being shot by Israeli forces” in the camp.
AFP footage from Nur Shams showed army bulldozers clearing a path in front of buildings in the densely packed camp, which is home to about 13,000 people.
The Israeli military earlier said its forces were “expanding the operation in northern Samaria,” using the biblical term for the north of the West Bank, which Israel has occupied since 1967.
“The combat team of the Ephraim Brigade began operations in Nur Shams,” the military said in a statement, adding that soldiers had “targeted several terrorists and arrested additional individuals in the area.”
The Palestinian health ministry has said at least 70 Palestinians have been killed by Israeli fire in the West Bank this year.
Violence there has escalated since the October 2023 outbreak of war in the Gaza Strip.
According to the Palestinian health ministry, at least 887 Palestinians including militants have been killed by Israeli forces or settlers in the West Bank since the Gaza war began.
At least 32 Israelis, including some soldiers, have been killed in Palestinian attacks or confrontations during Israeli operations in the West Bank over the same period, according to official Israeli figures.


UN humanitarian chief says Gaza ceasefire has averted famine but any truce collapse brings danger

UN humanitarian chief says Gaza ceasefire has averted famine but any truce collapse brings danger
Updated 10 February 2025
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UN humanitarian chief says Gaza ceasefire has averted famine but any truce collapse brings danger

UN humanitarian chief says Gaza ceasefire has averted famine but any truce collapse brings danger
  • Fletcher urged both Hamas, which quickly reasserted its control of the territory in the hours after the ceasefire took effect, and Israel to stick to the deal that has “saved so many lives”

CAIRO: Famine has been mostly averted in Gaza as a surge of aid enters the territory during a fragile ceasefire, the United Nations humanitarian chief said Sunday. But he warned the threat could return quickly if the truce collapses.
Tom Fletcher spoke to The Associated Press after a two-day visit to Gaza, where hundreds of trucks carrying humanitarian aid have arrived each day since the ceasefire began on Jan. 19.
“The threat of famine, I think, is largely averted,” Fletcher said in Cairo. “Those starvation levels are down from where they were before the ceasefire.”
He spoke as concerns grow over whether the ceasefire can be extended and talks are meant to begin on its more difficult second phase. The six-week first phase is halfway through.
As part of the agreement, Israel said it would allow 600 aid trucks into Gaza each day, a major increase after months of aid officials expressing frustration about delays and insecurity hampering both the entry and distribution of food, medicines and other badly needed items.
The UN humanitarian office has said more than 12,600 aid trucks have entered Gaza since the ceasefire took effect.
Fletcher urged both Hamas, which quickly reasserted its control of the territory in the hours after the ceasefire took effect, and Israel to stick to the deal that has “saved so many lives.”
“The conditions are still terrible, and people are still hungry,” he said. “If the ceasefire falls, if the ceasefire breaks, then very quickly those (famine-like) conditions will come back again.”
The internationally recognized mortality threshold for famine is two or more deaths a day per 10,000 people.
For months before the current ceasefire, food security monitors, UN officials and others had been warning of possible famine in parts of devastated Gaza, especially the north, which had been largely isolated since the earliest weeks of the 16-month war. Hundreds of thousands of Palestinians have been able to return to the north under the ceasefire.
“We can’t ... sit by and just allow these people to starve to death,” Cindy McCain, the American head of the UN World Food Program, told CBS in December. The Biden administration repeatedly urged Israel to allow more aid deliveries and warned that failing to do so could trigger US restrictions on military support.
Fletcher said more food and medical supplies are crucially needed for the territory of more than 2 million people, most of them displaced, and he expressed concerns about disease outbreaks due to the lack of basic health supplies. He also called for scaling up the delivery of tents and other shelters to those who have returned to their home areas, as winter continues.
“We must get tens of thousands of tents very rapidly in, so that people who are moving back, particularly moving back into the north, are able to take shelter from those conditions,” he said.
Fletcher entered the Palestinian territory through the Erez crossing between Israel and northern Gaza, where he said he drove through “bombed-out, flattened and pulverized” areas.
“You can’t see the difference between a school or a hospital or a home,” he said of the north.
He said he saw people trying to find where their homes had been and collecting the bodies of loved ones from the rubble. He saw dogs looking for corpses in the rubble, too.
“It is a horror movie. It’s a horror show,” he said. “It breaks your heart again and again and again. You drive for miles and miles and miles, and this is all you see.”
Fletcher acknowledged that some Palestinians have been angry at the international community over the war and its response.
“There was despair and anger. And I can understand the anger at the world that this has happened to them,” he said. “But there was also a sense of defiance as well. People were saying, ‘We will go back to our homes. We will go back to the places that we have lived for generations, and we will rebuild.’”