Sudan

People in need: 15.8 million¹
People targeted: 12.5 million
People in need of health assistance: 10.3 million
Requirements (US$): 43 M

Context

Humanitarian needs across Sudan are at record levels one year after a military coup. Protracted and new displacement induced by localized conflict, the rise in criminality and insecurity in parts of Darfur and other conflicts-affected areas, unprecedented spikes in acute food insecurity due to dry spells and erratic rains, high inflation for food, fuel and other commodities, floods and persistent disease outbreaks, have resulted in record numbers of people in need of humanitarian assistance.

Humanitarian partners estimate that about 15.8 million people – roughly 32% of the population – will be in need of humanitarian assistance in 2023. This is an increase of 1.5 million people compared to the previous year and is the highest since 2011. This also includes a 2 million increase in the number of food insecure people. Of the 15.8 million people in need, around 11 million require emergency assistance for life-threatening conditions related to critical physical and mental well-being and need life-sustaining support to meet minimum living standards.

Sudan also hosts over 1 million refugees, and is a source, transit and destination country for mixed movements of refugees, asylum-seekers and migrants across the sub-region towards Europe and other destinations.

The public health system is severely affected by years of underfunding, resulting in a lack of qualified health staff and insufficient access to basic and essential services. The disease surveillance system is fragmented, with only 2 168 out of 6 300 total health facilities (34.4%) representing Sentinel Surveillance and 70% of health facilities lacking essential lifesaving medicines. Sudan is the leading contributor to malaria in the Eastern Mediterranean Region, accounting for around 56% of cases, and is also endemic for the arboviruses chikungunya, dengue and yellow fever.

WHO / Lindsay Mackenzie
Health workers from the Ministry of Health in North Darfur, Sudan, conduct environmental sampling for polio outside of a health facility in El Fasher.

Emergency response

In collaboration with the Federal and States ministry of health (FMoH, SMoH), UN partners and the health cluster, WHO mapped high risk populations and identified six hazards that cause 80% of health emergencies in Sudan: measles, cholera, dengue fever, malaria, floods and armed conflict.

Using an integrated risk-based approach, the priority States will be supported with a package of primary health care through emergency mobile clinics, the provision of essential medicines and capacity building. Support will also include the enhancement of water, sanitation and hygiene (WASH) infrastructure in health facilities and the provision of infection, prevention and care (IPC) supplies, especially in remote areas and regions prone to annual floods and droughts, which exacerbate food insecurity, intercommunal conflicts and other biological hazards.

In all 18 States, and at the national level, Rapid Response Teams (RRTs) will be trained to rapidly respond to emergencies. To enhance vector control and WASH, WHO will strengthen water quality and vector surveillance capacities and infrastructure, offer capacity building, support operational cost for efficient control strategies and strengthen community engagement.

In 14 states, 115 localities have been identified as those most affected by the prolonged dry spell and erratic rains. To ensure sustainability in health services provision, WHO will continue to support existing primary health care and stabilization centers through the Ministry of Health and partners already providing services. Stabilization centers will be supplied with medical and non-medical equipment and existing staff will receive training and technical support from WHO nutrition experts. The response will include a combination of lifesaving interventions to prevent children from becoming malnourished.

To ensure the quality of intervention, in line with the WHO Emergency response framework, coordination and leadership will be key to WHO’s response. At national and sub-national levels, the incident management system (IMS) will lead the coordination and leadership with health, nutrition and WASH clusters through the strengthening of the One Health Public Health Emergency Operations Center (PHEOC).

Strategic objectives

Key activities

Provision of primary health care facilities to support integrated health services, and routine and emergency vaccination campaigns.
Procurement of essential medical supplies for health facilities and state-based and regional laboratories.
Training of health care workers (HCW) on WASH and support for primary health care infrastructure
Enhancement of timely detection and response to potential outbreaks through supporting sentinel sites with technology to ensure timely reporting.
Supporting laboratories and rapid response teams.
Digitalization of the surveillance system, including water quality surveillance and enhancement of multi-sectoral coordination.
Capacity building offered to health care workers, including community sensitization sessions and RCCE activities and medical waste management support.
Rehabilitation of WASH and isolation facilities.
Management of severe acute malnutrition (SAM) with medical complications at Stabilization Centers (SCs) through the provision of SAM kits, strengthening nutrition surveillance, provision of infant and child feeding counseling services, supporting baby friendly hospital initiatives and offering capacity building for health workers
Supporting operational costs of main reference SCs.
Enhancement of risk communication and community engagement (RCCE) and health promotion activities, including the training and deployment of 1 000 community health workers to affected areas.
Supporting community and religious leaders to conduct community awareness sessions.
Improving implementation through strengthening sub-national coordination through the activation of the PHEOC and orientation of stakeholders on the IMS in 16 states.
Supporting IMS operational costs and improving surge capacity at national and sub-national level to strengthen drought response.
Supporting the supervision, monitoring and evaluation of emergency response at national and sub-national level.

Funding Requirements

Overall country funding requirements, including COVID-19, by pillar (US $ '000)

WHO Sudan/ Sara Makki
West Kordofan State Dengue Fever outbreak response and Surveillance system assessment mission.

Success stories

“One Health” approach to tackle zoonotic diseases

Zoonotic diseases are highly prevalent in the 120 million livestock in Sudan, posing a concerning threat to public health, as well as animal and environmental health. The risk of disease outbreaks in the country are further impacted by Sudan's long open-country borders, its wildlife habitat, conflict and civil unrest as well as the large number of refugees and internally displaced persons (IDPs). To help better coordinate actions and policies to prevent zoonotic disease outbreaks, the Sudanese government, alongside WHO, developed a 'One Health Forum' approach.

Building on the 2016 Joint External Evaluations (JEE), the August 2022 One Health Zoonotic Disease Prioritization (OHZDP) recommended the establishment of a ‘One Health Forum’ approach to support institutional coordination between the human, animal and environment sectors to address zoonotic disease. The WHO Country Office for Sudan supported the Federal Ministry of Health, the Federal Ministry of Animal Resources and the Higher Council of Environment and Natural Resources in officially endorsing the "Sudan One Health Platform” in September 2022.

The Sudan One Health Platform was immediately put into action, with official outbreak response missions conducted for mpox in six states. The missions were undertaken in coordination with the three sectors and with technical support from WHO. Additionally, recommendations from the joint One Health mission led to a significant improvement across all strategic pillars of response. Investigations in refugee camps highlighted the importance of strengthening the One Health platform at state level along with strengthening surveillance, case management, IPC and several other capacities required for robust monitoring and prevention of zoonotic disease.

On its presentation at the 2022 IHR Emergency Committee meeting by Sudan's Federal Ministry of Health, the Sudan One Health approach provided an important evidence base to establish a future global roadmap for mpox. It also provided the WHO Director-General with temporary recommendations to address the immediate emergency.

A cross-border surveillance committee is now being established by EMRO in Sudan, South Sudan, Chad and Ethiopia as a first step towards the revival of the Khartoum Declaration.

Dengue Fever outbreak response

In Sudan, dengue fever remains one of the top causes of health emergencies in the country. The disease places a major burden on population health, further exacerbated by poor access to basic health care services following years of underfunding of the health care system.

To help mitigate the impact of the disease in the most affected areas, the WHO Country Office for Sudan, along with the Federal and State Ministries of Health conducted a joint mission in response to a dengue fever outbreak in West Kordofan State in November 2022.

The mission investigated key aspects of surveillance, including routine immunization coverage. The joint team reviewed the notifiable diseases surveillance system, focusing on reporting and data flow through indicator-based and community-based surveillance. In addition, they monitored the rapid response team’s (RRT) readiness and support needed for halting the ongoing outbreak. The mission also supported state and local level surveillance officers with basic on-the-job training on surveillance and data management skills and supported the state level coordination and planning of surveillance activities.

The mission identified gaps in outbreak response activities, including a lack of governmental support, a lack of data analytical capabilities, shortages of reporting tools and the stockout of rapid diagnostic tests (RDTs) for COVID-19, HIV, cholera, dengue fever and meningitis. Recommendations made following the mission resulted in the procurement of laboratory supplies including RDTs and the provision of reporting tools, leading to an improvement in timely and complete reporting. The provision of capacity building sessions further improved analytical and technical capacities of the State Ministry of Health, and strengthened the One Health response coordination.

WHO / Lindsay Mackenzie
On 26 April 2022, a laboratory technician looks at blood slides for malaria in a laboratory in a health facility for women and children in Abu Shouk IDP camp in North Darfur.