The fight against Cholera in Sudan

Sudan is currently the largest humanitarian crisis in the world with 30 million people in need of urgent lifesaving assistance – nearly half of them are children.

For nearly two years now, the war has greatly affected access to critical services, especially for the most vulnerable displaced populations. The country’s health system is at the verge of collapse affecting access to health, nutrition and water services, subsequently exposing millions of children to diseases. Continued displacement has pushed millions in congested conditions with limited access to shelter, water and sanitation facilities, heightening the risks of disease outbreaks like cholera and acute watery diarrhoea.

It is in these environments that cholera, a disease driven by unsafe water and poor sanitation, has taken hold and spread with deadly force.

Water under attack

The conflict has destroyed water and energy infrastructure in 13 states affecting the functionality of water facilities by 70 per cent due to partial or complete damage. The damage to water treatment plants, boreholes, storage reservoirs and transmission mains has left about nine million women and children without access to safe water at home, in schools and health facilities. The greatest risk is faced by those in internally displaced people’s camps and shelters where access to safe and clean water and adequate sanitation services are limited.

Moreover, majority of the staff who ably supported the operation and maintenance of the water systems before the war have fled for safety.

The damage to water systems is also impacting the delivery of social services and access to clean water across the country. For instance, in White Nile, the cholera outbreak was triggered by a damage to essential energy and water pumping stations, forcing communities to rely on unsafe water sources. 

When pipelines and treatment plants are destroyed, communities lose access to clean water. This not only leads to disease outbreaks and malnutrition but is also a threat to the already vulnerable and displaced populations especially children. 

The conflict fuels Cholera

The cholera outbreaks in Sudan are exacerbated by multiple compounding factors. War has displaced millions, forcing them into overcrowded camps with inadequate sanitation. Health centres, schools, and water facilities have been either destroyed or repurposed for shelters. Frontline health workers, who are vital to containing the outbreak, have gone unpaid for months. Yet, the rainy seasons also worsen the crisis, as flooding increases water contamination and disease transmission.

The deadly combination of war, displacement, destruction of critical services and infrastructure and disease outbreaks has put millions of people at risk, with children under five, particularly vulnerable. 

Since the conflict begun in 2023, three waves of cholera outbreaks have been declared in Sudan with the most recent in January 2025 in White Nile State. 

The constant attack on water infrastructure and systems including treatment plants that connect clean and safe water to displaced and host communities in various states is forcing millions to collect water from unsafe and contaminated sources.  

In White Nile, the disease that spreads swiftly through contaminated water and poor sanitation, killed at least 65 people including ten children and a total of 2,700 cases including 500 children confirmed between 1 January and 24 February 2025. The outbreak was triggered by a power outage following attacks on power plants that disrupted the water supply in the localities of Kosti and Rabak. With the disease spreading rapidly, schools were shut down to contain the outbreak especially among children. 

By March 3, 2025, cholera had impacted 12 states and 90 localities across Sudan with over 57,000 suspected cholera cases and 1,534 related deaths. Some of the highest fatalities have been reported from White Nile, Gedaref, and Aj Jazirah states.

Despite being preventable, cholera if left untreated, can kill within hours. Acute watery diarrhoea, a major symptom of cholera causes severe dehydration, which can be fatal. 

Stopping the outbreak

Strengthening the cholera response plan for Sudan is a matter of urgency as well as a public health emergency. To prevent further spread of the disease and reduce mortality in the affected states, UNICEF’s cholera prevention and response interventions focuses primarily on health, water, sanitation and hygiene (WASH) and social and behavioral change (SBC) interventions under a coordinated multidisciplinary approach.

Water, Sanitation, and Hygiene (WASH) interventions are vital in preventing further spread. Therefore, UNICEF is providing access to safe and clean water, chlorinating safe drinking water, restoring water treatment plants in affected states, and delivering emergency sanitation services to thousands. In addition, UNICEF is actively supporting the procurement and transportation of essential water treatment chemicals throughout the country. 

A total of 38 Water, Sanitation and Hygiene (WASH) extenders and community health volunteers have been trained and deployed in cholera outbreak and high-risk areas to deliver hygiene promotion sessions and life-saving information, reinforcing the importance of safe water handling, proper sanitation, and handwashing in Gedaref, Kassala, and Aj Jazirah states.

Risk Communication and Community Engagement (RCCE) efforts are reaching beneficiaries through mass communication and community-led initiatives as well as door-to-door awareness campaigns.

Prepositioning essential medical and WASH supplies is allowing UNICEF to quickly distribute water treatment chemicals, Oral Rehydration Salts (ORS), and diagnostic kits in affected localities.

Oral Rehydration Points (ORPs) have been set up within communities to provide immediate care for suspected cholera cases. These points serve as the first line of treatment, preventing dehydration among suspected cases before they access further medical care at health facilities.

Through the strong collaboration between UNICEF, World Health Organization, and the state level ministries of health, cholera vaccination drives have been organized and communities mobilized to actively participate.  

“The demand for the vaccination is very high,” said Mohmed Almugtba Khider, UNICEF’s Health Officer in Kosti. “This is a good thing.”

Great strides, but challenges remain

However, despite these efforts, significant challenges remain. Conflict-driven constraints make it difficult to reach affected populations were insecurity hampers aid delivery. The collapse of Sudan's healthcare system means that cholera patients often struggle to access treatment, as many health facilities lack the necessary resources, equipment, or trained personnel. The lack of clean water and sanitation infrastructure continues to be a major risk factor, particularly in displacement gathering shelters where open defecation is widespread.

Current Support

UNICEF in coordination with partners, is striving to mitigate the crisis through:

• Chlorination of water sources and provision of treatment chemicals to major water plants.
• Emergency repair and maintenance of damaged WASH infrastructure.
• Water trucking and last-resort rehabilitation where no other options exist.
• Expansion of sanitation and hygiene services, and awareness-raising on their link to disease prevention and nutrition outcomes.

Urgent Needs

The demand for WASH services on the ground is vast and growing. There is an urgent need for:

• Major investment in repair, rehabilitation, and reconstruction of damaged water systems.
• Restoration and continuity of existing water supply operations.
• Scaled-up collaboration and funding to meet unprecedented needs.