GENEVA — U.N. agencies are scaling up cholera prevention and treatment programs to get on top of a new, deadly cholera outbreak in Sudan that threatens to further destabilize communities suffering from hunger and the ill effects of more than 16 months of conflict.

The recent cholera outbreak has resurged after several weeks of heavy rainfall and resulting flooding,” Kristine Hambrouck, UNHCR representative in Sudan, told journalists Friday in Geneva.

Speaking on a video-link from Port Sudan, she warned, “Risks are compounded by the continuing conflict and dire humanitarian conditions, including overcrowding in camps and gathering sites for refugees and Sudanese displaced by the war, as well as limited medical supplies and health workers.”

She expressed particular concern about the spread of the deadly disease in areas hosting refugees, mainly in Kassala, Gedaref and al-Jazirah states.

“In addition to hosting refugees from other countries, these states are also sheltering thousands of displaced Sudanese who have sought safety from ongoing hostilities,” she said.

The United Nations describes Sudan as the largest displacement crisis in the world.  Latest figures put the number of people displaced inside Sudan at more than 10.7 million, with an additional 2 million who have fled to neighboring countries as refugees.

Additionally, the UNHCR says Sudan continues to host tens of thousands of refugees from countries such as Ethiopia and Eritrea.

Sudan’s health ministry officially declared a cholera outbreak on August 12. In the one month since the first suspected cases were reported, the World Health Organization says 658 cholera cases and 28 deaths have been reported by five states, “with a high case-fatality ratio of 4.3%.”

Kassala has reported the highest number of cholera cases at 473, followed by Gedaref with 110 cases, and al-Jazairah with 51 cases. Two other states, Khartoum and River Nile, have reported fewer numbers.

“These cases are not linked to the previous cholera outbreak, which had been declared in September 2023,” said Dr. Shible Sahbani, the WHO representative to Sudan, noting that the outbreak “technically ended” in May 2024 after no cases were reported for two consecutive incubation periods.

Speaking from Port Sudan, Sahbani described the situation in Kassala as very worrisome. He said the state’s health system already was under stress because of the large number of displaced people and refugees living there. “So, the health system is not able to cope with the additional influx of refugees and IDPs [internally displaced persons].”

“But in addition to that, it puts a big burden on the WASH system — the water, sanitation, and hygiene system. So, this makes the situation more complicated in favor of the spread of cholera,” he said.

Besides the dangers posed by cholera, UNICEF representative Hambrouck also warns of an increasing number of cases of waterborne diseases, including malaria and diarrhea, which also need to be brought under control.

“Constraints in humanitarian access are also impacting response efforts. Violence, insecurity and persistent rainfall are hampering the transportation of humanitarian aid,” she said.

She noted that more than 7.4 million refugees and internally displaced Sudanese living in White Nile, Darfur and Kordofan states are having to do without “critical medicines and relief supplies” because of delays in delivery.

The WHO and UNHCR are working closely with Sudan’s Ministry of Health to coordinate the cholera outbreak response. Among its many initiatives, UNHCR says it is working with health partners to strengthen surveillance, early warning systems and contact tracing in affected locations.

“Disease surveillance and testing are ongoing, and awareness-raising and training on cholera case management for health staff are also being conducted,” said Hambrouck.

For its part, Sahbani said the WHO has prepositioned cholera kits and other essential medical supplies “in high-risk states in anticipation of the risks associated with the rainy season.”

He said the WHO was spearheading a cholera vaccination campaign, noting that “a three-day oral cholera vaccination campaign in two localities of Kassala state concluded Thursday.”

He said the campaign already has used 51,000 doses and “the good news is that we got the approval of an additional 155,000 doses of cholera vaccine. So, this is the good news in the middle of this horrible crisis.”

One dose of the vaccine, he said, would protect the population against cholera for six months, while two doses would provide protection for up to three years.

“So, this is really good news because this will help us to contain the outbreak,” he said.  Without more funding, however, he warned the good news will quickly evaporate, noting that the WHO has received just one-third of its $85.6 million appeal.

“This will indeed limit our capacity to launch a robust response to reach a larger segment of the people in need,” he said.

His UNHCR colleague, Hambrouck, echoed the sentiments.

“With the humanitarian situation and funding level already precarious prior to this latest cholera outbreak, funds are desperately needed to support the provision of health care and other life-saving aid,” she said.
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