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SITUATION OVERVIEW
Cholera has a long history in Sudan, characterised by recurrent outbreaks driven by conflict, environmental factors, and inadequate WASH and health infrastructure. Cholera spreads primarily through contaminated water, with poor sanitation making many areas in Sudan highly susceptible. Severe forms of cholera can cause the sudden onset of acute watery diarrhoea, which can lead to rapid dehydration and death if left untreated (WHO 11/12/2023).
Significant past epidemics include the 2017 outbreak, when disrupted health services and poor sanitation led to approximately 700 deaths and 22,000 infections in two months, and the 2019–2020 outbreak, when heavy rains and flooding contaminated water supplies, leading to hundreds of cases across several states (AJ 21/08/2024; Radio Dabanga 13/06/2017; WHO 24/11/2019). Sudan has also faced outbreaks since the start of the war in April 2023 (MSF 11/09/2024).
In August 2024, a cholera outbreak was declared in Gedaref, Kassala, and River Nile states (MSF 11/09/2024). By 16 December, over 47,365 cases had been reported across 81 localities in 11 of Sudan’s 18 states, with approximately 1,235 casualties and a case fatality rate of 2.6%, exceeding the WHO acceptable standard of under 1% (General Directorate of Health Emergencies & Epidemics Control accessed 18/12/2024; WHO 16/12/2022). As a result of challenges accessing and reporting data, however, the actual figures are likely higher (AJ 21/08/2024; KII 21/11/2024). Limited access and slowed community referrals to health facilities also contribute to underreporting (STC 05/09/2024). According to the General Directorate of Health Emergencies & Epidemics Control, by 16 December there was no cholera reporting from Blue Nile and Central, East, and West Darfur states as a result of lack of network, with limited network availability also affecting reporting in eight other states (General Directorate of Health Emergencies & Epidemics Control accessed 18/12/2024). Across the country reported cases have increased by 33.3% from October to November (OCHA 4/12/2024). By 16 December, the highest number of reported cases were in Aj Jazirah (11,179), Al Qadarif (9,745), Kassala (7,364), White Nile (6,646) and River Nile (5,824) (General Directorate of Health Emergencies & Epidemics Control accessed 18/12/2024). Gedaref also saw a 117% increase in cases from November to October; by 28 October, 5,770 cases were reported in the state (OCHA 4/12/2024; OCHA 01/11/2024).
The recent escalation of hostilities in Aj Jazirah and Sennar states has caused further displacement to Gedaref, Kassala, and Blue Nile states, straining the already limited response capacities in these regions (Camp Coordination and Camp Management Cluster 17/11/2024).
Overcrowded displacement sites and settlements without adequate water and sanitation facilities, clean water, and sanitation mean that IDP populations are particularly at risk (Health Cluster 13/11/2024).
Cholera has affected all age groups, with over 70% of cases occurring in infants and adults up to age 50. While deaths have occurred across all age ranges, individuals aged 70 and above have experienced the highest mortality rate (14.56%) closely followed by ages 60-69 and 20-29 (12.09%). This higher mortality rate may be attributable to weakened immune systems, preexisting conditions such as cardiovascular or kidney diseases, which worsen dehydration, and limited access to timely healthcare, which delays treatment. The data indicates no significant disparity between genders (General Directorate of Health Emergencies & Epidemics Control accessed 26/11/2024).