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.”

 


First Gaza aid ship arrives at Egypt’s El-Arish port since ceasefire

Updated 30 January 2025
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First Gaza aid ship arrives at Egypt’s El-Arish port since ceasefire

CAIRO: A Turkish ship docked at Egypt’s El-Arish on Wednesday, delivering the first aid destined for Gaza through the port since a fragile ceasefire went into effect, a Turkish official and Egyptian sources said.
“We are prepared to heal the wounds of our Gazan brothers and sisters and to meet their temporary shelter needs,” Turkish Interior Minister Ali Yerlikaya posted on X on Wednesday.
The ship was loaded with 871 tons of humanitarian aid, including 300 power generators, 20 portable toilets, 10,460 tents and 14,350 blankets, according to Yerlikaya.
A team from the Egyptian Red Crescent received the Turkish aid to make the necessary arrangements for its delivery to the Strip, a source at the port, 50 kilometers (30 miles) west of the Gaza Strip, said.
Two staff from the Egyptian Red Crescent also confirmed its arrival.
Since the start of the truce in the Palestinian territory, hundreds of truckloads of aid have entered Gaza while some has been airlifted in.
The truce between Israel and Hamas came after more than 15 months of war sparked by Hamas’s October 7, 2023, attack on Israel.


Syria’s Sharaa: jihadist to interim head of state

Updated 30 January 2025
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Syria’s Sharaa: jihadist to interim head of state

DAMASCUS: In less than two months, Syria’s Ahmed Al-Sharaa has risen from rebel leader to interim president, after his Islamist group led a lightning offensive that toppled Bashar Assad.
Sharaa was appointed Wednesday to lead Syria for an unspecified transitional period, and has been tasked with forming an interim legislature after the dissolution of the Assad era parliament and the suspension of the 2012 constitution.
The former jihadist has abandoned his nom de guerre Abu Mohammed Al-Jolani, trimmed his beard and donned a suit and tie to receive foreign dignitaries since ousting Assad from power on December 8.
The tall, sharp-eyed Sharaa has held a succession of interviews with foreign journalists, presenting himself as a patriot who wants to rebuild and reunite Syria, devastated and divided after almost 14 years of civil war.
Syria’s new authorities also announced Wednesday the dissolution of armed factions, including Sharaa’s own Hayat Tahrir Al-Sham (HTS), which is rooted in the Syrian branch of Al-Qaeda.
Since breaking ties with Al-Qaeda in 2016, Sharaa has sought to portray himself as a more moderate leader, and HTS has toned down its rhetoric, vowing to protect Syria’s religious and ethnic minorities.
But Sharaa has yet to calm misgivings among some analysts and Western governments that still class HTS as a terrorist organization.
“He is a pragmatic radical,” Thomas Pierret, a specialist in political Islam, told AFP.
“In 2014, he was at the height of his radicalism,” Pierret said, referring to the period of the war when he sought to compete with the jihadist Daesh group.
“Since then, he has moderated his rhetoric.”
Born in 1982 in Saudi Arabia, Sharaa is from a well-to-do Syrian family and was raised in Mazzeh, an upscale district of Damascus.
In 2021, he told US broadcaster PBS that his nom de guerre was a reference to his family’s roots in the Golan Heights. He said his grandfather was among those forced to flee the territory after its capture by Israel in 1967.
According to the Middle East Eye news website, it was after the September 11, 2001 attacks that he was first drawn to jihadist thinking.
“It was as a result of this admiration for the 9/11 attackers that the first signs of jihadism began to surface in Jolani’s life, as he began attending secretive sermons and panel discussions in marginalized suburbs of Damascus,” the website said.
Following the US-led invasion of Iraq in 2003, he left Syria to take part in the fight.
He joined Al-Qaeda in Iraq, led by Abu Musab Al-Zarqawi, and was subsequently detained for five years, preventing him from rising through the ranks of the jihadist organization.
In March 2011, when the revolt against Assad’s rule erupted in Syria, he returned home and founded Al-Nusra Front, Syria’s branch of Al-Qaeda.
In 2013, he refused to swear allegiance to Abu Bakr Al-Baghdadi, who would go on to become the emir of the Daesh group, and instead pledged his loyalty to Al-Qaeda’s Ayman Al-Zawahiri.
A realist in his partisans’ eyes, an opportunist to his adversaries, Sharaa said in May 2015 that he, unlike Daesh, had no intention of launching attacks against the West.
He also proclaimed that should Assad be defeated, there would be no revenge attacks against the Alawite minority that the president’s clan stems from.
He cut ties with Al-Qaeda, claiming to do so in order to deprive the West of reasons to attack his organization.
According to Pierret, he has since sought to chart a path toward becoming a credible statesman.
In January 2017, Sharaa imposed a merger with HTS on rival Islamist groups in northwestern Syria, thereby taking control of swathes of Idlib province that had been cleared of government troops.
In areas under its grip, HTS developed a civil administration and established a semblance of a state in Idlib province, while crushing its rebel rivals.
Throughout this process, HTS faced accusations from residents and human rights groups of brutal abuses against those who dared dissent, which the United Nations has classed as war crimes.


Palestinian Red Crescent says Israeli strike kills 7 in West Bank

Updated 30 January 2025
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Palestinian Red Crescent says Israeli strike kills 7 in West Bank

  • Palestinian Red Crescent: ‘An Israeli strike in the village of Tamun in the northern West Bank killed seven people’
  • Israeli said that its forces were involved in a ‘counterterrorism operation’ in the area

RAMALLAH, Palestinian Territories: The Palestinian Red Crescent said an Israeli drone strike in a village in the occupied West Bank killed at least seven people on Wednesday, while the military said it had struck an “armed cell.”
“An Israeli strike in the village of Tamun in the northern West Bank killed seven people,” the group said in a statement.
The Palestinian health ministry in Ramallah said eight people had been killed.
The Israeli military told AFP its forces were involved in a “counterterrorism operation” in the area.
As part of the operation, an Israeli “aircraft, with the direction of ISA (security agency) intelligence, struck an armed terrorist cell in the area of Tamun,” the military said in a statement.
Violence has soared throughout the West Bank since the war between Hamas and Israel broke out in Gaza on October 7, 2023.
Israeli troops or settlers have killed at least 870 Palestinians, including many militants, in the West Bank since the start of the Gaza war, according to the Palestinian health ministry.
At least 29 Israelis have been killed in Palestinian attacks or during Israeli military raids in the territory over the same period, according to official Israeli figures.


Palestinians’ return to northern Gaza complicates Netanyahu’s war aims

Updated 30 January 2025
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Palestinians’ return to northern Gaza complicates Netanyahu’s war aims

  • “There is no war to resume,” said Ofer Shelah, a senior researcher at the Institute for National Security Studies, a Tel Aviv think tank
  • The “total victory” envisioned by Netanyahu remains elusive

TEL AVIV: Prime Minister Benjamin Netanyahu vowed 15 months ago that Israel would achieve “total victory” in the war in Gaza — by eradicating Hamas and freeing all the hostages. One week into a ceasefire with the militant group, many Israelis are dubious.
Not only is Hamas still intact, there’s also no guarantee all of the hostages will be released. But what’s really raised doubts about Netanyahu’s ability to deliver on his promise is this week’s return of hundreds of thousands of Palestinians to their homes in northern Gaza. That makes it difficult for Israel to relaunch its war against Hamas should the two sides fail to extend the ceasefire beyond its initial six-week phase.
“There is no war to resume,” said Ofer Shelah, a senior researcher at the Institute for National Security Studies, a Tel Aviv think tank. “What will we do now? Move the population south again?”
“There is no total victory in this war,” he said.
‘Total victory’ is elusive
Israel launched its war against Hamas after the militant group’s Oct. 7, 2023, attack on southern Israel, in which some 1,200 people were killed and roughly 250 were taken hostage. Within hours, Israel began a devastating air assault on Gaza, and weeks later it launched a ground invasion.
Israel has inflicted heavy losses on Hamas. It has killed most of its top leadership, and claims to have killed thousands of fighters while dismantling tunnels and weapons factories. Months of bombardment and urban warfare have left Gaza in ruins, and more than 47,000 Palestinians are dead, according to local health authorities who don’t distinguish between militants and civilians in their count.
But the “total victory” envisioned by Netanyahu remains elusive.
In the first phase of the ceasefire, 33 hostages in Gaza will be freed, nearly 2,000 Palestinian prisoners in Israel will be released, and humanitarian aid to Gaza will be vastly increased. Israel is also redeploying troops to enable over 1 million Palestinians to return to their homes in northern Gaza.
In the second phase of the ceasefire, which the two sides are expected to begin negotiating next week, more hostages would be released and the stage would be set for a more lasting truce.
But if Israel and Hamas do not agree to advance to the next phase, more than half of the roughly 90 remaining hostages will still be in Gaza; at least a third of them are believed to be dead.
Despite heavy international and domestic pressure to develop a postwar vision for who should rule Gaza, Netanyahu has yet to secure an alternative to the militant group. That has left Hamas in command.
Hamas sought to solidify that impression as soon as the ceasefire began. It quickly deployed uniformed police to patrol the streets and staged elaborate events for the hostages’ release, replete with masked gunmen, large crowds and ceremonies. Masked militants have also been seen along Gaza’s main thoroughfares, waving to and welcoming Palestinians as they head back home.
A Hamas victory?
Despite the scale of death and destruction in Gaza — and the hit to its own ranks — Hamas will likely claim victory.
Hamas will say, “Israel didn’t achieve its goals and didn’t defeat us, so we won,” said Michael Milshtein, an Israeli expert on Palestinian affairs.
The return of displaced Palestinians to northern Gaza is an important achievement for Hamas, Milshtein said. The group long insisted on a withdrawal of Israeli troops and an end to war as part of any deal — two conditions that have effectively begun to be realized.
And Hamas can now reassert itself in a swath of the territory that Israel battled over yet struggled to entirely control.
To enable Palestinians to return to northern Gaza, Israel opened the Netzarim corridor, a roughly 4-mile (6-kilometer) military zone bisecting the territory. That gives Hamas more freedom to operate, while taking away leverage that would be difficult for Israel regain even if it restarted the war, said Giora Eiland, a former Israeli general who had proposed a surrender-or-starve strategy for northern Gaza.
“We are at the mercy of Hamas,” he said in an interview with Israeli Army Radio. “The war has ended very badly” for Israel, he said, whereas Hamas “has largely achieved everything it wanted.”
Little appetite to resume war
President Donald Trump could play an important role in determining the remaining course of the war.
He has strongly hinted that he wants the sides to continue to the second phase of negotiations and shown little enthusiasm for resuming the war. A visit by his Mideast envoy, Steve Witkoff, to Israel this week and a visit to the White House next week by Netanyahu will likely give stronger indications of where things are headed.
In announcing the ceasefire, Netanyahu said Israel was still intent on achieving all the war’s goals. He said Israel was “safeguarding the ability to return and fight as needed.”
While military experts say Israel could in practice relaunch the war, doing so will be complicated.
Beyond the return of displaced Palestinians, the international legitimacy to wage war that it had right after Hamas’ attack has vanished. And with joyful scenes of freed hostages reuniting with their families, the Israeli public’s appetite for a resumption of fighting is also on the decline, even if many are disappointed that Hamas, a group that committed the deadliest attack against Israelis in the country’s history, is still standing.
An end to the war complicates Netanyahu’s political horizon. The Israeli leader is under intense pressure to resume the war from his far-right political allies, who want to see Hamas crushed. They envision new Jewish settlements in Gaza and long-term Israeli rule there.
One of Netanyahu’s coalition partners already resigned in protest at the ceasefire deal and a second key ally has threatened to topple the government if the war doesn’t resume after the first phase. That would destabilize the government and could trigger early elections.
“Where is the total victory that this government promised?” Itamar Ben-Gvir, the former Cabinet minister who quit the government over the ceasefire said Monday.
Israel Ziv, a retired general, said restarting the war would require a new set of goals and that its motivations would be tainted.
“The war we entered into is over,” he told Israeli Army Radio. “Other than political reasons, I don’t see any reason to resume the war.”


Israel to free 110 Palestinian prisoners in Gaza truce swap Thursday: NGO

Updated 29 January 2025
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Israel to free 110 Palestinian prisoners in Gaza truce swap Thursday: NGO

  • Palestinian Prisoners’ Club said 30 minors are included in the release
  • 48 prisoners were serving jail terms of varying lengths

RAMALLAH: A Palestinian prisoners advocacy group said Israeli authorities would release 110 prisoners, including 30 minors, on Thursday as part of an exchange under a Gaza ceasefire deal agreed with Hamas.
“Tomorrow, 110 Palestinian prisoners are to be released,” the Palestinian Prisoners’ Club said in a statement, referring to the third exchange of hostages and prisoners under the truce, which began on January 19.
The group said the prisoners were expected to arrive in the “Radana area of Ramallah at around noon.”
Publishing the list of the prisoners, the group said 30 were under the age of 18, 32 had been sentenced to life imprisonment, and 48 others were serving jail terms of varying lengths.
The group also said that 20 of the prisoners set to be released would be sent into exile.
In the previous two swaps, seven Israeli hostages were freed by militants in exchange for 290 prisoners — almost all Palestinians, with the exception of one Jordanian.
On Thursday, three Israeli hostages are to be freed, along with five Thai nationals.
The three Israeli hostages are Arbel Yehud, Agam Berger and Gadi Moses. The identities of the five Thais are still unknown.
A fourth swap planned for Saturday will see three Israeli men released, according to Prime Minister Benjamin Netanyahu’s office.