Protecting war-weary people in Sudan from a second deadly cholera outbreak is proving a huge challenge for aid teams after more than 16 months of heavy fighting, combined with flooding and ongoing access obstacles, they reported on Friday.

“The needs are huge in Sudan; we are talking about people dying of hunger, we have conflict, we have protection issues, we have displacements on a daily basis; the needs are just huge,” compounded by several weeks of heavy rainfall, said Kristine Hambrouck, UNHCR Representative in Sudan.

Famine ‘ongoing’

In addition to cholera, famine is still “ongoing” in Zamzam camp near El Fasher town, according to the UN World Health Organization (WHO). It said that 658 cases have been reported since the latest outbreak was declared on 12 August, with 28 deaths. The last outbreak of cholera in May saw more than 11,300 cases and at least 300 deaths.

Underscoring the dire humanitarian situation across Sudan, WHO also warned that at least 12 of Sudan’s 18 states now face three or more disease outbreaks of cholera in addition to malaria, measles and/or dengue.

Yet despite the urgent need for lifesaving healthcare interventions, the UN health agency said that resources and local capacity to detect and respond to outbreaks remain limited, particularly in hard-to-reach areas such as the Darfurs and Kordofan states.

Kassala, Gedaref, Jazirah at risk

Meanwhile, the UN refugee agency’s Ms. Hambrouck warned that cholera is spreading in areas hosting internally displaced people uprooted by the violence and those from other countries, in particular Kassala, Gedaref and Jazirah states.

“We have seen quite large numbers of cholera cases in Kassala; Kassala is an important area for us, it hosts a large number of refugees, but also internally displaced. So far, we have 119 cholera cases in three refugee sites in Kassala and five refugees have passed away regretfully of the disease.”

The UNHCR official highlighted the difficulty of trying to address this latest emergency in Sudan, where fighting between rival militaries erupted in April 2023 over a proposed transition to civilian rule, following a military coup in 2021 and the 2019 ousting of long-time President Omar Al-Bashir.

“This is just one (challenge), one on top of all the other ones that we somehow have to reprioritize and make sure that investments are being made,” she said, emphasizing that in refugee camps and displacement sites, “people live on top of each other” and are “hugely overcrowded with the movements of Sudanese (and) also refugees from Khartoum, from Wad Madani, from the Darfurs” to Kassala.

“All these areas have become hugely overcrowded, the water systems that were in place do not have the capacity to respond, it really needs massive investments,” she insisted.

Vaccine success

An initial vaccination campaign has successfully protected more than 50,000 people from cholera, with hundreds of thousands more doses on the way.

“The vaccination campaign already started and we used the 51,000 doses that were already in the country,” said Dr Shible Sahbani, WHO Representative in Sudan. Speaking from Port Sudan, he confirmed that the inoculation campaign concluded in Kassala state on Thursday.

“We were aiming to reach the 97 per cent of the target population,” he said, adding that the UN health agency has also secured the approval to procure an additional 455,000 doses of cholera vaccine – “good news in the middle of this horrible crisis”.

Elsewhere, aid access problems have continued to interrupt the humanitarian response. “We are still facing some obstacles and some challenges, either because there is a miscommunication between the decision-makers and those who are on the field, or because there are other issues. Of course, this is in addition to other challenges due to floods and the quality of the roads,” Dr Sahbani said.

Echoing that message, the UN aid coordination office, OCHA, said that the 15 trucks that crossed into Sudan from Chad via the Adre crossing earlier this week were “a step in the right direction”.

But transport conditions remain difficult because of the rainy season said spokesperson Jens Laerke, who underscored the importance of ensuring that aid trucks can continue to cross there “and secure a steady flow of food, nutrition, water, sanitation, hygiene and medical emergency supplies for people in more than a dozen areas at risk of famine”.

Seeds of hope

Vital farming supplies including seeds are among the supplies being transported into Darfur, the OCHA spokesperson noted. “This is an important point, because they need to plant before the rainy season ends. Boosting food production in Sudan is one of the most effective ways to address the overwhelming hunger crisis, which is only worsening after more than 16 months of conflict.”

Since the start of the conflict in Sudan, more than 10.3 million people have been driven from their homes inside Sudan or in neighbouring countries, according to UNHCR.

It emphasized that the humanitarian situation and funding levels for the lifesaving aid response were “already precarious” before the latest cholera outbreak, and that funds are urgently needed to support an expansion of cholera treatment centres and other health facilities, additional health staff and increased stocks of intravenous fluid and medicines.

Response plan frustrated

Of the $1.5 billion required by UNHCR and other partners for the Regional Refugee Response Plan to provide assistance in countries bordering Sudan, just 22 per cent has been received. The inter-agency response inside Sudan is only 37 per cent funded.

“I think the funding levels are extremely challenging and do not allow us to address all the needs, both in Sudan, as well as across the border. So, this really, it really requires an international effort to make sure that we can stabilize at least this cholera situation,” said Ms. Hambrouck.