Cholera and violence: Sudan's twin epidemic
مدار الساعة ـ نشر في 2026/09/28 الساعة 15:31
Communication Initiative Framework (CIF) – August 2026
Background (internal)
Sudan has faced at least sixteen cholera outbreaks since the 1960s, with major waves in 2006, 2016–2018 and 2019. But the last one, in 2024/2025, closed with more than 124,000 cases and around 3,500 deaths, after reaching all 18 of Sudan's states; a scale and spread to be considered as a largest and most widespread the country has recorded in its modern history.
What made it different was not only its size. The outbreak was fueled by the war, and it began before the rainy season.
Previous waves in Sudan were driven mainly by weak infrastructure and seasonal flooding. This one was driven by the conflict that began in April 2023. Cholera moved along retreat routes, convoyed paths, and regrouping zones, from Al Jazirah towards Kassala, El Gedaref, and the River Nile, surging wherever large numbers of people were pushed into unsafe conditions.
Clusters in Port Sudan, El Gedaref, Khartoum and Kosti appeared during dry periods, outside the seasonal pattern entirely. Rainfall magnified the epidemic; it did not cause it.
In an internal retrospective analysis based on MSF's operational data and response, covering the past two years, it reveals a consistent and alarming pattern across all intervention sites: conflict-triggered attacks on water and power systems; restricted humanitarian access; and a near-total absence of preparedness. Together, these factors led to sharp, deadly surges that followed the rhythms of war.
The conditions that spread cholera were made, not inherited. Water and electricity infrastructure were deliberately attacked. Chlorine ran short because of supply impediments; blackouts crippled treatment plants and hospitals alike, and funding shortfalls, including the suspension of water trucking, compounded the crisis. Households were left to choose between unsafe water and trucked water priced beyond their reach.
The burden fell on those with the least protection. Millions of people have been displaced inside Sudan, moving between host communities, makeshifts, or IDP camps. Many arrived in informal settlements and overcrowded camps without clean water, sanitation or health services, some fleeing areas that already had cholera, and that humanitarian actors had been unable or not allowed to reach. Due to the bad living conditions in the displaced sites, lack of services, like water and sanitation, outbreaks erupted within days or weeks of arrival.
This largest outbreak was contained by March 2026, but the danger has not ended. A new outbreak was declared in West Kordofan in June, after acute watery diarrhoea cases had appeared in May, before the rainy season was fully underway. Cases also emerged in North Kordofan, though numbers have been decreasing. Once again, conflict, lack of clear surveillance data, and inadequate access to safe water created conditions for disease to appear.
This public communications initiative raises the alarm based on the lessons learnt from the past two years response to the cholera, based on MSF's own observations, gathered across multiple locations during the deadliest cholera outbreak Sudan has recorded in 2024–2025.
Objectives
- Bear witness to what our teams experienced and documented, from MSF's own field data across multiple locations, how the deadliest cholera epidemic in Sudan's history unfolded in the middle of conflict dynamics: where cases spiked, when alerts were raised, and what happened next, at a time when national surveillance has collapsed and few other accounts exist.
- Highlight that this epidemic was violence-driven, not purely seasonal. Show that cholera followed the war: along the bad living conditions in displaced sites and retreat routes, after attacks on water and power infrastructure, in the unsafe conditions people were forced into, and outside the rainy season entirely.
- Raise the alarm on the gaps of data surveillance, fast-track response, and supply delays, while passing on urgent call for better preparedness.
What (main messages)
- Cholera in Sudan is conflict-driven, not seasonal. Based on our own data and field observations in 2024 and 2025, the epidemic followed the war, attacks on civilian infrastructure, bad living conditions in displaced sites, and in unsafe conditions people were forced into. Clusters in Port Sudan, El Gedaref, Khartoum and Kosti appeared during dry periods, outside the rainy season entirely. Rainfall magnified this epidemic; violence caused it.
- The conditions that spread cholera were man-made, not only inherited. Water and electricity infrastructure were deliberately attacked. Large percent of Khartoum's water infrastructure has been non-functional. Chlorine ran short, blackouts crippled treatment plants and hospitals alike.
- The burden fell on those with the least protection. Displaced families arriving in informal settlements and overcrowded camps, without clean water, sanitation or health services, were the first to be hit, sometimes within days of arrival. Some were fleeing areas that already had cholera, and that humanitarian actors had been unable or not permitted to reach.
- This account is based on MSF's own field observations, because little else exists. National surveillance has collapsed under insecurity, staff displacement and resource shortages. MSF's operational data, gathered across multiple locations and co-managed with the Ministry of Health, offers one of the few verifiable pictures of how this epidemic unfolded. That reflects how little verified data is available, not a claim to be the only responder. In several locations, including Kosti, the first alerts came from the Ministry of Health staff and local responders.
To whom
- Sudanese authorities in both east and west
- Humanitarian organizations and state donors
- Local, regional, and international media and online audiences.
- MSF donors and supporters
- Medical audiences through medical magazines and science-based outlets, i.e. Nature, SciDev.
How (Communication tools)
- Op-ed signed by By Dr Micaela Serafini, the President of MSF Switzerland.
- Video by Mohamed Ahmed, the former Head of Mission, who spent two and half years in Sudan, and took part of that cholera response in 2024/2025.
- Social media collage of photos and main messages and calls highlighted.
- Internal: Q & A for spokes (in case of media requests after the publication of the OpEd).
- Internal: An exchange with the media team in Sudan Teams channel with the advocacy colleague worked on the internal report, to explain it further and answer questions about how solid the pitch can go.
Spokespeople
Available on demand from the field and HQ.
Who
OCG
When
Internal: 23 of September 2026 (for OpEd pitch)
External:
A. 01 October (OpED publication on MSF channels)
B. From 24 Sept onward: the video and social media carousel can be posted on MSF channels.
Communication contact
- OCG Communications Advisor: Rasha AHMED
- OCG Advocacy Advisor: Jessica MINARRO
Background (internal)
Sudan has faced at least sixteen cholera outbreaks since the 1960s, with major waves in 2006, 2016–2018 and 2019. But the last one, in 2024/2025, closed with more than 124,000 cases and around 3,500 deaths, after reaching all 18 of Sudan's states; a scale and spread to be considered as a largest and most widespread the country has recorded in its modern history.
What made it different was not only its size. The outbreak was fueled by the war, and it began before the rainy season.
Previous waves in Sudan were driven mainly by weak infrastructure and seasonal flooding. This one was driven by the conflict that began in April 2023. Cholera moved along retreat routes, convoyed paths, and regrouping zones, from Al Jazirah towards Kassala, El Gedaref, and the River Nile, surging wherever large numbers of people were pushed into unsafe conditions.
Clusters in Port Sudan, El Gedaref, Khartoum and Kosti appeared during dry periods, outside the seasonal pattern entirely. Rainfall magnified the epidemic; it did not cause it.
In an internal retrospective analysis based on MSF's operational data and response, covering the past two years, it reveals a consistent and alarming pattern across all intervention sites: conflict-triggered attacks on water and power systems; restricted humanitarian access; and a near-total absence of preparedness. Together, these factors led to sharp, deadly surges that followed the rhythms of war.
The conditions that spread cholera were made, not inherited. Water and electricity infrastructure were deliberately attacked. Chlorine ran short because of supply impediments; blackouts crippled treatment plants and hospitals alike, and funding shortfalls, including the suspension of water trucking, compounded the crisis. Households were left to choose between unsafe water and trucked water priced beyond their reach.
The burden fell on those with the least protection. Millions of people have been displaced inside Sudan, moving between host communities, makeshifts, or IDP camps. Many arrived in informal settlements and overcrowded camps without clean water, sanitation or health services, some fleeing areas that already had cholera, and that humanitarian actors had been unable or not allowed to reach. Due to the bad living conditions in the displaced sites, lack of services, like water and sanitation, outbreaks erupted within days or weeks of arrival.
This largest outbreak was contained by March 2026, but the danger has not ended. A new outbreak was declared in West Kordofan in June, after acute watery diarrhoea cases had appeared in May, before the rainy season was fully underway. Cases also emerged in North Kordofan, though numbers have been decreasing. Once again, conflict, lack of clear surveillance data, and inadequate access to safe water created conditions for disease to appear.
This public communications initiative raises the alarm based on the lessons learnt from the past two years response to the cholera, based on MSF's own observations, gathered across multiple locations during the deadliest cholera outbreak Sudan has recorded in 2024–2025.
Objectives
- Bear witness to what our teams experienced and documented, from MSF's own field data across multiple locations, how the deadliest cholera epidemic in Sudan's history unfolded in the middle of conflict dynamics: where cases spiked, when alerts were raised, and what happened next, at a time when national surveillance has collapsed and few other accounts exist.
- Highlight that this epidemic was violence-driven, not purely seasonal. Show that cholera followed the war: along the bad living conditions in displaced sites and retreat routes, after attacks on water and power infrastructure, in the unsafe conditions people were forced into, and outside the rainy season entirely.
- Raise the alarm on the gaps of data surveillance, fast-track response, and supply delays, while passing on urgent call for better preparedness.
What (main messages)
- Cholera in Sudan is conflict-driven, not seasonal. Based on our own data and field observations in 2024 and 2025, the epidemic followed the war, attacks on civilian infrastructure, bad living conditions in displaced sites, and in unsafe conditions people were forced into. Clusters in Port Sudan, El Gedaref, Khartoum and Kosti appeared during dry periods, outside the rainy season entirely. Rainfall magnified this epidemic; violence caused it.
- The conditions that spread cholera were man-made, not only inherited. Water and electricity infrastructure were deliberately attacked. Large percent of Khartoum's water infrastructure has been non-functional. Chlorine ran short, blackouts crippled treatment plants and hospitals alike.
- The burden fell on those with the least protection. Displaced families arriving in informal settlements and overcrowded camps, without clean water, sanitation or health services, were the first to be hit, sometimes within days of arrival. Some were fleeing areas that already had cholera, and that humanitarian actors had been unable or not permitted to reach.
- This account is based on MSF's own field observations, because little else exists. National surveillance has collapsed under insecurity, staff displacement and resource shortages. MSF's operational data, gathered across multiple locations and co-managed with the Ministry of Health, offers one of the few verifiable pictures of how this epidemic unfolded. That reflects how little verified data is available, not a claim to be the only responder. In several locations, including Kosti, the first alerts came from the Ministry of Health staff and local responders.
To whom
- Sudanese authorities in both east and west
- Humanitarian organizations and state donors
- Local, regional, and international media and online audiences.
- MSF donors and supporters
- Medical audiences through medical magazines and science-based outlets, i.e. Nature, SciDev.
How (Communication tools)
- Op-ed signed by By Dr Micaela Serafini, the President of MSF Switzerland.
- Video by Mohamed Ahmed, the former Head of Mission, who spent two and half years in Sudan, and took part of that cholera response in 2024/2025.
- Social media collage of photos and main messages and calls highlighted.
- Internal: Q & A for spokes (in case of media requests after the publication of the OpEd).
- Internal: An exchange with the media team in Sudan Teams channel with the advocacy colleague worked on the internal report, to explain it further and answer questions about how solid the pitch can go.
Spokespeople
Available on demand from the field and HQ.
Who
OCG
When
Internal: 23 of September 2026 (for OpEd pitch)
External:
A. 01 October (OpED publication on MSF channels)
B. From 24 Sept onward: the video and social media carousel can be posted on MSF channels.
Communication contact
- OCG Communications Advisor: Rasha AHMED
- OCG Advocacy Advisor: Jessica MINARRO
مدار الساعة ـ نشر في 2026/09/28 الساعة 15:31