Urgent action is needed to address Sudan’s growing humanitarian crisis.

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Editorial

Hanan Balkhy ¹

¹Regional Director, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt.

Citation: Balkhy H. Urgent action is needed to address Sudan’s growing humanitarian crisis. East Mediterr Health J. 2024;30(7):465–466.

https://doi.org/10.26719/2024.30.7.465.

Copyright: © Authors 2024; Licensee: World Health Organization. EMHJ is an open access journal. All papers published in EMHJ are available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

Sudan represents yet another evolving humanitarian catastrophe with negative impact on public health in the Eastern Mediterranean Region (EMR). Away from the spotlight, the situation is dire, with millions of lives hanging in the balance. Urgent action is needed to avert the worst and protect the health and wellbeing of Sudan’s people.

The statistics present a deeply disturbing picture: half of Sudan’s population, i.e. about 25 million people (1), needs humanitarian assistance. Tragically, close to 18,916 (as of 21 July 2024) (2) lives have been lost due to violence since the conflict started in April 2023, and an estimated 7.9 million (3,4) people are displaced within Sudan and another 2.1 million (4) have fled across the border to neighbouring countries. With a total of 10.7 million (5) internally displaced persons, including those displaced before the crisis, Sudan now faces the world’s largest and fastest growing internal displacement crisis. Among these displaced populations are many who have been displaced multiple times. Close to 18 million (6) people are acutely food-insecure across the country and 755 000 (2% of the population) are in integrated food security phase 5 (IPC 5) (catastrophe) in 10 states (7) on the brink of famine. Shockingly, 1 in every 5 under-5 children arriving in South Sudan from Sudan is acutely malnourished, facing a grave and uncertain future (8) and more than 6.7 million women and girls are at risk of gender-based violence (9) A staggering 4.9 million under-5 children and pregnant and nursing mothers are estimated to be acutely malnourished in 2024 (17).

The high levels of violence, insecurity and access constraints continue to constrain humanitarian response. The healthcare system has been massively degraded, particularly in hard-to-reach areas, with many health facilities destroyed, looted, or struggling with acute shortages of staff, medicines, vaccines, and equipment. It is estimated that 65% of the population lacks access to healthcare and 70–80% of hospitals in the conflict-affected areas are non-functional or partially functional (10). The consequences are dire: pregnant women, newborn babies and patients with chronic illnesses are deprived of essential care, while survivors of rape are left without support. At least two-thirds of the states are experiencing 3 or more simultaneous disease outbreaks (11), particularly malaria, cholera, measles, dengue fever, and ongoing vaccine-derived polio, which exceed most disease control efforts.

Attacks on healthcare and humanitarian workers is another disturbing feature of the conflict. Since the beginning of the crisis, there have been 85 attacks, leading to 55 deaths and 104 injuries (12), while at least 45 humanitarian aid workers have been reportedly killed. These numbers are likely underestimated because only a few stakeholders are reporting attacks.

The neighbouring countries hosting Sudanese refugees have been seriously impacted by the influx. Chad and South Sudan, currently hosting close to 70% of all Sudanese refugees in the region, face similar healthcare challenges, further straining their already fragile health systems.

Since the beginning of the crisis, WHO and partners have provided essential support and services to millions of Sudanese in spite of the major access and resource constraints. WHO reached close to 2.5 million people through direct support to health services and delivery of emergency supplies in 2023 (13). WHO has distributed 500 million tonnes (US$ 10 million) worth of critical medical supplies since the conflict erupted, caring for more than 3.3 million people through the WHO-supported mobile clinics and treating 433 000 Sudanese refugees in Eastern Chad through the mobile clinics.

Collective efforts with local healthcare workers and partners have contributed to a decline in the number of cases of cholera, dengue and malaria (13). An estimated 5 million people above one year of age have received the oral cholera vaccine in 6 high-risk states, and 6.7 million people in 7 states were vaccinated against measles/rubella. WHO also delivered supplies for the treatment of 115 000 children suffering from severe acute malnutrition with medical complications through 122 stabilization centres, with plans to scale-up to 170 in 2024.

Given the high levels of food insecurity, United Nations agencies, including WHO, are moving forward with implementation of the Sudan Famine Prevention Plan, to halt food insecurity and malnutrition (14). Through the plan, 7.6 million people in 167 priority localities across the country will be provided with live-saving assistance over a period of 6 months.

While these actions are bearing some fruit, major gaps remain – especially in the hard-to-reach areas of Darfur, the Kordofan states, Khartoum, and Omdurman. These gaps are becoming more challenging because of the very poor funding situation. As of 20 July 2024, only 31.3% of the US$ 2.7 billion Sudan Humanitarian Response Plan 2024 had been funded (15,16). Two-thirds of the financial requirement for 2024 humanitarian response plan and two-thirds of the financial requirement for health cluster is not funded 7 months into the year.

Given that this is an entirely human-made crisis, several obvious actions are required. Firstly, reliable humanitarian access across the borders and corridors is critical, especially in areas not controlled by the government. Secondly, all warring parties must respect the international humanitarian and human rights law, ensuring the protection of health and humanitarian workers, patients and healthcare facilities from attacks. Thirdly, increased support from donors is urgently needed to scale-up operations in the health sector, which currently suffers from inadequate funding.

Moreover, political leaders must prioritize efforts to find a sustainable ceasefire and political resolution to the conflict. Time is running out! Without immediate action to halt the fighting and ensure unhindered humanitarian access, Sudan’s crisis will only worsen, with grave implications for the entire region.

References

1. United Nations Office for the Coordination of Humanitarian Affairs. Sudan humanitarian fund 2023 annual report. Geneva: OCHA, 2023. https://www.unocha.org/attachments/469c7e8a-879c-4c87-8826-386a827d43df/Sudan%202023%20AR_FINAL.pdf.
2. Armed Conflict Location and Event Data. Data and tools. ACLED, 2024. https://acleddata.com/dashboard/#/dashboard
3. International Organization for Migration. DTM Sudan - monthly displacement overview (08). Geneva: IOM, 2024. https://dtm.iom.int/reports/dtm-sudan-monthly-displacement-overview-08?close=true.
4. United Nations Office for the Coordination of Humanitarian Affairs. Sudan: Humanitarian impact of heavy rains and flooding. Flash Update, No. 1, 28 July 2024. https://reports.unocha.org/en/country/sudan/.
5. Reliefweb. WFP Sudan regional crisis external situation report #3. Reliefweb, 25 April 2024. https://reliefweb.int/report/sudan/wfp-sudan-regional-crisis-external-situation-report-3-25-april-2024?_gl=1*1gx6so8*_ga*OTk3ODY3MDI0LjE3MDc3NDI1OTk.*_ga_E60ZNX2F68*MTcxNzMxMzg2MS4xNi4xLjE3MTczMTM5ODAuNjAuMC4w
6. Famine Early Warning Systems Network. Sudan’s worsening food security emergency leads to a risk of famine in some areas. Food Security Outlook, February-September 2024. https://fews.net/east-africa/sudan/food-security-outlook/february-2024.
7. Famine Early Warning Systems Network. Sudan faces a risk of Famine as conflict threatens access to food for millions. Sudan Food Security Alert, 3 May 2024. https://fscluster.org/sites/default/files/2024-05/Sudan-Food-Security-Alert-20240503-final_0.pdf.
8. Machol D. The UN food agency says that 1 in 5 children who arrive in South Sudan from Sudan are malnourished. Associated Press, 3 October 2023. https://apnews.com/article/south-sudan-sudan-conflict-malnourishment-5867bb866d86021fa59dba508b9ca441
9. UN Women. A year of suffering for Sudanese women and girls. News and Stories, 14 April 2024. https://www.unwomen.org/en/news-stories/statement/2024/04/a-year-of-suffering-for-sudanese-women-and-girls
10. United Nations Office for the Coordination of Humanitarian Affairs. Sudan: Ten months of conflict - Key Facts and Figures (15 February 2024). Geneva: OCHA, 2024. https://www.unocha.org/publications/report/sudan/sudan-ten-months-conflict-key-facts-and-figures-15-february-2024.
11. World Health Organization. Sudan conflict and refugee crisis. Multi-country External Situation Report No. 11, 18 June 2024. https://cdn.who.int/media/docs/default-source/documents/emergencies/situation-reports/20240611_sudan-emergency-sitrep-1.pdf?sfvrsn=314b523_2&download=true.
12. World Health Organization. Surveillance systems for attacks on health. Geneva: World Health Organization, 2024. https://extranet.who.int/ssa/Index.aspx.
13. World Health Organization. Sudan Health Emergency. Situation Report No. 4, 15 December 2023. https://www.emro.who.int/images/stories/sudan/WHO-Sudan-conflict-situation-report-15-December_2023.pdf?ua=1
14. Sudan: Famine Prevention Plan 2024 - Through Accelerated Mitigative Actions to Halt Deterioriation of Food Insecurity, Livelihood Impoverishment and Malnutrition
15. Reliefweb. Sudan: Famine prevention plan 2024 - Through accelerated mitigative actions to halt deterioriation of food insecurity, livelihood impoverishment and malnutrition. Reliefweb, 12 April 2024. https://reliefweb.int/report/sudan/sudan-famine-prevention-plan-2024-through-accelerated-mitigative-actions-halt-deterioriation-food-insecurity-livelihood-impoverishment-and-malnutrition?_gl=1*1t55syo*_ga*OTk3ODY3MDI0LjE3MDc3NDI1OTk.*_ga_E60ZNX2F68*MTcxNzMxMzg2MS4xNi4xLjE3MTczMTM5ODAuNjAuMC4w.
16. United Nations Office for the Coordination of Humanitarian Affairs. Financial Tracking Service – Sudan 2024. Geneva: OCHA, 2024. https://fts.unocha.org/countries/212/summary/2024.
17. United Nations Office for the Coordination of Humanitarian Affairs. Sudan Humanitarian Update, 25 April 2024. Geneva: OCHA, 2024. https://www.unocha.org/publications/report/sudan/sudan-humanitarian-update-25-april-2024-enar.