A year into one of the most brutal conflicts in decades, the war in Sudan has triggered the world’s largest displacement crisis and left the country’s healthcare system in tatters.

Nearly 25 million people need immediate humanitarian assistance, according to the United Nations (UN) and over  18 million people face acute food insecurity, with the World Food Programme (WFP) warning that the situation could quickly slip into “catastrophic” food insecurity levels.

In light of this accelerating humanitarian crisis, governments, donors, and aid organizations met in Paris on the first anniversary of the war, aiming to “break the silence surrounding this conflict and mobilize the international community,” said French Foreign Minister Stéphane Séjourné said in his opening remarks. 

The Sudanese people have suffered not only from the catastrophe of war, but also from international “indifference,” said Séjourné, while international organizations struggled to meet key funding needs.

“The scale of this catastrophe far outstrips the international community’s attention,” said World Health Organization (WHO) director-general Dr. Tedros Adhanom Ghebreyesus.

The conflicts in Gaza and Ukraine have garnered most of the international community’s attention, and funding. Only 6% of the UN’s emergency funding appeal was met before the Paris conference. Similarly, only 7% of the $1.4 billion Regional Refugee Response Plan for the Sudan Crisis was funded.

Donors responded to pleas for humanitarian funding, pledging 2.13 billion in aid for Sudan. Top contributors were the European Union (EU), co-sponsors France and Germany, the US and the UK. 

“We can manage together to avoid a terrible famine catastrophe, but only if we get active together now,” German Foreign Minister Annalena Baerbock said, adding that, in the worst-case scenario, one million people could die of hunger this year.

Tedros echoed this sentiment, calling for access across borders and humanitarian corridors, the cease of attacks on healthcare facilities, funding for both health-related aid and for the UN in general: “This is a health crisis that could reverberate across generations.”

Heavy fighting persists

“People in Sudan are suffering immensely as heavy fighting persists, including bombardments, shelling and ground operations in residential urban areas and in villages, and the health system and basic services have largely collapsed or been damaged by the warring parties,” said Jean Stowell, Medecins sans Frontieres (MSF) head of Sudan mission. 

“Only 20-30% of health facilities remain functional in Sudan, meaning that there is extremely limited availability of health care for people across the country.”

The number of operational healthcare facilities has decreased even further since February 2024. Healthcare facilities themselves have been subject to attacks. The World Health Organization (WHO) reports 62 confirmed attacks, but notes that these numbers are most likely underestimates.

In the 12 months of conflict the warring sides repeatedly and intentionally blocked humanitarian and medical aid. 

A United Nations graphic of the humanitarian crisis in Sudan

The disruption of basic needs has meant that routine immunizations, care for pregnant women and babies, and chronic disease care has “dropped precipitously.” In the Darfur region alone, only 30% of children have received routine immunizations, according to the United Nations Children’s Fund (UNICEF.) The country has seen outbreaks of measles, malaria, dengue fever, cholera, and other water-borne illnesses.

Since March, the country has reported over 5,000 cases of measles and 106 deaths. While a nationwide “catch up” measles vaccination campaign was successfully conducted across seven Sudanese states in January 2024, the campaign was unable to cover the Darfur or Kordofan states. Both regions have seen some of the heaviest fighting; no immunizations have been possible since the conflict began. 

Children bear the brunt of these healthcare disruptions. “After 365 days of conflict, the children of Sudan remain at the sharp end of a horrific war,” said UNICEF Deputy Executive Director, Ted Chaiban this week.

“If immediate steps are not taken to halt the violence, facilitate humanitarian access and provide lifesaving aid to those in need, an even worse catastrophe is likely to impact children for many years to come.” 

The threat of malnutrition

Since violence erupted on 15 April 2023 between the Sudanese Armed Forces (SAF) and the paramilitary Rapid Support Forces (RSF), the country has experienced the highest levels of food insecurity in its history.

More than 710,000 children face severe acute malnutrition, “representing the highest number of people in need of nutrition assistance ever recorded in Sudan,” according to the WHO.

Without humanitarian assistance, the number could rise to 3.5 million children before the end of 2024. These levels surpass the WHO’s emergency thresholds for acute malnutrition, and raise concerns for an expected famine. 

For the first time since the crisis began, displacement in the Darfur states is now being driven by hunger rather than violence, according to the most recent WHO public health situation analysis.

This acceleration of widespread severe food insecurity is most prominent in rural households, where up to 59 percent face moderate or severe food insecurity. The states of West Kordofan, South Kordofan, and Blue Nile have seen the highest levels, according to a new study from United Nations Development Programme (UNDP) and the International Food Policy Research Institute (IFPRI). 

The study warns that a famine in Sudan is expected in 2024, particularly in the states of Khartoum, Aj Jazirah, and in the Darfur and Kordofan regions. 

Key food sources disrupted

The conflict has affected cereal production in particular, pushing more people into hunger, according to the Food and Agriculture Organization of the United Nations (FAO). 

The situation requires “urgent and at-scale agricultural support ahead of the planting season starting in June,” said Rein Paulsen, Director of the FAO Office of Emergencies and Resilience.

The production output of key cereal crops in 2023 decreased 46 percent from the previous year, and 40 percent below the average from the previous five years.

“This is a very practical manifestation of the impact of clashes, conflict and violence on food production. We clearly have a context that requires urgent and appropriate support. This is why FAO’s interventions are so incredibly important at this point in time,” said Paulsen, who is currently on a field mission to the country to evaluate the food security situation on the ground.

Preventing a looming famine requires an immediate ceasefire, unhindered humanitarian access, and increased support for humanitarian needs, concludes the report. 

Image Credits: UNICEF/UNI530171/Mohamdeen, Integrated Food Security Phase Classification, United Nations Office for the Coordination of Humanitarian Affairs (OCHA).