'We are racing against time': War-stricken Sudan battles cholera and other deadly diseases

Lying on a hospital bed, Aisha Mohammed said she is suffering from cholera symptoms, an increasingly common ailment in Sudan where a prolonged war has ravaged the healthcare system.

Cholera, caused by contaminated water or food, had been common in Sudan, particularly during the rainy season even before war broke out in April 2023 between rival generals.

But more than 18 months of fighting have forced most hospitals out of service, leaving the country of 48 million people struggling to control the sometimes deadly but treatable disease.

In the southeastern Sudanese town of Wad al-Hulaywah, 40-year-old Mohammed receives intravenous medicine to ease her crippling symptoms.

"I'm suffering from acute diarrhoea," she whispered.

"Sudan is grappling with multiple disease outbreaks including cholera, malaria, dengue fever, measles, and rubella"

Sudanese authorities and the United Nations have reported a surge in cholera cases. This was further exacerbated when the region faced several weeks of torrential rains a few months ago, battering parts of Sudan and displacing thousands.

Rains and floods have contributed to a resurgence of the largely waterborne disease, which can cause severe dehydration and lead to death within hours if not treated.

In September the health ministry reported that more than 430 people had died from cholera in the past month, with the number of infections rising to about 14,000.

“We are racing against time. With heavy rains and flooding, diseases can spread more rapidly and severely worsen the outlook for the children in the affected states and beyond,” said Sheldon Yett, UNICEF Representative to Sudan.

Sudan is grappling with multiple disease outbreaks including cholera, malaria, dengue fever, measles, and rubella and an estimated 3.4 million children under five are at high risk of epidemic diseases. 

'Polluted water' 

Before the start of the war between Sudan's army and paramilitary forces, the UN had said that about 40 percent of Sudanese did not have access to clean water. Conditions have since worsened.

The main problem is drinking water as most residents of Wad al-Hulaywah drink water directly from the river which is polluted water. During the rainy season, large amounts of silt are washed into the Setit River, which begins in neighbouring Ethiopia, increasing pollution levels. 

Near the local hospital, workers spray insecticide to fight the proliferation of flies, which one health official says is a symptom of poor sanitation.

Access to clean water has been hampered across the country, in areas under either the army or the paramilitary Rapid Support Forces, both vying for control of Sudan.

“The menacing mix of heavy flooding and torrential downpours with woeful living conditions and inadequate access to drinking water that millions have today, particularly in crowded camps for displaced people, have created the perfect storm for the spread of this often-deadly disease,” says Esperanza Santos, MSF’s emergency coordinator for Sudan.

'I will have no one' 

The paramilitaries have laid siege to entire areas, preventing the entry of fuel needed to pump clean water, while bureaucratic hurdles and fighting have blocked aid operations, putting key water stations out of service.

The war has killed tens of thousands of people, displaced more than 10 million and shuttered more than 70 percent of Sudan's healthcare facilities, according to the UN.

"With Sudan facing what the UN has called 'one of the worst humanitarian crises in recent memory' and aid groups unable to help, many feel they have to fend for themselves"

The rival forces have both been accused of war crimes, including targeting civilians and looting or obstructing humanitarian aid.

With Sudan facing what the UN has called "one of the worst humanitarian crises in recent memory" and aid groups unable to help, many feel they have to fend for themselves.

Sitting outside a hospital in Kassala, 49-year-old Hassan al-Junaid said he has been displaced by the war, and now "we are living in very bad conditions, which caused my sister to get cholera."

"I am the only one with her, but I can't go with her inside because she has been placed in quarantine," he said.

"So I'm staying here, worried for her and afraid that I might be infected myself," added Junaid.

"If that happens, I will have no one to buy me the medicine I would need."

Cholera hs added yet another challenge to the crisis in Sudan and more burden to the decimated health system, which is already struggling with increasing child malnutrition, high numbers of war wounded and regular cases of preventable diseases. Regularly obstructed by both warring parties, the humanitarian response remains far below what is needed.

“People are dying from cholera right now; hence we plead on the UN and international organisations to fund and scale up activities, particularly water and sanitation services,” said Frank Ross Katambula, MSF medical coordinator.

“These services are crucial to stop the lethal spread.”