A nation besieged by epidemics: Sudan caught between cholera, dengue and malaria

Yousif Abusin and Maab Al-Mirghani

At its regular session on Tuesday, September 16, Sudan’s Federal Ministry of Health Emergency Operations Centre reported 1,367 new cases of cholera recorded between September 6 and 12, including 52 fatalities across five states: North, Central, and East Darfur, South Kordofan, and Blue Nile.

In parallel, the number of reported dengue fever cases reached 1,523, with three deaths, concentrated in the states of White Nile, Kassala, Blue Nile, and Khartoum, the latter recording the highest rate of infection. Meanwhile, Al-Jazirah State reported 63 cases of hepatitis, with no fatalities confirmed to date.
On Thursday, August 18, the Ministry of Education in Al-Jazirah State announced a 15-day suspension of secondary school classes, from Sunday, September 21, to Saturday, October 4. In an official memo seen by Atar, the ministry attributed the decision to the widespread outbreak of both dengue and malaria. In response, the state’s Ministry of Health launched an aerial spraying campaign, accompanied by ground operations, in an effort to contain and eliminate disease vectors.

According to a medical source in the city of Hasaheisa in Al-Jazirah State, the dengue outbreak has been accelerating since July 2025. The source confirmed to Atar that Hasaheisa Teaching Hospital has been overwhelmed with patients, receiving no fewer than 100 daily cases.

On Tuesday, September 16 alone, 180 patients arrived from the village of Arbagee, east of Al-Jazirah. The cumulative number of cases in the state likely runs into the thousands, the source said, adding that the shortage of intravenous fluids and oral rehydration salts has exacerbated the crisis, as each patient typically requires five IV drips per day.

Alarming numbers in Jabal Marra

As fighting intensifies across Darfur and Kordofan, internally displaced persons (IDP) camps in these regions have become dangerously overcrowded, severely compounding the public health crisis.

Speaking to Atar, a medical source in the Dira area of East Jabal Marra, a region under the control of the Sudan Liberation Movement/Army led by Abdel Wahid Al-Nur confirmed a widespread cholera outbreak in the town of Dirbat, South Darfur.

Between August 3 and September 17, 134 cases were recorded in Dirbat, including 15 deaths. In Soni, 125 infections led to 17 fatalities. Dira’s health centre logged 37 cases, of which 13 died, while Jawa’s health facility reported 47 infections and eight deaths.
The source attributed the outbreak to the collapse of local infrastructure, the absence of clean drinking water, and the lack of basic sanitation tools and disinfectants, combined with the limited capacity of isolation centres to absorb the rising number of patients.

In Tawila, North Darfur, another medical source told Atar that the Médecins Sans Frontières (MSF) cholera isolation centre, designed to house 200 patients, was overwhelmed in July 2025, treating 300 to 400 patients per day. However, the situation has somewhat improved due to the efforts of several humanitarian organizations.

These include Saba Organization, which established two isolation units in Dali and Dabbat Nayra, and Save the Children and Tabashir, who manage health centres with support from UNICEF. As of September 16, the number of daily cholera cases had dropped to 21 in Tawila. Still, since the onset of the outbreak in July, the town has recorded 5,457 infections, with 80 fatalities.

The same source warned of a sharp rise in malaria cases in the region, especially with the ongoing rainy season, underscoring the precarious conditions in which the displaced population continues to live.

Bahri and Omdurman: Epidemics in the Urban Core

The city of Bahri (Khartoum North) is currently witnessing a widespread outbreak of epidemic diseases, with over 4,800 infections recorded by the end of August, amid an escalating healthcare crisis.

According to Bahri Emergency Room officials who spoke to Atar, the city has logged 2,137 cases of malaria, 1,177 cases of typhoid, 1,296 cases of dengue fever, and 265 cases of acute watery diarrhoea.

The epicentres of the outbreak are neighbourhoods with high population densities: Al-Sha’abiyya, Al-Danagla, Kober, and Hilla Khojaly, where stagnant water accumulates and sanitation systems are virtually non-functional.

The Emergency Room noted that the absence of healthcare facilities in central and southern Bahri has made matters worse. Existing centres are overwhelmed, operating under severe resource constraints, with acute shortages in medicines and diagnostic capabilities. In response, community-driven efforts have distributed over 3,000 mosquito nets across North and South Bahri, carried out an environmental sanitation campaign costing 36 million SDG, and launched cleaning and disinfection drives amounting to 13 million SDG.

In addition, 43 million SDG worth of medicine has been supplied to several health centres, and awareness workshops on cholera prevention have been conducted for students.

Despite these interventions, key indicators remain alarming. The Emergency Room warned that rising cases of acute watery diarrhoea point to the looming threat of a full-fledged cholera outbreak, unless water sources are urgently decontaminated and wastewater systems repaired.

The room also warned of a likely surge in malaria and dengue cases, especially as the rainy season stretches on, alongside a potential uptick in typhoid infections in neighbourhoods reliant on contaminated water supplies.

While Bahri has recorded the highest case counts, the neighbouring Sharq Al-Neel locality is also grappling with an expanding web of epidemics, particularly malaria and dengue fever. A member of the Medical Office in Sharq Al-Neel Emergency Rooms told Atar that field monitoring conducted by volunteers reveals that most households report two to three cases at minimum. At Umm Duwan Ban Hospital, roughly 200 patients are being received daily, with fevers comprising around 80 per cent of the cases.

Other health centres are unable to conduct proper diagnosis or treatment due to limited resources, and several government-run clinics remain out of service or operate at extremely reduced capacity. Even in the functioning facilities, recorded figures fall well short of actual infection levels, severely hampering any reliable epidemiological tracking or response.

Speaking to Atar, Mohamed Adam, a resident of Sharq Al-Neel locality, described the worsening public health situation as dire, with entire neighbourhoods infected by dengue fever. Mohamed attributed the rapid spread of the disease to a lack of treatment access, noting that Al-Ban Jadeed and Bashayer were the only hospitals currently functioning. Mohamed, who along with his family contracted dengue, said most of the fatalities were among individuals with chronic conditions, especially diabetes.

In Omdurman, Manasik Al-Hajj, a resident of the Al-Thawra neighbourhood, told Atar that three members of her family contracted malaria, and she faced significant challenges accessing care.

“Health centres are overcrowded — a line for the lab, a line for the doctor — and the wait can stretch to five hours,” Manasik recounted.

She reported purchasing malaria medication for 4,000 SDG, adding that patients from Khartoum North are forced to come to Omdurman due to the lack of available medications and operational facilities in Bahri. The recent power outages, caused by Rapid Support Forces drone strikes, further exacerbated the suffering of malaria and dengue patients.

Manasik noted that small mosquito nets are sold in pharmacies for 20,000 SDG, while humanitarian organizations distributed nets only to a limited number of displaced families from Al-Fashir, with three nets per family, despite a surge in mosquito populations due to stagnant rainwater.

Kassala and Its Rural Periphery

In Kassala State, Atar obtained informal reports from medical sources confirming 112 cholera cases recorded at Kassala Teaching Hospital from various localities up until August 7. This contrasts with an official Ministry of Health report, also reviewed by Atar, which stated that the outbreak began on August 19, following two suspected cases arriving from Galsa.

According to the Ministry of Health, as of September 16, a total of 394 cases had been recorded, with seven deaths. A ministry medical source informed Atar that Rural Kassala accounted for the bulk of the cases; amounting to 353, followed by 28 in Kassala city, seven in West Kassala, three in Aroma, and one in Khashm el-Girba. Patients are currently being treated at Kassala Teaching Hospital, Galsa Health Centre, and the Kuwaiti Hospital.

Masha’er Ahmed, a member of the statistics and information committee in Rural Kassala’s Emergency Room, told Atar that 12 cases of dengue fever were recorded, 10 in Idd Omeir and two in Wad Shareifi. She noted that Galsa has stabilized, with no new cholera cases as of the morning of September 17, but highlighted the increasing number of dengue infections, particularly in Idd Omeir, necessitating urgent interventions such as environmental spraying campaigns and public health education.

She also emphasized the humanitarian toll from recent floods, calling for emergency shelter and food assistance.

A disease-conducive environment
During Sudan’s 2025 rainy season, persistent heavy rainfall and poor environmental conditions led to the rampant spread of cholera, dengue fever, and a host of other communicable diseases. Floods severely damaged sanitation infrastructure, forcing many residents to relieve themselves outdoors, thereby contaminating the surroundings. The influx of displaced persons into camps and shelters compounded these risks, accelerating disease transmission.

In May 2025, cholera surged across Khartoum State during an unusually early summer outbreak, a phenomenon traditionally associated with the rainy season.

However, scientific findings confirm that the cholera bacteria (Vibrio cholerae), which thrives in aquatic environments such as rivers and stagnant water bodies, is not limited to the wet season. Instead, it becomes particularly active during summer, surviving and multiplying under favourable conditions, especially when cohabiting with zooplankton and phytoplankton.
This fragile public health environment, coupled with irregular vector control campaigns, also spurred the outbreak of dengue fever, a viral infection transmitted by the Aedes aegypti mosquito. This mosquito has adapted to urban environments, making its eradication highly difficult. It is recognizable by white markings on its legs and a lyre-shaped mark on its thorax. Active mostly during early mornings and late afternoons, the mosquito’s spread is further fueled by high temperatures and humidity, which accelerate both its life cycle and the viral replication process.
In an interview with Atar, Dr Adeeba Ibrahim Al-Sayed, an internist, epidemiologist, and member of the Omdurman branch of the Sudanese Doctors’ Union Preparatory Committee, asserted that the rampant spread of mosquitoes and flies, coupled with electricity blackouts and drinking water shortages, directly aggravates the outbreaks of cholera and dengue.

She warned that weakened immunity across the population, due to harsh economic and living conditions, is increasing vulnerability to typhoid, amoebic dysentery, and even chikungunya, alongside a surge in malaria across all Sudanese states.

“Despite the tireless efforts of health workers and humanitarian organizations, including the establishment of isolation centres, vector control drives, and sanitation campaigns, the pace of disease transmission remains alarmingly high amid a collapsing healthcare system and dwindling resources,” Dr Adeeba said.
Adeeba urged authorities to prioritize environmental sanitation, eliminate fly populations, safely dispose of waste, and tackle weed overgrowth and stagnant water, as part of a comprehensive public health response. She also emphasized the need to intensify awareness campaigns through local media in diverse dialects, at mosques, and via direct community engagement, targeting families, women, and water suppliers alike.

“We must immediately declare a public health emergency, and secure urgent support from the Ministry of Health and humanitarian agencies for isolation centres, medical supply chains, and IV rehydration solutions,” she concluded with a stark appeal.

Source: Atar