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

  • 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.”

 


Beirut airport to close Sunday during funeral of slain Hezbollah leader

Updated 16 min 31 sec ago
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Beirut airport to close Sunday during funeral of slain Hezbollah leader

  • “The airport will be closed, and takeoffs and landings... will halt on February 23, 2025, from 12:00 p.m. (1000 GMT) until 4:00 pm,” the authority said
  • Qassem at the weekend called for broad participation as a demonstration of the group’s strength

BEIRUT: Beirut airport will close for four hours on Sunday during the funeral of slain Hezbollah leader Hassan Nasrallah, Lebanon’s civil aviation authority has announced.
“The airport will be closed, and takeoffs and landings... will halt on February 23, 2025, from 12:00 p.m. (1000 GMT) until 4:00 pm,” the authority said in a statement carried by official media on Tuesday.
Nasrallah was killed in a huge Israeli air strike on Beirut’s southern suburbs on September 27, as Israel scaled up its campaign against the Iran-backed group following almost a year of cross-border hostilities.
Sunday’s funeral will also be for Hashem Safieddine, a senior Hezbollah figure who had been chosen to succeed Nasrallah, before he too was killed in an Israeli raid in October.
The funeral is to begin at 1:00 p.m. at a sports stadium in Beirut’s southern suburbs, a Hezbollah stronghold.
It will include a speech by current Hezbollah chief Naim Qassem, and is to be followed by a procession to Nasrallah’s burial site.
Iranian foreign ministry spokesman Esmaeil Baqaei said on Monday that Iran “will participate in this ceremony at a high level,” without specifying who would attend.
Qassem at the weekend called for broad participation as a demonstration of the group’s strength.
“We want to transform this funeral into a show of support and an affirmation of (Hezbollah’s) plan and approach, and hold our heads high,” Qassem said.
After decades at the helm of the group once seen as invincible, the killing of the charismatic Nasrallah sent shock waves across Lebanon and the wider region.
Hezbollah has said 79 countries would be involved in the commemoration, whether at an official or “popular” level.
Earlier this month in a security alert about the funeral, the US embassy urged its nationals to avoid the area “which includes the airport.”
Qassem has said Nasrallah would be buried on the outskirts of Beirut “in a plot of land we chose between the old and new airport roads.”
Safieddine will be buried in his hometown of Deir Qanun in southern Lebanon, he added.
Nasrallah had been temporarily buried elsewhere because of security concerns, Qassem said, and the group had also put off the public funeral for security reasons.
A November 27 ceasefire deal put a halt to two months of all-out war between Israel and Hezbollah that saw the group weakened and numerous senior commanders killed.


Lebanon presses for full Israeli withdrawal after troops remain in 5 points

Updated 18 February 2025
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Lebanon presses for full Israeli withdrawal after troops remain in 5 points

  • Aoun said Beirut was in contact with truce brokers the United States and France to press Israel to complete its withdrawal
  • In a statement, Aoun, along with Lebanon’s prime minister and parliament speaker, warned the government would ask the UN Security Council to push Israel to leave

KFAR KILA, Lebanon: Lebanese leaders said Beirut was in contact with Washington and Paris to press Israel to fully withdraw from south Lebanon, branding its presence in five points an “occupation” after a ceasefire deadline expired on Tuesday.
The UN called the incomplete pull-out a violation of a Security Council resolution, though it has allowed many displaced residents to return to border villages, many largely destroyed in more than a year of hostilities between Israel and Hezbollah.
Lebanese President Joseph Aoun said Beirut was in contact with truce brokers the United States and France to press Israel to complete its withdrawal, after an initial late January deadline set under the deal was already extended.
Decision-makers are “unified in adopting the diplomatic option, because nobody wants war,” Aoun said, according to a statement.
Earlier Tuesday, Lebanon said any Israeli presence on its soil constituted an “occupation.”
In a statement, Aoun, along with Lebanon’s prime minister and parliament speaker, warned the government would ask the UN Security Council to push Israel to leave, and said that Lebanese armed forces were ready to assume duties on the border, adding Beirut had “the right to adopt all means” to make Israel withdraw.
In the south, many returned to destroyed or heavily damaged homes, farms and businesses after more than a year of fighting between Israel and Iran-backed Hezbollah that included two months of all-out war, which halted with the November 27 ceasefire.
“The entire village has been reduced to rubble. It’s a disaster zone,” said Alaa Al-Zein, back in Kfar Kila.
Israel had announced just before the pullout deadline that it would keep troops in “five strategic points” near the border, and on Tuesday its Foreign Minister Gideon Saar said they would withdraw “once Lebanon implements its side of the deal.”
Israel’s army had said it would remain on the five hilltops, overlooking swathes of both sides of the border, “temporarily” to “make sure there’s no immediate threat.”
Lebanon’s army announced it had deployed, starting Monday, in 11 southern border villages and other areas from which Israeli troops have pulled out.
The official National News Agency said two people were found alive in Kfar Kila, three months after contact was lost. One was a Hezbollah fighter thought to have been killed.
The agency also said that “enemy forces” set off a powerful explosion outside the village of Kfarshuba.
In a joint statement, UN envoy Jeanine Hennis-Plasschaert and the UNIFIL peacekeeping force said that at “the end of the period set” for Israel’s withdrawal and the Lebanese army’s deployment, any further “delay in this process is not what we hoped would happen.”
They said it was a violation of a Security Council resolution that ended a 2006 Israel-Hezbollah war.
In Lebanon, the cost of reconstruction is expected to reach more than $10 billion, while more than 100,000 people remain displaced, according to the United Nations.
Despite the devastation, returning resident Zein said his fellow villagers were adamant about going home.
“The whole village is returning, we will set up tents and sit on the ground” if need be, he said.
Others were going south to look for the bodies of their relatives under the rubble.
Among them was Samira Jumaa, who arrived in the early hours to look for her brother, a Hezbollah fighter killed in Kfar Kila with others five months ago.
“We have not heard of them until now. We are certain they were martyred,” she said.
“I’ve come to see my brother and embrace the land where my brother and his comrades fought,” she added.
Hezbollah strongholds in south and east Lebanon, as well as in south Beirut, suffered heavy destruction during the hostilities, initiated by Hezbollah in support of ally Hamas during the Gaza war.
Under the ceasefire, Lebanon’s military was to deploy alongside United Nations peacekeepers as the Israeli army withdrew from the south over an initial 60-day period that was later extended to February 18.
Hezbollah was to pull back north of the Litani River, about 30 kilometers (20 miles) from the border, and dismantle remaining military infrastructure there.
Since the cross-border hostilities began in October 2023, more than 4,000 people have been killed in Lebanon, according to the health ministry.
On the Israeli side of the border, 78 people including soldiers have been killed, according to an AFP tally based on official figures, with an additional 56 troops killed in southern Lebanon during the ground offensive.
Around 60 people have reportedly been killed in Lebanon since the truce began, two dozen of them on January 26 as residents tried to return to border towns on the initial withdrawal deadline.


Villagers in southern Lebanon prepare to return home as Israeli army withdraws under ceasefire deal

Updated 18 February 2025
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Villagers in southern Lebanon prepare to return home as Israeli army withdraws under ceasefire deal

  • Most of the villages waited by the roadside for permission to go and check on their homes but some pushed aside the roadblocks to march in
  • In the border village of Kfar Kila, people were stunned by the amount of destruction, with entire sections of houses wiped out

DEIR MIMAS, Lebanon: Israeli forces withdrew Tuesday from border villages in southern Lebanon under a deadline spelled out in a US-brokered ceasefire agreement that ended the latest Israel-Hezbollah war, but stayed put in five strategic overlook locations inside Lebanon.
Top Lebanese leaders denounced the continued presence of the Israel troops as an occupation and a violation of the deal, maintaining that Israel was required to make a full withdrawal by Tuesday. The troops’ presence is also a sore point with the militant Hezbollah group, which has demanded action from the authorities.
Lebanese soldiers moved into the areas from where the Israeli troops pulled out and began clearing roadblocks set up by Israeli forces and checking for unexploded ordnance. They blocked the main road leading to the villages, preventing anyone from entering while the military was looking for any explosives left behind.
Most of the villages waited by the roadside for permission to go and check on their homes but some pushed aside the roadblocks to march in. Elsewhere, the army allowed the residents to enter.
Many of their houses were demolished during the more than year-long conflict or in the two months after November’s ceasefire agreement, when Israeli forces were still occupying the area.
In the border village of Kfar Kila, people were stunned by the amount of destruction, with entire sections of houses wiped out.
“What I’m seeing is beyond belief. I am in a state of shock,” said Khodo Suleiman, a construction contractor, pointing to his destroyed home on a hilltop.
“There are no homes, no plants, nothing left,” said Suleiman, who had last been in Kfar Kila six months ago. “I am feeling a mixture of happiness and pain.”
In the main village square, Lebanese troops deployed as a military bulldozer removed rubble from the street.
Israeli Defense Minister Israel Katz said the Israeli army “will stay in a buffer zone in Lebanon in five control posts” to guard against any ceasefire violations by Hezbollah. He also said the army had erected new posts on the Israeli side of the border and sent reinforcements there.
“We are determined to provide full security to every northern community,” Katz said.
However, Lebanon’s three top officials — the country’s president, prime minister and parliament speaker — in a joint statement said that Israel’s continued presence at the five locaions was in violation of the ceasefire agreement. They called on the UN Security Council to take action to force a complete Israeli withdrawal.
“The continued Israeli presence in any inch of Lebanese territory is an occupation, with all the legal consequences that result from that according to international legitimacy,” the statement said.
The Israeli troop presence was also criticized in a joint statement by the UN special coordinator for Lebanon, Jeanine Hennis-Plasschaert, and the head of the UN peacekeeping force in the country, Lt. Gen. Aroldo Lázaro.
The two, however, warned that this should not “overshadow the tangible progress that has been made” since the ceasefire agreement.
Near the Lebanese villages of Deir Mimas and Kfar Kila, hundreds of villagers were gathered early on Tuesday morning as an Israeli drone flew overhead.
Atef Arabi, who had been waiting with his wife and two daughters before sunrise, was eager to see what’s left of his home in Kfar Kila.
“I am very happy I am going back even if I find my home destroyed,” said the 36-year-old car mechanic. “If I find my house destroyed I will rebuild it.”
Later on Tuesday, Kfar Kila’s mayor Hassan Sheet told The Associated Press that 90 percent of the village homes are completely destroyed while the remaining 10 percent are damaged. “There are no homes nor buildings standing,” he said, adding that rebuilding will start from scratch.
The Lebanese militant group Hezbollah began firing rockets across the border on Oct. 8, 2023, one day after a deadly Hamas-led incursion into southern Israel that sparked the war in Gaza. Israel responded with shelling and airstrikes in Lebanon, and the two sides became locked in an escalating conflict that became a full-blown war last September.
More than 4,000 people were killed in Lebanon and more than 1 million were displaced at the height of the conflict, more than 100,000 of whom have not been able to return home. On the Israeli side, dozens of people were killed and some 60,000 are displaced.
Hussein Fares left Kfar Kila in October 2023 for the southern city of Nabatiyeh. When the fighting intensified in September he moved with his family to the city of Sidon where they were given a room in a school housing displaced people.
Kfar Kila saw intense fighting and Israeli troops later detonated many of its homes.
“I have been waiting for a year and the half to return,” said Fares who has a pickup truck and works as a laborer. He said he understands that the reconstruction process will take time.
“I have been counting the seconds for this day,” he said.


Over 200 killed in three-day Sudan paramilitary assault: lawyers

Updated 18 February 2025
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Over 200 killed in three-day Sudan paramilitary assault: lawyers

  • The Emergency Lawyers group, which documents rights abuses, said RSF attacked unarmed civilians in the villages of Al-Kadaris and Al-Khelwat
  • The lawyer group said some residents were shot at while attempting to flee across the Nile River

PORT SUDAN: Sudanese paramilitaries have killed more than 200 people, including women and children, in a three-day assault on villages in the country’s south, a lawyer group monitoring the war said Tuesday.
The Emergency Lawyers group, which documents rights abuses, said the paramilitary Rapid Support Forces attacked unarmed civilians in the villages of Al-Kadaris and Al-Khelwat, in White Nile state.
The RSF carried out “executions, kidnappings, enforced disappearances and property looting” during the assault since Saturday, which also left hundreds wounded or missing, it said.
The lawyer group said some residents were shot at while attempting to flee across the Nile River. Some drowned in the process, with the lawyers calling the attack an act of “genocide.”
Sudan’s army-aligned foreign ministry said the death toll from the RSF attacks so far was 433 civilians, including babies. It called the assault a “horrible massacre.”
Both the army and the RSF have been accused of war crimes, but the paramilitaries have been specifically notorious for committing ethnic cleansing and systematic sexual violence.
The war has killed tens of thousands, displaced over 12 million and created what the International Rescue Committee has called the “biggest humanitarian crisis ever recorded.”
White Nile state is currently divided by the warring parties.
The army controls southern parts, including the state capital, Rabak, as well as two major cities and a key military base.
The RSF meanwhile holds northern parts of the state, bordering the capital Khartoum, which include several villages and towns and where the latest attacks took place.
Witnesses from the two villages, about 90 kilometers (55 miles) south of Khartoum, said thousands of residents fled their homes, crossing to the western bank of the Nile following RSF shelling.
A medical source speaking to AFP on condition of anonymity for their safety on Monday said some bodies were lying in the streets while others were killed inside their homes with no one able to reach them.
Fighting has intensified in recent weeks as the army advances in its bid to reclaim full control of the capital from paramilitaries.
The UN’s children agency, UNICEF, said on Sunday that those trapped in areas and around the fighting in Khartoum had reported indiscriminate shooting, looting, and forced displacement, as well as alarming accounts of families being separated, children missing, detained or abducted and sexual violence.
Many children, it added, showed signs of distress having witnessed the events around them.
“This is a living nightmare for children, and it must end,” said Sheldon Yett, UNICEF representative for Sudan.
Elsewhere, RSF shelling and gunfire shook the streets this week in a famine-hit camp near North Darfur’s besieged capital El-Fasher in the country’s west.
Hundreds of families fled the violence to neighboring towns with civilians saying that they were robbed and attacked on the roads.
The Zamzam camp, home to between 500,000 and a million people according to aid groups, was the first place famine was declared in Sudan last August under a UN-backed assessment.


Israel confirms planned handover of six living Gaza hostages, four bodies this week

Family and supporters of hostages protest to mark the 500 days since Oct. 7, 2023.
Updated 18 February 2025
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Israel confirms planned handover of six living Gaza hostages, four bodies this week

  • Four hostage bodies would be returned to Israel on Thursday, ahead of four others next week

JERUSALEM: Israel said Tuesday it expects the bodies of four hostages held in Gaza to be returned on Thursday, ahead of the release of six living captives on Saturday, confirming an earlier announcement from Hamas.
During indirect negotiations in Cairo between Israel and the Palestinian militant group, “agreements were reached according to which the six living hostages (due for release under) the first phase will be released on Saturday,” said a statement from Israeli Prime Minister Benjamin Netanyahu’s office, referring to the truce agreement that went into effect last month.

It added that four hostage bodies would be returned to Israel on Thursday, ahead of four others next week.