Cholera in Sudan: "If this is life, I wonder what hell is"

A scene of devastation at Al Fao Hospital

Deaths from cholera occur far too frequently, leading to tragic losses that all hope to avoid.

In a 150-bed cholera treatment center in Al Fao Hospital in Sudan's eastern Gedaref state, patients lie on the ground, vomiting and pleading for help. The ward is packed with patients, forcing doctors and paramedics to attend to some lying in hallways and on the floor. At one point, doctors and nurses stand over patients, holding bags of intravenous fluid due to a shortage of IV drip stands. Meanwhile, non-medical staff and caregivers step in to assist, distributing oral rehydration salt to patients to save their lives.

One young boy sits beside his mother’s body, unable to comprehend that she is not asleep, but has passed away from cholera. The shock of her death leaves him momentarily silent before being overcome with grief, tears streaming down his face. Nearby, another patient who had briefly shown signs of improvement after receiving fluids begins to fade. Despite the doctors’ best efforts to rehydrate him, his body is too weak to recover. 

“As a doctor, I’ve seen quite a few deaths; it is always difficult to witness one,” says Dr. Asma Abbas, an MSF doctor. “You always feel a sense of guilt—did I do enough to save this life? Could I have done something differently to prevent this?”

Multiple displacements take constant toll on people 

In Gedaref state and elsewhere in the country, the consequences of the ongoing conflict have been devastating. More recently, armed clashes and the ensuing violence in Al Jazirah state drove hundreds of thousands of people into Gedaref state and beyond. For many, it was not the first time they had to flee to escape the violence.

Salman Al Taha, from eastern Al Jazirah State, shares how, in just one year, he was forced to move between four different houses across three cities. The constant upheaval left him and many others feeling unstable, with no sense of security. Another woman named Afra Salah describes the terrifying experiences she endured as she moved from one place to another. She was robbed once, witnessed her father being beaten by armed men, and, on another occasion, had to bribe an armed group just to be allowed to move to a safer location—all while facing severe shortages of food and water. With such dire circumstances, one woman said, "If this is life, I wonder what hell is."

Overcrowded conditions in host communities

Fleeing violence and enduring dangerous journeys does not guarantee safety for people across Sudan. In Gedaref and other parts of the country, displaced communities are forced to live in overcrowded conditions, lacking proper shelter, safe drinking water, and adequate sanitation and hygiene facilities. Although the cholera outbreak in this region had begun to decline, the new wave of displacement led to the resurgence and spread of the disease among the people.

The cholera outbreak is particularly affecting displaced people through person-to-person transmission as they flee violence in large numbers. The outbreak is exacerbated by a lack of access to safe water and basic sanitation as people are already vulnerable from long journeys, and are more vulnerable to the severe dehydration associated with cholera. As a result, more people are dying in this outbreak, which has had a mortality rate of 4.5 percent compared to the typical mortality rate of less than 2 percent for cholera. In the MSF-supported cholera treatment center in Al Fao, 70 patients died in November out of 1,549 patients admitted.

To provide support closer to hot spots of transmission, MSF teams simultaneously launched a community cholera intervention. MSF set up and supported oral rehydration points in two nearby displacement gathering sites, Harira and Al Boudra, as well as in a nearby village, by training and incentivizing volunteer staff and donating essential medical supplies as well as the provision of safe water.

MSF continues to also treat patients at its cholera treatment center in Gedaref city, which was established during the first outbreak. Last month, 1,625 patients were treated there last month, in addition to nearly 600 patients treated at MSF’s cholera treatment center in Tandeba.

In recent weeks, fewer people have arrived at Al Fao. In parallel with the scaling up of safe water in the gathering sites by MSF and other actors, we are seeing a decrease in the number of admissions per day to the Al Fao Hospital cholera treatment center – almost in single digits. In the coming days, MSF will hand back the management of the center to the Ministry of Health and it staff. MSF will ensure the provision of adequate supplies of essential medicine and medical materials as well as safe water until the end of the year.

About our work in Sudan 

Since the conflict erupted in Sudan in April 2023, the country has been plunged into turmoil. Thousands have lost their lives, and millions have been displaced, forced to flee their homes and seek refuge within Sudan and beyond. Amid this chaos, MSF has adapted operations to respond to the evolving humanitarian needs, supporting war-damaged health facilities and deploying mobile clinics.

MSF currently works in 11 of Sudan’s 18 states, running and supporting health facilities as well as launching short-term emergency responses as urgent needs arise, such as support for the cholera treatment center at the Ministry of Health’s Al Fao Hospital.

MSF is prioritizing providing staff, supplies, and resources for the most acute phases of emergencies. Health services in many areas of Sudan are stretched to the breaking point due to high needs and ongoing violence.