Sudan Humanitarian Update (28 September 2023) [EN/AR]

HIGHLIGHTS

• About 5.4 million people have fled their homes and sought refuge within Sudan or neighbouring countries since fighting started in mid-April.

• An estimated 188,000 refugees have abandoned hotspot areas to other locations across Sudan.

• Cholera/acute watery diarrhoea outbreak is reported in Gedaref city with 160 suspected cases recorded.

• At least 56 attacks on health care, resulting in 11 deaths and 38 injuries, have been identified since April.

• Food Security and Livelihoods partners have provided 7 million people with live-saving and livelihood assistance.

• The revised 2023 Sudan Humanitarian Response Plan appeal is only 31.7 per cent funded as of 28 September

SITUATION OVERVIEW

Fighting in Sudan continues to displace civilians. An estimated 5.4 million people have fled their homes since fighting erupted in mid-April between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) and have sought refuge within Sudan or in neighbouring countries. That is an average of 1 million people displaced per month.

According to the International Organization for Migration Sudan Response Situation Update Displacement Tracking Matrix (IOM DTM), about 4.3 people have been displaced within Sudan since the fighting began. The caseload will increase in the coming months if the conflict is unresolved. Those displaced have taken refuge in 4,080 locations in 167 of Sudan’s 189 localities in all 18 states. IOM reports that the newly displaced people, most originally from Khartoum, are staying with host communities (67 per cent) or in rented accommodation (9.5 per cent) in urban areas. The majority (55 per cent) have taken refuge in northern, eastern, and central Sudan, while the rest (45 per cent) have sought refuge in the Darfur and Kordofan regions. About 1.1 million people have crossed into neighbouring Central African Republic (CAR), Chad, Egypt, Ethiopia and South Sudan, according to the UN Refugee Agency (UNHCR).

The Refugee Consultation Forum (RCF) reports that as of 24 September, an estimated 188,000 refugees have fled hotspot areas in Sudan to other locations. Meanwhile, an estimated 19,000 refugees from Ethiopia and the CAR have left Sudan seeking safety in third countries. RCF partners continue to deliver protection and life-saving assistance in 12 refugee-hosting states including protection, education, food security, health and nutrition, water, sanitation and hygiene (WASH), shelter and non-food items (S/NFIs), since mid-April. Between 1 and 24 September, RCF partners reported that about 182,000 refugees in Gedaref, Kassala, North and South Kordofan, and Blue and White Nile states received food rations. Protection awareness campaigns were carried out for refugees in Aj Jazirah, Gedaref, Kassala and White Nile states, and 54 service providers were trained on protection approaches. On health responses, RCF partners have reported 8,801 outpatient consultations, 903 inpatient admissions, 333 antenatal care visits, and 56 deliveries assisted by skilled attendants over the same period.

The Health Cluster reports several disease outbreaks across the country, including suspected cholera/acute watery diarrhoea (AWD), dengue fever, measles and malaria.

In Gedaref city, the capital of Gedaref State in eastern Sudan, about 160 suspected cholera/AWD cases including 10 associated deaths have been reported, according to the Health Cluster. One case was reported among IDPs in a gathering site. Some 80 suspected cases tested positive through Rapid Diagnostic Test (RDT). No vibrio cholera was isolated at the Public Health Laboratory in Port Sudan, while Ecoli was isolated from five of the six samples tested.

Since August 2022, an ongoing outbreak of acute watery diarrhoea (AWD) has been reported across seven regions in Ethiopia including the border areas with Sudan, with 20,000 cases and 271 deaths recorded. The international NGO (INGO) Médecins Sans Frontières (MSF) has established two cholera treatment centres in the affected localities and two mobile teams. The World Health Organization (WHO) and the UN Children’s Agency (UNICEF) have provided cholera kits, but there is a need to improve the supply chain management system in Gedaref State. UNHCR has renovated the isolation centre at Gedaref Teaching Hospital and WHO delivered beds for patients. WHO is planning to provide full support to the centre to make it fully functional. In addition, WHO conducted workshops on standard case management and surveillance.

Health partners report 506 suspected dengue cases, of which RDT confirmed 295, have been reported mostly in Gedaref city. The actual number of cases is likely much higher because most patients rely on home remedies and private health care providers which are not picked up by the surveillance system. The main reason for the outbreak is improperly stored home water, which becomes breeding sites for Aedes aegypti mosquitos—the vector that transmits dengue fever. State authorities in Gedaref have started a vector control campaign and WHO has carried out surveillance and case management training and is supporting surveillance and rapid response teams. Partners report shortages of paracetamol and insecticide-treated nets, especially for IDPs.

Health partners report that between 15 April and 15 September, the Federal Ministry of Health (FMoH) identified over 4,000 measles cases and 107 associated deaths, most from White Nile and Aj Jazirah states. In addition, about 697,000 malaria cases and eight associated deaths were identified, mostly in White Nile, Aj Jazirah and Gedaref states. The Director of Operations of Médecins Sans Frontières MS), Dr Ahmed Abd-elrahman said in a statement that MSF teams conducted over 1,500 major surgical interventions in a single hospital in Khartoum, 90 per cent of which were to treat gunshot and blast wounds (this indicates surgical treatment of at least 1,350 injuries).

In August, in a single MSF-supported hospital in Omdurman, MSF teams treated over 2,100 trauma cases, almost half of that facility's total emergency room consultations. WHO has verified 56 attacks on health care, resulting in 11 deaths and 38 injuries, since mid-April, WHO said on 21 September. The organisation expressed concern that 26 of these attacks took place after the signing, on 11 May 2023, of the Jeddah Declaration of Commitment to Protect the Civilians of Sudan. About 70 per cent of hospitals in conflictaffected states are non-functional because of ongoing attacks combined with insecurity, shortage of medical supplies, and lack of cash to meet operational costs and salaries. Functioning hospitals and clinics in non-conflict-affected states are overwhelmed by the influx of internally displaced people.

Food Security and Livelihoods (FSL) partners provided 7.01 million people with live-saving and livelihood assistance in 18 states across Sudan between 15 April and 20 September. This included food to 1.76 million people and livelihood assistance to 5.25 million people, according to the FSL Cluster. This year, high prices and shortages of key inputs have impacted the agriculture sector, including fuel, seeds and agrochemicals. In addition, there is widescale unavailability of livestock vaccines and drugs due to the destruction of the Central Veterinary Research Laboratory in Khartoum and damage to facilities owned by private drug suppliers and manufacturing companies. In parts of Gedaref, Sennar, Blue Nile, South Kordofan, and West Kordofan states, cumulative seasonal rainfall has been poorly distributed, with belowaverage rainfall in the latter months of the production season (July and August) linked to the current El Niño. These factors will increase the prices of staple goods in most markets when income opportunities are deteriorating, leading to declining purchasing power, according to FSL.

As the rainy season progresses in Sudan, heavy rains and flooding have affected people in Northern, River Nile, North Darfur, Gedaref, White Nile, North Kordofan and South Kordofan states. On 13 and 14 September, heavy rains and flooding 4ffected 1,700 people in North Darfur’s Al Fasher and Al Lait localities. In Al Fasher locality, 84 homes were destroyed and 210 damaged, and 266 latrines were either washed away or damaged in Zamzam internally displaced persons (IDP) camp, affecting about 1,500 IDPs living with relatives or neighbours. In Al Lait town, heavy rains destroyed 44 homes and 11 shops, and damaged 42 other homes, affecting about 220 people living with neighbours and in a school building in the town. Since July, about 72,000 people in seven states have been affected by heavy rains and flooding, according to the 2023 Sudan Floods Dashboard. Reports indicate that at least 5,717 homes have been destroyed and 6,611 damaged.