How conflict created the conditions for Sudan’s deadly cholera crisis

Special 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

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.”

 


Cairo building collapse kills 10: state media

Updated 3 sec ago
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Cairo building collapse kills 10: state media

Cairo building collapse kills 10: state media
  • Eyewitnesses told the state-owned outlet that “a gas cylinder explosion” caused the collapse
CAIRO: A building collapse in the Egyptian capital killed 10 people and injured eight more on Monday, with several others believed to be missing under the rubble, state media reported.
Ambulances were dispatched to the scene in the working class neighborhood of Kerdasa, where civil defense teams searched for people thought to be missing under the rubble, according to the Al-Akhbar Al-Youm newspaper.
Eyewitnesses told the state-owned outlet that “a gas cylinder explosion” caused the collapse, and a police investigation was under way.
Building regulations are unevenly enforced in the sprawling metropolis of Cairo, home to over 26 million people.
The city has seen a number of deadly building collapses in recent years, both due to the dilapidated state of some and, at times, failure to comply with building regulations.

500 days of the Israel-Hamas war, by the numbers

500 days of the Israel-Hamas war, by the numbers
Updated 54 min 55 sec ago
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500 days of the Israel-Hamas war, by the numbers

500 days of the Israel-Hamas war, by the numbers
  • The current phase of the truce is set to expire in early March and it is unclear if the sides will extend it
Monday is the 500th day of the war triggered by Hamas’ Oct. 7, 2023 attack into southern Israel.
A tenuous ceasefire in the Gaza Strip has held for nearly a month. But the current phase of the truce is set to expire in early March and it is unclear if the sides will extend it, begin negotiations for a more lasting ceasefire or resume fighting.
Here are some numbers that show the scale of death and devastation. Sources include the Israeli government, the Gaza Health Ministry and UN agencies.
People killed in Israel on Oct. 7, 2023: Around 1,200
Hostages taken into Gaza: 251
Hostages remaining in Gaza: 73, including 3 taken before Oct. 7, 2023
Hostages in Gaza believed to be dead: 36, including one from before Oct. 7, 2023
Palestinians killed in Gaza: Over 48,200 (This figure from the Gaza Health Ministry does not distinguish between combatants and civilians, but the ministry says more than half of the dead were women and children)
Palestinians wounded in Gaza: Over 111,600
Israeli soldiers killed since Oct. 7, 2023: 846
Rockets fired at Israel from Gaza since Oct. 7, 2023: Over 10,000
Percentage of Gaza’s population displaced: Around 90 percent
Palestinians who have crossed into northern Gaza since the ceasefire began: 586,000
Israelis displaced by attacks from Gaza and Hezbollah in Lebanon at their peak: Over 75,500
Housing units damaged or destroyed in Gaza: Over 245,000
Primary roads damaged or destroyed in Gaza: Over 92 percent
Health facilities damaged or destroyed in Gaza: Over 84 percent

Experts push to restore Syria’s war-torn heritage sites, including renowned Roman ruins at Palmyra

Experts push to restore Syria’s war-torn heritage sites, including renowned Roman ruins at Palmyra
Updated 17 February 2025
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Experts push to restore Syria’s war-torn heritage sites, including renowned Roman ruins at Palmyra

Experts push to restore Syria’s war-torn heritage sites, including renowned Roman ruins at Palmyra
  • One of Syria’s six UNESCO World Heritage sites, Palmyra was once a key hub to the ancient Silk Road
  • Control of Palmyra shifted between Daesh and the Syrian army before Assad’s forces recaptured it

PALMYRA, Syria: Experts are returning to Syria’s war-ravaged heritage sites, hoping to lay the groundwork for restoring them and reviving tourism, which they say could provide a much-needed boost to the country’s decimated economy after nearly 14 years of war.
Once-thriving landmarks like the ancient city of Palmyra and the medieval Crusader castle of Crac des Chevaliers remain scarred by years of conflict, but local tourists are returning to the sites, and conservationists hope their historical and cultural significance will eventually draw international visitors back.
Palmyra
One of Syria’s six UNESCO World Heritage sites, Palmyra was once a key hub to the ancient Silk Road network linking the Roman and Parthian empires to Asia. Located in the Syrian desert, it is renowned for its 2,000-year-old Roman-era ruins. It is now marked by shattered columns and damaged temples.
Before the Syrian uprising that began in 2011 and soon escalated into a brutal civil war, Palmyra was Syria’s main tourist destination, attracting around 150,000 visitors monthly, Ayman Nabu, a researcher and expert in ruins said. Dubbed the “Bride of the Desert,” he said “Palmyra revitalized the steppe and used to be a global tourist magnet.”
The ancient city was the capital of an Arab client state of the Roman Empire that briefly rebelled and carved out its own kingdom in the third century, led by Queen Zenobia.
In more recent times, the area had darker associations. It was home to Tadmur prison, where thousands of opponents of the Assad family’s rule in Syria were reportedly tortured. The Daesh group demolished the prison after capturing the town.
Daesh militants later destroyed Palmyra’s historic temples of Bel and Baalshamin and the Arch of Triumph, viewing them as monuments to idolatry, and beheaded an elderly antiquities scholar who had dedicated his life to overseeing the ruins.
Between 2015 and 2017, control of Palmyra shifted between Daesh and the Syrian army before Assad’s forces, backed by Russia and Iran-aligned militias, recaptured it. They established military bases in the neighboring town, which was left heavily damaged and largely abandoned. Fakhr Al-Din Al-Ma’ani Castle, a 16th-century fortress overlooking the city, was repurposed by Russian troops as a military barracks.
Nabu, the researcher, visited Palmyra five days after the fall of the former government.
“We saw extensive excavation within the tombs,” he said, noting significant destruction by both Daesh and Assad government forces. “The (Palmyra) museum was in a deplorable state, with missing documents and artifacts – we have no idea what happened to them.”
At the theater, the Tetrapylon, and other ruins along the main colonnaded street, Nabu said they documented many illegal drillings revealing sculptures, as well as theft and smuggling of funerary or tomb-related sculptures in 2015 when Daesh had control of the site. While seven of the stolen sculptures were retrieved and put in a museum in Idlib, 22 others were smuggled out, Nabu added. Many pieces likely ended up in underground markets or private collections.
Inside the city’s underground tombs, Islamic verses are scrawled on the walls, while plaster covers wall paintings, some depicting mythological themes that highlight Palmyra’s deep cultural ties to the Greco-Roman world.
“Syria has a treasure of ruins,” Nabu said, emphasizing the need for preservation efforts. He said Syria’s interim administration, led by the Islamist former insurgent group Hayat Tahrir Al-Sham, has decided to wait until after the transition phase to develop a strategic plan to restore heritage sites.
Matthieu Lamarre of the UN’s scientific, educational and cultural organization UNESCO, said the agency had since 2015, “remotely supported the protection of Syrian cultural heritage” through satellite analyzes, reports and documentation and recommendations to local experts, but it did not conduct any work on site.
He added that UNESCO has explored possibilities for technical assistance if security conditions improve. In 2019, international experts convened by UNESCO said detailed studies would need to be done before starting major restorations.
Crac des Chevaliers
Beyond Palmyra, other historical sites bear the scars of war.
Perched on a hill near the town of Al-Husn, with sweeping views, Crac des Chevaliers, a medieval castle originally built by the Romans and later expanded by the Crusaders, was heavily bombarded during the Syrian civil war.
On a recent day, armed fighters in military uniform roamed the castle grounds alongside local tourists, taking selfies among the ruins.
Hazem Hanna, an architect and head of the antiquities department of Crac des Chevaliers, pointed to the collapsed columns and an entrance staircase obliterated by airstrikes. Damage from government airstrikes in 2014 destroyed much of the central courtyard and the arabesque-adorned columns, Hanna said.
“Relying on the cultural background of Syria’s historical sites and their archaeological and historical significance to enthusiasts worldwide, I hope and expect that when the opportunity arises for tourists to visit Syria, we will witness a significant tourism revival,” he said.
Some sections of Crac des Chevaliers were renovated after airstrikes and the deadly 7.8 magnitude earthquake in 2023 that struck a wide area of neighboring Turkiye and also Syria, Hanna said. However, much of the castle remains in ruins.
Both Nabu and Hanna believe restoration will take time. “We need trained technical teams to evaluate the current condition of the ruin sites,” Nabu said.
The Dead Cities
In Northwest Syria, more than 700 abandoned Byzantine settlements called Dead Cities, stretch across rocky hills and plains, their weathered limestone ruins featuring remnants of stone houses, basilicas, tombs and colonnaded streets. Despite partial collapse, arched doorways, intricate carvings and towering church facades endure, surrounded by olive trees that root deep into history.
Dating back to the first century, these villages once thrived on trade and agriculture. Today, some sites now shelter displaced Syrians, with stone houses repurposed as homes and barns, their walls blackened by fire and smoke. Crumbling structures suffer from poor maintenance and careless repurposing.
Looters have ravaged the ancient sites, Nabu said, leaving gaping holes in search of artifacts. Local visitors carve names and messages into centuries-old walls. Sheep enclosures dot the ruins, plastic debris blending with ancient stone.
Moustafa Al-Kaddour, a local resident, returned after eight years. Touring the ruins with family members he brought from Quneitra, he reflected on childhood memories.
“This is where we went to school,” he said, pointing in the distance. “In the middle of class, we used to leave and come here to see the ruins.”
“My feelings are indescribable,” Al-Kaddour, who also saw his father for the first time in years, told the AP. “My brain still cannot comprehend that after eight years, by God’s will, we made it back home.”
He said the Assad forces had established a military position in the village, subjecting the ruins to heavy shelling and gunfire. The area was then controlled by rebels, who made the area off-limits to most Syrians and international tourists, unlike Palmyra, which still saw some visitors during the war.
The Dead Cities were added to UNESCO’s World Heritage List in 2011 as an open-air museum, said Nabu. Idlib province alone hosts “over 1,000 heritage sites spanning different time periods – about a third of Syria’s total ruins,” he added.
Beyond the bombings and air raids, looting and unauthorized digging have caused significant damage, Nabu said, adding that new construction near the ruins lacks planning and threatens preservation.
“Tens of thousands” of looted artifacts remain undocumented, he said. For those documented, authorities are compiling case files for international circulation in coordination with the Directorate of Antiquities and Museums to locate them and hopefully retrieve them.


Ukraine’s Zelensky in UAE for official visit

Ukraine’s Zelensky in UAE for official visit
Updated 17 February 2025
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Ukraine’s Zelensky in UAE for official visit

Ukraine’s Zelensky in UAE for official visit
  • The UAE has been an important mediator between Russia and Ukraine, helping with prisoner exchanges

KYIV: Ukrainian leader Volodymyr Zelensky said Sunday he had arrived in the United Arab Emirates for a visit with a “large humanitarian program,” ahead of an expected meeting between Donald Trump and Vladimir Putin.
Zelensky posted a video of him getting off the plane in UAE and holding talks with officials.
“An official visit with the First Lady to the United Arab Emirates,” Zelensky said on Telegram.
“The priority is to bring even more of our people home from captivity. As well as investment and economic partnership. A large humanitarian program,” he added.

 


He said this week that he planned to visit the country – as well as Turkiye and Saudi Arabia – in the coming days.
But he said on Friday that he had no plans to meet with Russian or US officials there.

Ukrainian President Volodymyr Zelenskyy, center, and first lady Olena Zelenska were welcomed to UAE by Reem Al-Hashimy, the minister of State for International Cooperation. (X: @ZelenskyyUa)


Moscow and Washington are preparing for a summit between their two leaders, with Europe and Kyiv worried they will try to settle the three-year war in Ukraine without them.
The UAE has been an important mediator between Russia and Ukraine, helping with prisoner exchanges and the return of Ukrainian children from Russia, throughout the war.

 


In northern Syria, displaced owners return to houses with no roofs

In northern Syria, displaced owners return to houses with no roofs
Updated 17 February 2025
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In northern Syria, displaced owners return to houses with no roofs

In northern Syria, displaced owners return to houses with no roofs
  • An aerial video of the area shows rows of houses that are still standing but with their roofs missing

MARAAT AL-NUMAN, Syria: After a decade of war and displacement, many Syrians are returning to their homes, only to find them looted and roofless.
In towns like Maarat Al-Numan and Kfar Nabl in northern Syria, residents who fled years ago have returned since the fall of former President Bashad Assad but are now confronting the harsh reality of widespread theft and destruction.
Strategically located on the route between the cities of Aleppo and Damascus, Maarat Al-Numan became a touchpoint in the Syrian civil war.
Assad’s forces seized the area back from rebel control in 2020. After that, groups affiliated with Assad looted houses and demolished some of them to extract valuable materials and furniture, human rights groups said. Steel and wires were taken out of rooftops to be sold.
An aerial video of the area shows rows of houses that are still standing but with their roofs missing.
Anmar Zaatour, a resident who left in 2019, said he came back in 2025 to find his home destroyed.
“There was nowhere to put our children,” he said. “This destruction isn’t from the bombing, it was the military. And it’s not just mine, it’s my neighbors, and friends.”
Zakaria Al-Awwad burst into tears of mixed joy and sorrow upon his return to Maarat Al-Numan. His house was destroyed, “one of the first ones to get hit,” he said.
“There is no place like home,” he said. “Even if I have to put on a sheet of cloth, it is better than anything else. We have freedom now, and that is priceless.”
Others were more circumspect about the future.
“The problem is, it’s impossible to resume a life without a roof,” said returning resident Hassan Barbesh. “Maarat Al-Numan is an impoverished town. It’s a very difficult task to start from scratch.”