In Sudan, health crises are a constant and inescapable reality, exacerbated by ongoing economic and political instability. For decades, the country has endured successive health emergencies, and with a fragile healthcare infrastructure, epidemics continue to wreak havoc, especially in rural and underserved areas. Diseases such as malaria, dengue fever, cholera, and respiratory infections are endemic, ravaging communities already grappling with poverty and limited access to services.
Sudan’s health system has always struggled to cope, but the situation has worsened dramatically with the ongoing armed conflict, which began in April 2023 between the Sudanese Armed Forces (SAF) and the Rapid Supported Forces (RSF). For nearly a year and a half, this conflict has deepened the country’s health catastrophe. Many hospitals have been destroyed or have shut down entirely, leaving millions without access to basic medical care. Essential medicines and equipment have become scarce, and the collapse of the healthcare system has left epidemics unchecked, turning an already dire situation into an unprecedented health disaster.
Seasons of bounty or periods of crisis?
Sudan’s annual floods, once seen as life-giving forces for its agrarian communities, have increasingly become agents of devastation. Each rainy season brings torrents that wreak havoc across the country, causing widespread displacement, destruction of homes, and the emergence of life-threatening epidemics. In 2024, the floods were no different. In Khartoum, once a bustling capital, floodwaters mixed with sewage to contaminate water supplies, transforming them into breeding grounds for cholera, typhoid, and other diseases.
The Nile River state faced a similar disaster. Floods turned stagnant water into a haven for malaria-carrying mosquitoes, resulting in a sharp increase in cases. Kassala state, in the east, was hit particularly hard in 2019 when floods led to a severe dengue fever outbreak, killing dozens. In northern Sudan, floods not only caused epidemics but also forced snakes and scorpions into residential areas, resulting in a spike in bites and stings, with little access to medical treatment to save lives.
floodwaters mixed with sewage to contaminate water supplies, transforming them into breeding grounds for cholera, typhoid, and other diseases
Meanwhile, Darfur is grappling with a food crisis so severe that it threatens widespread famine. The lack of essential services, combined with the displacement caused by both floods and conflict, has exacerbated the suffering of its people. Epidemics and malnutrition have become intertwined, pushing the region towards the brink of collapse.
System buckling under pressure
Sudan’s government has long tried to downplay the severity of these recurring disasters, using euphemisms to calm citizens’ fears. But as epidemics spread unchecked, pharmaceutical factories collapse, and health facilities shutter, it has become impossible to mask the scale of the crisis.
The war that broke out in 2023 has compounded these issues. Central medical laboratories like the renowned “Stack” laboratory in Khartoum have been destroyed. Without access to proper storage, medical samples have been exposed, heightening fears of new diseases. The sight of decomposing bodies in the streets of the capital, left untreated due to the conflict, has only worsened the risk of epidemics.
Hospitals are overwhelmed, with patients waiting in long queues, unable to receive treatment. The critical shortage of medicines and trained medical personnel has left Sudan’s healthcare system barely functional, and the rainy season only worsens the situation. As rains drench the country, new diseases are expected to emerge, putting further strain on an already crumbling system.
New health threats
Sudan’s healthcare system, already in a state of collapse, is facing an impossible battle against the twin forces of war and natural disaster
As the rains began in 2024, new health concerns emerged. The prolonged exposure to intense heat led to fears of sunstroke, while outbreaks of meningitis have already been reported in some states. Calls for urgent vaccination campaigns, particularly targeting schoolchildren, have gone largely unanswered. Rural areas are particularly vulnerable, as scorpion stings become more frequent, yet supplies of anti-venom are scarce, further heightening the risk of fatalities.
Sudan’s healthcare system, already in a state of collapse, is facing an impossible battle against the twin forces of war and natural disaster. Without immediate international assistance and a comprehensive plan to rebuild the health infrastructure, the country’s already desperate health crisis will only deepen, leaving millions more vulnerable to disease and death.
How Sudan’s floods kill through disease and drowning
Every year, Sudan’s rainy season brings with it not just the destruction of homes and farmland but a more insidious threat: death from contaminated water. Floods create the perfect conditions for waterborne diseases such as cholera and typhoid, turning life-saving rains into killers. Previous years, including 2020, 2021, and 2022, saw hundreds of people die from drowning or the rapid spread of diseases in flood-affected areas, where already inadequate medical services were overwhelmed.
Dr Leila Hamad Al-Neel, a public health specialist with the Federal Ministry of Health, stressed that they monitor annual forecasts and mobilise medical supplies and staff to the most vulnerable areas. Yet, the 2024 rainy season has been catastrophic. Forecasts predicting moderate rainfall in some areas were proven wrong, with the Northern State and River Nile State experiencing unprecedented flooding. The health crisis worsened when floodwaters mixed with sewage and mining waste, creating a hazardous environment. Additionally, Khartoum saw an alarming new threat as floodwaters swept away unexploded ordnance from conflict zones, endangering civilians.
Since July 2024, contaminated water has been the leading cause of widespread disease, with vector-borne illnesses flourishing. Stagnant water breeds disease-carrying insects, triggering outbreaks of conjunctivitis and skin infections. These easily transmitted diseases add to the complexity of the humanitarian crisis. The collapse of homes leads not only to injuries but also to deaths from drowning, as residents struggle to survive in treacherous flood conditions.
Meanwhile, shortages of drinking water and food supplies are exacerbating the situation in camps such as Zamzam and other regions, where famine looms. Heartbreaking videos circulating online show exhausted Sudanese citizens battling against the torrents, standing in waterlogged streets, trying desperately to hold back the floods with nothing but their own weakened bodies.
Under the weight of conflict
Sudan’s already stretched health system is buckling under the weight of twin disasters: relentless conflict and catastrophic floods. The Federal Ministry of Health, struggling to address a widening scope of healthcare needs due to the war, now faces a health disaster in displacement camps, where diseases are spreading uncontrollably. Displaced populations from states like Sinnar have flooded into Kassala and Al-Gadarif, where overcrowded camps, poor sanitation, and inadequate healthcare services allow diseases to thrive.
International organisations have sounded the alarm about an impending famine, yet the situation is complicated further by heavy rains and flooding across nine states. Médecins Sans Frontières (MSF) has reported that 70% of hospitals are out of service due to shelling or insecurity, leaving the health ministry powerless and without the financial means to launch effective campaigns against the spread of diseases. The war has drained the government’s resources, rendering it unable to address the growing health crises, especially in remote areas like “Sarkamto” village in the Northern State, where residents face perilous journeys just to access healthcare.
Preparing for epidemics
As the torrential rains continue, Sudan’s federal autumn Emergency Room works tirelessly to track the rising death tolls from drowning and house collapses, while also addressing an escalating epidemic crisis. Malaria, dengue fever, cholera, and watery diarrhoea are spreading fast, with cholera emerging as a particularly deadly threat. By mid-September, 8,350 cholera cases had been recorded, with 270 deaths. Acute conjunctivitis is another serious concern, affecting thousands, particularly in the Northern State, which reported over 5,000 cases. Additionally, nearly 750 bacterial skin infections were recorded in the same region.
Emergency Room works tirelessly to track the rising death tolls from drowning and house collapses, while also addressing an escalating epidemic crisis
In an attempt to contain cholera, isolation centres have been established in key locations, including Kassala and River Nile State. Dr. Leila Al-Neel has emphasised the importance of hygiene and confirmed that while there are rumours of Nile water contamination due to mining, there is no laboratory confirmation yet. Regardless, ensuring clean water remains a top priority, as waterborne diseases continue to ravage the population.
Overcoming obstacles in delivering medicines
The ongoing conflict has paralysed many of Sudan’s pharmaceutical factories, most of which are located in Khartoum. The closure of these factories, alongside blocked national highways, has made it almost impossible to get much-needed medicines to flood-affected areas. The situation worsened significantly after an attack on Sinnar city earlier in the autumn season, further complicating the delivery of aid.
In response, the health ministry has created three distribution centres in the Red Sea, Kassala, and River Nile States to send medical supplies where they are needed most. Despite these efforts, the situation remains dire, with many regions still inaccessible due to conflict.
Amid the devastation, Omdurman, a city at the heart of recent armed clashes, has seen its healthcare services severely compromised. Yet, on 15 September, a vaccination campaign against yellow fever and poliomyelitis was launched in several Omdurman health centres as part of an effort to combat further public health disasters.
Sudan’s overlapping crises of floods, war, and epidemics paint a grim picture. With no end in sight to the conflict and the rainy season causing more harm than relief, the country faces an ever-worsening humanitarian emergency, where the floodwaters themselves become the cause of death.
Sudan’s health crisis continues to spiral, exacerbated by the ongoing armed conflict and natural disasters, leaving millions of people in desperate need of assistance. Local initiatives and organisations are facing profound challenges due to the instability caused by the fighting, with humanitarian convoys at high risk and widespread looting of aid supplies. The loss of vital resources—food, medicine, and essential services—has created a dire situation, especially in regions like North Darfur’s Zamzam camp, where children are suffering from severe malnutrition.
Dr Hiba Omer Ibrahim, speaking to the Sudanese American Physicians Association (SAPA), revealed that 80 per cent of Sudan’s health facilities are no longer functional
A Médecins Sans Frontières (MSF) survey highlighted that 10.1% of children under five are experiencing severe acute malnutrition, with overall acute malnutrition rates reaching a staggering 34.8%. MSF officials warned of an impending catastrophe if aid is not swiftly delivered, and their concerns are compounded by the Rapid Support Forces controlling key roads, effectively blocking access to critical areas. As prices for food and fuel soar, water provision and the operation of medical clinics are becoming increasingly difficult.
Dr Hiba Omer Ibrahim, speaking to the Sudanese American Physicians Association (SAPA), revealed that 80 per cent of Sudan’s health facilities are no longer functional, and 15 million people are without access to basic healthcare. The spread of diseases such as tuberculosis, AIDS, and cholera is exacerbated by shortages of medicines and personnel. Malnutrition, particularly among children, is reaching lethal levels, with one child dying every two hours in displacement camps.
The collapse of Sudan’s health infrastructure—70 per cent of which has been destroyed—poses a monumental barrier to addressing the crisis. Epidemics of bacterial dermatitis, cholera, and malaria are spreading uncontrollably, while local efforts to respond are severely undermined by a lack of resources.
Dr Hiba stressed that international cooperation, the provision of safe environments for healthcare workers, and innovative solutions for delivering aid—such as air drops—are crucial to prevent further loss of life. MSF and other organisations have issued urgent calls to the United Nations and international bodies to take action, emphasising that every delay intensifies the suffering and raises the death toll among Sudan’s most vulnerable.
