Sudan Humanitarian Crisis

• According to UN OCHA in Sudan’s 2023 Humanitarian Needs Overview, “the four most significant risks identified are conflict, disasters associated with natural hazards, disease outbreaks, and economic deterioration.”
• At least 15.8 million people – one-third of the country’s population – were in need of humanitarian assistance as of January 2023, which is an increase from 14.3 million in 2022. However, recent events and increased military actions have dramatically increased the number of people needing support. In the revised Humanitarian Response Plan, 24.7 million people were identified as being in need, and 18.1 million are targeted in the plan. In the prior plan, 57% of people in need were women, 55% were children and 15% had disabilities.
• Humanitarian workers have faced increasing violence, with at least 18 aid workers killed and more injured since April 15. More have been detained or are missing. Fifty warehouses and 82 offices of humanitarian operations have been looted. More than 200 vehicles have been stolen from humanitarian aid workers.
• A severe flooding season between May–September 2022 (typically between June–September) affected 16 out of 18 states in Sudan. Over 100,000 people were displaced due to this flooding. Above-average rainfall is expected in 2023, with much of it likely to take place in areas that previously flooded.
• According to IOM, from April 15 to Aug. 1, 2023, the Displacement Tracking Matrix “estimates that approximately 3,020,517 individuals ( 603,918 households) have been displaced internally as a result of the conflict. The highest proportions of IDPs have been observed in River Nile (15.48%), Northern (11.95%), North Darfur (9.83%), and White Nile (9.01%) states. Field teams report that the IDPs observed were originally displaced from eight states. The majority (71.41%) have been reportedly displaced from Khartoum state; followed by North Darfur (9.32%), South Darfur (7.46%), West Darfur (6.01%), Central Darfur (4.87%), South Kordofan (0.51%), North Kordofan (0.41%), and Aj Jazirah (0.01%). Furthermore,  the conflict has led to the mixed-cross-border movements of 926,841 individuals.”

The health care system in Sudan is weak, and the fighting has reduced medical access as health facilities have been attacked, destroyed or had to close their services. The shortage of food, fuel and supplies is also concerning, as are power outages and dangers to staff and patients.

On July 20, a group from Doctors Without Borders (MSF) was attacked by armed men. The assailants beat the members of the team and stole a vehicle less than half a mile from the Turkish Hospital to which they were transporting supplies. The hospital is one of only two medical facilities that remain open in southern Khartoum. Both are supported by MSF, which warns that unless the safety of their staff is guaranteed, they may no longer be able to support the Ministry of Health.

“Following this horrific incident, MSF is warning that activities in the hospital are now in serious jeopardy, and we will not be able to continue to provide medical care if minimum safety guarantees are not met.”

According to the WHO Surveillance System of Attacks on Healthcare, since the start of the conflict, “WHO has verified 53 attacks on health care resulting in 11 deaths and 38 injuries … Attacks on health care include incidents involving hospitals, ambulances, laboratories, warehouses, health workers and patients.” Since these are only verified attacks, there may be others.

According to UN OCHA, “Disease outbreaks—including malaria, measles, dengue and acute watery diarrhoea—that had been under control before the conflict are increasing due to the disruption of basic public health services. As the rainy season begins, outbreaks are likely to claim more lives unless urgent action is taken to control their spread. A measles outbreak has been reported in 28 localities across 11 states. To date, over 900 cases have been reported.”

On Thursday, July 28, the World Health Organization (WHO) said, “Cases of infectious diseases and other illness have been reported among the displaced population who have sought shelter in hard-to-reach locations, where health services are limited. ‘The scale of the health crisis is enormous. We are working hard to step up our response, delivering critical medical and other emergency health supplies’ said Dr. Nima Saeed Abid, WHO Representative in Sudan, speaking during a virtual press conference.”

As of July 28, more than 80% of health care services in areas where the most fighting is occurring are closed. At least 17 of them have been bombed. It is believed that some have been turned into military bases. Only 20% of hospitals are located outside of Khartoum, home to the most significant fighting.

The NGO Forum has confirmed that medical supplies are in short supply and at least 60 facilities supported by NGOs are going to run out of these critical necessities by mid-August.

UN OCHA says that, “Across all affected areas, health staff have not been paid for nearly three months, and most of them have relocated to safer areas. There are serious shortages of specialized medical personnel, including anaesthesiologists and surgical specialists, most of whom have relocated. Shortages of medicines and medical supplies, including treatment for chronic diseases, oxygen supplies and x-ray films, continue to be reported in some states, despite the provision of supplies by some health partners.”

UNICEF reports that more than 13.6 million (1 in 2) children are in urgent need of humanitarian aid. At least 1.7 million children have been newly displaced, adding to the 1.9 million children who were displaced before this crisis.

According to UNICEF, at least 435 children have been killed since April 15 and more than 2,025 children have been injured. They also state that there is an average of at least one violation of children’s rights every hour (more than 2,500 total).

Ted Chaiban, UNICEF Deputy Executive Director for Humanitarian Action and Supply Operations, stated, “Every day children are being killed, injured, abducted and seeing the schools, hospitals and the vital infrastructure and life-saving supplies they rely on damaged, destroyed or looted.”

Millions of children are out of school because of school closures. Almost a million have been forced to flee because of the conflicts. There are 89 schools being used to house displaced populations in North Darfur, White Nile, Gedaref, Kassala, South Darfur, West Darfur and Blue Nile states. This will make education access even more challenging in September or October if new shelter accommodations are not found for IDPs. Being out of school puts young people at increased risk of recruitment in one of the armed groups, sold in child marriage or forced into child labor.

According to UNICEF, “As of 23 June, more than 140,000 Sudanese refugees and 34,000 Chadian returnees have crossed the border – over 90% of them women and children – and thousands more are expected to arrive as violence escalates in Darfur.” However, the agency reports that it is running out of resources to treat the refugees.

There are 1.7 million children under the age of one who are at risk of missing one or more essential vaccinations.

Child refugees from South Sudan have faced measles outbreaks, in addition to malnutrition, with 300 of them dying from one or the other since April.

At least 14.9 million people are in need in the WASH sector, according to the updated Sudan Humanitarian Needs Overview 2023, dated May 2023. The amount of funding needed has grown from $129 million to $230.9 million.

UNICEF has found that, “Inadequate water, hygiene and sanitation practices poses major risks for communities especially children. Moreover, water and sanitation related diseases are one of the leading causes of death for children under five. In Sudan 17.3 million people lack access to basic level drinking water supply and are at risk of disease. About 24 million lack access to proper sanitation facilities. Sanitation coverage has stagnated with more than 10.5 million people practice open defecation. This poses a major hazard to children and communities and has a significant impact on food security, rising malnutrition, disease outbreaks, conflict, and ultimately child morbidity and mortality.”

Key infrastructure, including pipes, has been damaged by the fighting (although it was not well maintained prior). Residents are using the Nile River for all water needs, including drinking, bathing and cleaning.

Sudan, as an agricultural nation, uses 97% of its water to support that industry, but climate change – including water scarcity and desertification – is affecting that water supply as well.

One of the key goals of the WASH sector will be to create better gender-sensitive sanitation and basic water services for millions of women and girls.

Sudan’s economy remains in crisis, with high inflation, a shortage of foreign currency and a large national debt. The country is struggling to provide basic services to its citizens, and many people are experiencing food insecurity and poverty. Even prior to the latest civil war it had the highest poverty rate in Northern Africa.

The 2022 poverty rate was 15.3% when looking at the $2.15/day marker. But when increased to the lower middle-income poverty rate of $3.65/day, the rate jumped to 49.7%. The upper middle-income poverty rate of $6.85 shows a rate of 86.2%. While the GDP were expected to grow in 2023, the war has caused the economy to freeze. Food prices have increased dramatically and the banking system has essentially collapsed. The informal economy is behind much of the employment currently.

According to the World Bank, “The secession of South Sudan [in 2011] led to multiple economic shocks, including the loss of oil revenue that had accounted for more than half of the Sudan government’s revenue and 95% of its exports. This has reduced economic growth and resulted in double-digit consumer price inflation…”

Since 2011, inflation has increased to triple-digit numbers, although it decreased throughout 2022. As of January 2023, school fees had increased 400% and oil prices had grown by 300%.

There are ongoing concerns about human rights abuses in Sudan, including reports of extrajudicial killings, arbitrary detentions, and restrictions on freedom of expression and association. The government has taken some steps to address these issues, but progress has been slow. The protection issues have been amplified by the war, with fighting happening in urban areas leading to civilian deaths.

According to Amnesty International, there have been “extensive war crimes including mass killings of civilians, rape and sexual slavery of women in the ongoing conflict … Amnesty detailed waves of violence in West Darfur province —one of five constituting the Darfur region — including the killing of civilians, looting and destruction of homes and facilities such as the main hospital and markets.”

On July 13, the UN Security Council was informed about a mass grave of 87 bodies found outside the region’s capital El-Geneina. Most are Masalit, who are often targeted by the RSF and their allied militias, especially Arab militias. It is believed they were killed between June 13-21. This ethnic cleansing is reminiscent of the genocide in Darfur in 2003, which killed hundreds of thousands of people.

The ongoing conflicts in some parts of Sudan, including in the Darfur region and in the Blue Nile and South Kordofan states, have led to the displacement of millions of people, who are often living in difficult conditions in camps and settlements.

Before the outbreak of fighting, more than 15 million people faced severe food insecurity in Sudan, an increase of over two million people since last year.

The United Nations expected hunger to grow to 19.1 million because of the crisis. According to the Integrated Food Security Classification (IPC), as of Aug. 3, 20.3 million people, or 42% of the population, are acutely food insecure. While the harvesting season (October 2023 to February 2024) will reduce this to 15 million, the long-term outlook is not good.

UNICEF says that 3.4 million children under the age of five suffer from acute malnutrition, up from three million before the fighting started. Of these, 690,000 are severely malnourished, up from 612,000 children. Much of this increase comes from families displaced by the crisis.

According to the Food and Agriculture Organization, “With 14 million people facing Crisis (IPC Phase 3) and nearly 6.3 million people facing Emergency (IPC Phase 4) levels of acute hunger, the situation is critical.”

The IPC blames, “disruption of supply chains, population displacement, and damage to infrastructure caused by the conflict” for the increase in hunger and food insecurity. There are also concerns that climate and fighting will impact the growth and production of crops.

IPC says that, “The most highly food insecure populations are in locations and states with active conflict, including West Darfur (where 62 percent of the population is highly food insecure), Khartoum and South Kordofan (56 percent of the population in IPC Phase 3 or above in these states), the Central Darfur, the East and the South Darfur as well as West Kordofan (53 percent of the population is in IPC Phase 3 or above in these states).”

Food prices have doubled since April 15, when the fighting began. These numbers are expected to increase dramatically as the conflict continues. Much of the fighting is concentrated in Khartoum, which already had the highest number of South Sudanese refugees and a highly food-insecure population.

The World Food Programme says that the price of a local food basket increased 18% between the first two weeks of April and end of May (from $0.74 USD to $0.88 USD/447 Sudanese pound to 527 Sudanese pound).

UN OCHA said that basic commodities had increased at least 60% as of May 10 and supply chain challenges were being made worse by the fighting. There has also been an increase in neighboring countries due to Sudan’s conflict.

Despite above-average cereal production this year due to favorable weather, the Famine Early Warning Systems Network says levels of acute food insecurity are expected to deteriorate further. Making matters worse, UN OCHA reported that a factory in Khartoum that manufactured critical supplies to treat malnourished children was burned to the ground.

A Rapid Gender Analysis on Power and Participation conducted by CARE in Sudan’s Kassala State showed women are often not consulted in decision-making, and social norms are a key barrier towards greater inclusion. The report highlights opportunities to enhance women’s participation and leadership. Bringing women (and youth) into community organizing can reduce extremism.

Gender-Based Violence (GBV) is increasing. As many as 4.2 million women and girls face the risks of GBV.

Sudan is also subject to the impacts of climate change. Sudan is one of the ten countries in the world most vulnerable to climate change.

These vulnerabilities include seasonal rains becoming more unpredictable, increasingly frequent droughts and rise in temperature. Land degradation and forestation compound the impacts of climate hazards.

Climate change has also been a source of conflict due to competition for water resources, grazing land and pastures. Available evidence suggests that climate change has also heightened competition for access to water sources, pastures and traditional grazing lands.

According to UNEP research, “approximately 40% of internal conflicts over the past six decades can be attributed to the exploitation of natural resources, including competition over scarce resources, such as fertile land and water.”

Nearly 200,000 people have fled Sudan for South Sudan, which won independence from Sudan in 2011. South Sudan is facing a massive hunger crisis and has its own shaky power-sharing leadership agreement. However, the terms of the peace deal signed in 2018 after a five-year civil war that caused 400,000 deaths have not been met.

The United Nations envoy to South Sudan says that the crisis in Sudan should “serve as a wake-up call for Juba” (the capital of South Sudan). He adds, “‘[The situation] reinforces the imperative to move swiftly in strengthening the foundations for peace, stability and inclusive governance. A conducive political and civic environment is required for all political parties, civil society groups, media and all South Sudanese.’ The United Nations has repeatedly criticized South Sudan’s leadership for its role in stoking violence, cracking down on political freedoms and plundering public coffers.”

Due to its own crises, South Sudan faces many challenges in welcoming and meeting the needs of the Sudanese refugees. The Acting Humanitarian Coordinator for South Sudan, Peter Van der Auweraert said, “When people arrive South Sudan today, they are more vulnerable than they used to be, they are more likely to be undernourished, they are more likely to be sick and they are more likely to need more assistance than before.”

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