By Ephraim Agbo
The war between Sudan’s national army and the paramilitary Rapid Support Forces (RSF) has become the backdrop for one of the world’s worst humanitarian disasters. Fighting that began in April 2023 has ripped apart towns, forced millions to flee, and left whole regions without the basics that stop disease and starvation. But beyond the headlines about guns and politics there is a quieter — and deadlier — disaster unfolding: a cholera epidemic that is racing through displacement camps and besieged cities already running out of food and medicine.
Below is an in-depth look at what’s happening on the ground, why cholera has exploded now, how the siege of cities such as El Fasher has amplified the emergency, and why the international response is struggling to keep up.
How bad is the crisis right now?
- Displacement and hunger: The conflict has produced a displacement crisis on an unprecedented scale. Millions of people have been forced from their homes — a humanitarian emergency that relief agencies describe as historic in its size and severity.
- Cholera cases and deaths: Since the outbreak began in mid-2024, hundreds of thousands of suspected cholera cases have been reported across Sudan, with thousands of deaths recorded in some tallies. Official and humanitarian tracking shows the outbreak has been widespread across most states, and the cumulative caseload and fatalities are alarming.
- Besieged cities and famine risk: Cities under siege — most notably El Fasher in North Darfur — are facing collapsing commercial and humanitarian supply lines. Large displaced-person sites and some urban neighborhoods are now at acute risk of famine or have passed technical famine thresholds in localized areas.
- Access and deliberate obstruction: Relief agencies report that access to those who need help has been severely constrained by the fighting, by bureaucratic impediments, and by tactics that amount to the weaponization of humanitarian aid — looted convoys, blocked relief corridors and complex security checklists that prevent lifesaving supplies from reaching people.
- Funding gap: Agencies and UN bodies repeatedly warn that funding shortfalls are blocking an adequate response — meaning fewer vaccines, fewer water-and-sanitation interventions, and far smaller distributions of food and medical supplies than are needed.
Why cholera now — and why it’s so deadly
Cholera is an acute diarrhoeal illness caused by the bacterium Vibrio cholerae. The pathogen is not new to Sudan, but cholera requires a specific set of conditions to explode: crowded populations, poor or non-existent sanitation, contaminated drinking water, disrupted healthcare, malnutrition (which increases vulnerability), and population movement. All of these are present in Sudan now:
- Mass displacement. Millions are sheltering in makeshift camps, informal settlements or overcrowded city neighborhoods where latrines are inadequate or absent. Displaced people often share single water points and have limited means to treat or store water safely.
- Broken water and sanitation systems. Damage to infrastructure, lack of fuel for pumps, looted water treatment sites and destroyed sewage lines make it trivial for sewage to contaminate drinking water. Heavy seasonal rains then disperse contamination more widely.
- Healthcare collapse. Hospitals and clinics have been damaged or run out of supplies; staff have been killed, displaced, or are unable to reach facilities. That means delayed diagnosis and treatment, and fewer oral-rehydration points or IV fluids available when cholera patients present.
- Malnutrition. Starved and malnourished children and adults have weaker immune responses and are more likely to suffer severe disease and death when infected.
These factors turn a controllable diarrhoeal disease into a fast-moving killer. Vaccination campaigns, water purification, hygiene promotion and timely case management stop cholera — but all of those interventions require secure access, funding and functioning supply lines.
El Fasher: a city under siege and the human face of the crisis
El Fasher — the provincial capital of North Darfur — has become emblematic of how urban sieges amplify humanitarian disaster. Hundreds of thousands of people (residents and displaced persons) remain trapped inside or around the city. Markets, bakeries and fuel supplies have been interrupted by shelling and drone attacks; electricity is intermittent or gone; and humanitarian convoys are repeatedly blocked or attacked.
Inside the city, accounts from aid workers and survivors paint a bleak picture: mothers scouring for minimal food, children with visible wasting, exhausted families surviving on one meal a day or less, and funerals multiplying as death from hunger, disease and violence rise. Localized famine indicators have been recorded in camps and neighborhoods where access is weakest — a situation made worse when the rainy season collapses remaining supply routes and sanitation degrades further.
What aid groups are doing — and why their efforts are limited
Humanitarian responders operate on several fronts:
- Medical response: Organizations such as Médecins Sans Frontières (MSF) and local health authorities are setting up cholera treatment centres, running mobile clinics, and training local staff to provide oral rehydration therapy and intravenous fluids when necessary. They are also distributing water purification tablets and hygiene kits. (MSF and other groups have repeatedly warned that the situation is one of the worst cholera surges in years.)
- Vaccination: Oral cholera vaccine (OCV) campaigns can blunt large outbreaks. But vaccines require cold-chain logistics, security to reach target populations, and stable funding for procurement and delivery. Interruptions in access translate into interrupted vaccination efforts.
- Nutrition and food aid: Agencies are trying to deliver food rations and therapeutic feeds for malnourished children, but the scale of need and constraints on movement make coverage partial at best.
- Water, sanitation and hygiene (WASH): Repairing boreholes, establishing latrines and providing water trucking are costly and slow when roads are insecure and equipment is scarce.
Why the response is limited:
- Access constraints. Frontlines are fluid. Some areas are under RSF control and others under the SAF; negotiable humanitarian windows are rare or short. Aid convoys reported looting or being blocked. These are not incidental delays — they are the difference between life and death.
- Funding shortfalls. Relief plans are chronically underfunded. Appeals to scale up cholera vaccination, WASH and nutrition programs repeatedly fall short of targets, forcing organizations to prioritize and reduce coverage.
- Logistics and seasonal barriers. The rainy season degrades roads and stretches transport times from days into dangerously long treks; fuel shortages and insecurity compound the problem.
- Security for staff. Humanitarian staff have been attacked, kidnapped or killed in some areas; that constrains who will travel and where. When staff aren’t able to go, clinics close and vital services stop.
Cross-border risk: the epidemic does not stop at Sudan’s borders
Refugees fleeing into Chad, South Sudan and beyond have carried both urgent protection needs and infectious disease risks. Refugee reception sites in neighboring countries struggle with their own WASH and health gaps. That means outbreaks can seed new transmission chains across borders, increasing regional humanitarian needs and complicating international response planning. Several agencies are therefore appealing for flexible funding that can be used for both in-country and cross-border interventions.
The politics of aid — why the system is failing the people it was meant to protect
Humanitarian response in Sudan is not merely a technical challenge; it’s political. Multiple reports document how relief has been obstructed by parties to the conflict through bureaucratic manipulation, refusal to allow crossing points, and direct looting of supplies. When humanitarian access becomes a bargaining chip — or when convoys are pillaged — the fundamentals of humanitarian law and practice are undermined. UN bodies, human rights monitors and relief organisations have repeatedly warned that relief is being weaponized.
What needs to happen next — practical, urgent priorities
- Unimpeded humanitarian access. Immediate, sustained corridors for life-saving food, medicines, WASH supplies and fuel are essential. International pressure should be focused on guaranteeing protected humanitarian routes and preventing looting or seizure of supplies.
- Surge funding and flexible grants. Donors must close the funding gap so agencies can run vaccination campaigns, establish cholera treatment centres, and scale nutrition programs. Flexible funding is particularly important to respond rapidly to moving populations.
- Scale up WASH at scale. Rapid repairs to water systems, emergency latrine construction, mass distribution of water purification materials and hygiene kits will reduce transmission quickly if delivered at scale.
- Vaccination campaigns where feasible. Coordinated, secure OCV campaigns in high-risk camps and towns can blunt outbreaks — but they require planning, cold-chains, and sustained security guarantees.
- Protection for civilians and aid workers. Stronger mechanisms to investigate and deter attacks on civilians and humanitarian actors are needed, alongside political pressure for ceasefires or humanitarian pauses.
What you — the reader — can do today
- Donate to reputable emergency responders working in Sudan and with refugees in neighboring countries (UN agencies such as UNICEF, WFP, UNHCR; medical NGOs such as MSF; and trusted humanitarian partners). These organizations are on the front lines of cholera treatment, WASH, nutrition and shelter.
- Raise awareness. Share verified reporting and fact-based updates. Public attention matters: political pressure and media coverage can unlock funding and diplomatic leverage.
- Write to policymakers. Urge your representatives to back humanitarian funding and to use diplomatic channels to demand safe passage for relief and protections for civilians.
Final note
The headlines tell part of the story: a war between two armed factions. But the harder, quieter catastrophe is human — a slow grinding down of civilians by hunger, disease and blocked aid. Cholera is currently the most visible and immediate health threat, but it is a symptom of broader collapse: broken infrastructure, ended trade, and desperate people trapped in cities under siege. Without a major change — safe access for aid, a surge of funding, and political will to protect civilians — the next months will see more death from hunger and disease even after the guns fall silent.
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