Famine indicators are worsening in the most vulnerable areas of Sudan, where “a situation that is already awful continues to deteriorate”, World Health Organization (WHO) Director-General Dr Tedros Adhanon Ghebreyesus told a media briefing on Wednesday.

Last week, acute malnutrition surpassing famine thresholds was identified in two areas of North Darfur, by the Integrated Food Security Phase Classification (IPC).

Thousands of people fled to these areas, Um Baru and Kernoi, last last year to avoid violent attacks on civilians in the town of El Fasher.

“Famine conditions were confirmed in two other cities in November last year, and we know that where hunger goes, disease follows,” said Tedros, adding that an estimated 4.2 million cases of acute malnutrition are expected across Sudan this year – a 14% increase from 2025.

Violence is ongoing, including attacks on healthcare facilities. In the past three years of the war, the WHO has verified 205 attacks on health facilities, which have led to 1,924 deaths and 529 injuries.

WHO’s Sudan Country Representative, Dr Shible Sahbani, told the media briefing that, aside from famine and violence, Sudan is battling major outbreaks of cholera, malaria, dengue and measles.

Over 2.9 million malaria cases have been recorded, 124,000 cholera cases and more than 3,500 deaths, and over 63,000 dengue cases.

“Water, hygiene, sanitation and health conditions are very bad in many, many states,” said Sahbani, adding that continued fighting made it impossible for humanitarian efforts to reach those who need help.

No support for rape survivors

Widespread rape and gender-based violence have been hallmarks of the conflict, and Sakhani said that there was little access to services such as emergency obstetric care, and clinical management of rape.

Meanwhile, Dr Teresa Zakaria, WHO head of Humanitarian and Disaster Action, told the briefing that “70% of women in crisis are subjected to gender based violence”. 

However, “over 60% of organisations that in the past have provided clinical care, social protection, and social assistance to survivors of sexual violence have had to scale back or stop services because of funding cuts”, added Zakaria.

“Humanitarian aid cuts to the gender based violence sector amount to over $110 million. In 2025, what this represented is that three million people, mostly women and girls, but also boys and men in humanitarian crisis are deprived of access to services,” she said, adding that the situation this year “is only going to become much worse”.

Guinea-Bissau trial is ‘unethical’

When asked about a controversial trial to examine various impacts of the hepatitis B vaccine on newborn babies in Guinea-Bissau, Tedros declared bluntly that it is not ethical.

“Guinea-Bissau is one of the countries with a high prevalence of hepatitis B, and withholding a birth dose could actually expose infants to a high chance of infection,” said Tedros.

“This violates basic protocol. When you have an effective medicine, denying half of the population of children access to a vaccine that has been there for more than 40 years, which is safe and effective, is not ethical.”

There has been global outrage over the ethics of the trial, which would only give half the 14,000 babies it aims to enrol a hepatitis B vaccination shortly after birth – despite clinical evidence that early vaccination is highly effective at preventing mother-to-child transmission of the virus, which is the leading global cause of liver disease. 

A Danish research group, Bandim Health Project, headed by Dr Christine Stabell Benn, an ally of US Health Secretary Robert F Kennedy Jr, has been given a $1,6 million, five-year grant by the US Centers for Disease Control and Prevention (CDC) to “assess the effects of neonatal Hepatitis B vaccination on early-life mortality, morbidity, and long-term developmental outcomes”.

Stabell Benn is an adviser to the US Advisory Committee on Immunization Practices (ACIP), which recently resolved to stop recommending hepatitis B vaccines to US newborns. 

“Of course, a sovereign country can decide whatever it wants. But as far as WHO is concerned, it’s unethical to proceed with this study,” Tedros stressed.

WHO’s head of immunisation and vaccines, Dr Kate O’Brien, questioned purpose of the trial, adding that WHO’s representative in Guinea-Bissau had been in regular contact with the country’s Health Ministry about the trial.

“It’s a safe and extremely effective vaccine,” she said, adding that over 150 countries currently use the hepatitis B vaccine.

“Whenever research is proposed, there has to be some foundation for proposing it, especially when it is asking a question about an authorised vaccine that has a very long-standing safety profile,” said O’Brien.

“There has to be some basis for expecting that there is an issue or a question that needs to be asked. And, to our knowledge, there is no underpinning evidence that would suggest that there is any concern with respect to hepatitis B vaccine.”

She added that, aside from policy relevance, the research needed to “protect the interests of the participants”.

“There are some very concerning aspects of the study that have been proposed, and these are some of the questions that we were asking of the investigators when we had a very good opportunity to discuss it with them.”

Two weeks ago, Guinea-Bissau Health Minister, Quinhim Nanthote, told a media briefing that the trial had been “suspended or cancelled”.

This is despite recent assertions by the US Health and Human Services (HHS) Department that it was going ahead.

‘Non-specific effects’ of vaccines

Nanthote initially told the briefing that his country’s ethics committee had not yet held a meeting about the trial, but later said that it “did not have the required technical resources” to approve the trial.

Nanthote, who addressed the briefing in military fatigues, was only appointed health minister on 29 November 2025, following a military coup three days earlier, and was not part of the discussions about the trial.

For years, Stabell Benn, co-principal investigator of the trial, has researched the “non-specific effects” (NSE) of vaccines. She and colleagues have conducted trials involving thousands of children in Guinea-Bissau and Denmark, and assert that all vaccines should also be tested for NSEs.

One of the research aims of their Guinea-Bissau trial is to investigate the effect of the vaccination “on neuro-development by five years of age”. This dovetails with Kennedy’s belief that the rise of autism is linked to childhood vaccinations.

“RFK Jr. has manipulated the [Guinea-Bissau] study to support his unsupportable, science-resistant beliefs about harms caused by the hepatitis B vaccine,” observed US paediatrician Dr Paul Offit, co-inventor of a rotavirus vaccine, on his Substack platform.

Image Credits: UNICEF.