Epidemics, hunger and violence: the crisis in Sudan is becoming increasingly catastrophic
The crisis unfolding in Sudan is a humanitarian crisis of catastrophic proportions, and one that risks worsening further. This warning has been issued repeatedly by the United Nations, more than two years after the start of the internal conflict.
On 15 April 2023, the alliance between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) collapsed in a violent power struggle, quickly turning into a civil war. The violence, which initially broke out in Khartoum, the capital of Sudan, quickly spread throughout the country, leading to mass displacement, ethnic cleansing and widespread violence, particularly in Darfur. Sudan has a long history of civil wars and armed insurrections, which is why the conflict immediately reached higher levels of complexity, involving several other armed groups.
Thousands of civilians continue to be killed and subjected to brutal violence, while millions have been forced to leave their homes, seeking refuge throughout Sudan and beyond its borders.
The world’s most serious displacement crisis, affecting a total of 12 million people forced to flee their homes. Of these, 10.1 million are internally displaced and 4.1 million are refugees.
Several factors make Sudan’s crisis one of the most serious in the world: the large number of people in need of urgent humanitarian aid, corresponding to about half the population (25 million people); the risk of further worsening famine, which is rampant especially in Darfur and has now reached 8.5 million people in a state of food emergency; of these staggering figures, 3.7 million are children under five and pregnant or breastfeeding women.
Sudan is among the top four countries globally with the highest prevalence of Global Acute Malnutrition (GAM), estimated at 13.6%. The figures are also staggering for internally displaced persons and those who have fled to neighbouring countries such as Chad, the Central African Republic, Libya and Egypt. This is the most serious displacement crisis in the world, affecting a total of 12 million people who have been forced to leave their homes. Of these, 10.1 million are internally displaced persons and 4.1 million are refugees. The highest concentration of internally displaced persons is in South Darfur (18%), North Darfur (18%) and Central Darfur (9%). More than half of the internally displaced population is under the age of 18, and it is estimated that 90% of school-age children are currently not attending school.
Throughout the country, but particularly in the Darfur region, relentless violence, hunger and mass displacement are a daily and debilitating reality for the civilian population, effectively hindering humanitarian assistance. In addition, the armed conflict has severely damaged or destroyed essential infrastructure. According to the latest estimates from OCHA – the United Nations Office for Humanitarian Affairs – less than a quarter of health facilities are functioning in the areas most affected by the conflict. Further aggravating the overall situation is the rapid spread of a cholera epidemic, which has recorded 114,650 cases and 3,082 deaths since July 2024. This is one of the worst epidemics in Sudan’s history.
Women and girls of all ages suffer physical and psychological abuse. Sexual violence is, here too, a weapon of war used as an expression of conflict, and cases of rape and sexual slavery are a constant feature of civilian life at the hands of armed groups and factions involved in the fighting, with the ultimate aim of weakening and destabilising communities. For this reason, the latest estimates from the OCHA agency indicate that 12.2 million individuals in Sudan are at risk of gender-based violence, an increase of 80% compared to 2024. The trauma of living in a conflict zone such as Sudan has a profound impact on mental wellbeing. It is estimated that one in five people living in the areas most affected by conflict suffer from some form of mental disorder.
The extensive use of explosive devices in the conflict – such as mines, bullets and mortar bombs – exacerbates the already catastrophic humanitarian crisis, not only by killing and maiming civilians, but also by restricting freedom of movement and safe access to essential services, infrastructure and livelihood opportunities. Among the most contaminated territories are the states of Khartoum, Al Jazirah and Kordofan. Humanitarian workers face the threat of explosive devices in many areas affected by armed conflict, which hinder the safe delivery of humanitarian aid to millions of people in desperate need. Border crossings and movement restrictions complicate humanitarian operations.
INTERSOS operated in Sudan for 12 years, from 2004 to 2015, mainly in the states of West and Central Darfur and in Khartoum, in the areas of Protection, WASH and Food Security. At the end of 2015, INTERSOS decided to close its mission in Sudan due to the decrease in humanitarian needs, but continued to respond to the needs of the Sudanese refugee community in neighbouring countries.
With the outbreak of conflict in April 2023, however, in addition to supporting the Sudanese refugee population in neighbouring countries, we took action to resume activities in Sudan, both in the east of the country, in areas controlled by the Sudanese Armed Forces (SAF), and in Darfur, which has been under the control of the Rapid Support Forces (RSF) since the beginning of the current conflict.
Darfur
Humanitarian access in Darfur is subject to enormous restrictions. Among the areas of greatest concern is El Fasher, in the north of the region, where intensifying clashes are putting the lives of an increasing number of civilians at risk and limiting their ability to flee. To date, approximately 260,000 civilians remain trapped in cities such as El Fasher with no safe way out. Bombing has become increasingly indiscriminate, hitting densely populated neighbourhoods and refugee camps. Civilians are exposed to serious risks, including sexual violence, forced recruitment and arbitrary detention. There are no safe escape routes for civilians: those who attempt to leave the city face a high risk of violence, harassment and looting, as well as being unable to access food, water and medical assistance.
Despite the difficulties of intervention and the security risks, INTERSOS has been working in the region since 2023 and in recent months has been responding to the ongoing health emergency caused by the spread of cholera cases. We support several medical facilities in North and West Darfur. We try to identify suspected cases promptly, report them and obtain rapid responses for treatment from the health authorities. The INTERSOS team is working on the front line in the health centres of Mangarsa, West Darfur, and Khazan Tunjur, North Darfur, supporting doctors and nurses, directly managing less serious cases and referring the most serious ones to the nearest hospitals. We organise awareness-raising campaigns to promote hygiene and sanitation practices in communities, as well as directly managing less serious cases to prevent their condition from worsening and posing a risk to their lives. We have provided medical services to a total of 14,326 individuals and conducted 4,500 medical consultations as part of our response to the displacement crisis in North Darfur.
We have treated dozens of boys and girls under the age of five suffering from severe acute malnutrition in North and West Darfur, also working on the importance of prevention through screening practices, which have enabled us to identify more than 4,400 children at risk in advance, both in communities and in health centres.
We are also addressing the serious issue mentioned above concerning the high number of cases of sexual violence. INTERSOS focuses on the protection and care of women and girls through psychosocial support, and plans are underway to open a safe space to guarantee their safety and offer some form of comfort from the trauma they have suffered.
To meet the basic needs of internally displaced persons, we have distributed kits and cash assistance to the most vulnerable people. A total of 400 hygiene kits and 450 emergency kits were delivered to displaced persons in West and Central Darfur, reaching 5,223 individuals. In North Darfur, we delivered kits containing basic necessities such as kitchen items, blankets, mosquito nets, water containers, sanitary pads, solar lights and soap, reaching a total of 7,500 individuals.
Over the last year the Darfur Region population has endured mass killings, widespread displacements, destruction of property, rampant human rights violations and gender-based violence.
Kassala and River Nile
The states of Kassala and River Nile are located in the east of the country and, due to their proximity to Khartoum and the presence of social networks, are among the main states that have welcomed people fleeing violence in the capital since the beginning of the crisis. River Nile has been home to over a million internally displaced persons for some time. Since April 2023, Kassala has welcomed 354,000 people. Even before the conflict, this area was a transit territory for migrants from Ethiopia and Eritrea to Europe, and humanitarian needs were already very high.
More than two years later, the International Organisation for Migration (IOM) reports a decrease in the number of displaced persons, especially in the Kassala area. In August 2025, Kassala hosted 79,405 internally displaced persons, recording a greater decrease than other states, equal to -18% compared to July 2025 (96,675 people). The reason for the decrease is, in turn, a growing increase in the number of people returning to their territories of origin, despite there being no guarantee of safety at the end of the hostilities. The state of River also saw a 4% decrease, again due to attempts to return to places of origin.
In these areas, INTERSOS, in consortium with Association for Aid and Relief (AAR) Japan and in partnership with the local organisation JASMAR, carries out activities aimed at ensuring access to healthcare and protection for internally displaced persons and host communities. In these two countries, we offer support to health centres, training for health personnel and awareness-raising sessions on health and hygiene promotion for displaced and local populations, as well as facilitating access to health services for pregnant and breastfeeding women and children under 5 years of age. We also support those at risk of violence or abuse through psychological assistance and the distribution of cash to access basic services, as well as conducting awareness-raising and psycho-education sessions.
Port Sudan
In the state of Port Sudan, INTERSOS supports four medical facilities: the Mental Health Hospital, the Blood Bank, a rural hospital and a primary healthcare facility. In addition to managing logistics, we offer rehabilitation activities with the aim of promoting the dignity, health and well-being of patients, with a particular focus on maternal and child health. We have launched training courses for staff working in these facilities to strengthen their skills and respond appropriately to the needs of the population. In addition, the communities involved participate in health promotion activities, particularly maternal and child health, and mental health awareness campaigns. Finally, 50 of the most vulnerable families have been supported with financial aid.
Photo © René Van Beek for INTERSOS