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UN warns of ‘worst humanitarian crisis on Earth’ in Sudan.
Food Insecurity and Malnutrition Update
Access restrictions exacerbate famine conditions in Zamzam IDP camp The blockade and escalating fighting in Al Fasher, North Darfur State, have delayed or prevented the delivery of commercial and humanitarian supplies to areas of acute need. The latest data collected by Médecins Sans Frontières (MSF) confirms that acute malnutrition rates remain above the Famine (IPC Phase 5) threshold in Zamzam internally displaced persons (IDP) camp. Famine conditions were confirmed in Zamzam camp in August. While data remains limited for nearby Abu Shouk and Al Salam IDP camps near Al Fasher, information from the field suggests significant civilian movement away from these camps and towards Zamzam, driven by the heavy fighting, for safety and access to services in the camp. However, on 10 October, Médecins Sans Frontières (MSF) was forced to stop outpatient treatment for 5,000 children with acute malnutrition in Zamzam IDP camp because reportedly for months the parties to the conflict had blocked the delivery of food, medicines, and other essential supplies, according to MSF.
Meanwhile, based on new information under review, the Famine Early Warning Systems Network (FEWS NET) is increasingly alarmed that similar extreme acute food insecurity outcomes are occurring among IDPs in the besieged areas of Dilling and possibly Kadugli in South Kordofan State.
Extreme food insecurity extends into the pre-harvest period The humanitarian crisis in Sudan continues to deteriorate as the lean season ends and the pre-harvest period begins amid increasing hostilities, soaring prices, and devastation caused by heavy rains and floods, reports FEWS Net in its latest alert update. Availability of food usually improves after the lean season in Sudan, which typically ends by September. However, early indications show marginal improvement in food security as historic flooding destroyed crops while ongoing conflict made it difficult for farmers to plant, cultivate and harvest. An updated food security analysis is currently ongoing to revise the projection for the harvest season. Nearly 26 million were projected to be in acute hunger with 755,000 people facing catastrophic hunger conditions (IPC5).
Healthcare Update
Declining healthcare system amid increasing cholera and dengue fever outbreaks Cases of cholera and dengue fever continue to be reported across the country. Cholera cases have continued to spike weeks after the end of the above-average rainy season and historic flooding which destroyed and contaminated water sources. Between 22 July and 28 October, 28,376 cases and 836 related deaths were reported in 74 localities across 11 states. The actual number of cases is likely higher due to under-reporting. The state with the highest number of cases is Kassala (6,868 cases and 198 deaths), followed by Gedaref (5,770 cases and 168 deaths), Aj Jazirah (4,361 cases and 90 deaths), and Northern (2,038 cases and 28 deaths). Sudan’s Federal Ministry of Health (FMoH) officially declared on 12 August 2024 a new wave of cholera cases that started on 22 July 2024.
Humanitarian partners and Sudanese health authorities continue to scale up the response to the ongoing cholera outbreak. The latest phase of the cholera vaccination campaign got underway in October targeting some 1.4 million people in the states of Kassala, Gedaref, and River Nile.
The cholera outbreak is happening at a time when the national healthcare system is barely functional and essentially defunct in some states, with serious challenges in providing medical supplies and fuel to hospitals and primary healthcare centres (PHCs). WHO estimates that 70-80 per cent of healthcare facilities in areas worst affected by conflict such as Al Jazirah, Kordofan, Darfur and Khartoum and about 45 per cent of health facilities in other parts of the country are now barely operational or closed. The childhood immunization programme is breaking down and infectious diseases are spreading across the country. The risk of all vaccine-preventable disease (VPD) outbreaks has been at its highest since the conflict broke out in mid-April 2023.
Dengue fever has been reported in Kassala, Gedaref, Red Sea, Khartoum and South Kordofan states. As of 28 October, 4,544 cases and 12 related deaths have been recorded. The state with the highest number of dengue fever cases is Kassala (2,357 cases and 8 deaths), followed by Khartoum (20,083 cases and 2 deaths), Gedaref (60 cases), Reds Sea (42 cases and 2 deaths), and South Kordofan (2 cases).
Over 2 million babies born during conflict are at risk due to decimated health system Save the Children (SC) reported that over 2 million babies born during the 18 months of conflict are at risk from the decimated healthcare system and crisis levels of hunger, according to a recent analysis. With up to 80 per cent of hospitals in the worst-affected areas closed and two out of three people unable to access essential health services, the delivery of healthcare – including reproductive and newborn care – has become increasingly challenging, putting mothers and children at risk of complications that could have lifelong and even fatal consequences. The risks to babies and their mothers have been compounded by staggering rates of hunger and malnutrition. Over half of Sudan’s population, or 25.6 million people, are facing crisis or worse levels of hunger, with one in every four people – 8.5 million – facing emergency levels of acute food insecurity. Children born to malnourished mothers are at higher risk of fetal growth restriction, which contributes to poorer health outcomes later in life and increased neonatal mortality.
Attacks on healthcare Since 15 April 2023, WHO’s Surveillance System for Attacks on Health Care (SSA) has reported 116 attacks on healthcare, which resulted in 188 deaths and 140 injuries. Health cluster partners and the media have been reporting direct violence, collateral damage, looting, intimidation, and other violations against health workers, health facilities, allied services such as ambulances, and patients themselves on an almost daily basis. These numbers, however, are assumed to be an under-representation of the real numbers on the ground due to limited access, communication and other challenges in obtaining the information and lack of verifiable data.
Conflict and Displacement Update
The international community is alarmed about the protection of civilians and displacement from eastern Aj Jazirah State Senior UN officials have raised alarm over the escalation of hostilities and the brutal violent attacks that resulted in the death of at least 124 people – including at least 10 children – the injury of scores more, and the displacement of tens of thousands of people from eastern parts of Aj Jazirah State.
During a major assault on 30 villages and towns in eastern Aj Jazirah between 20 and 25 October, Rapid Support Forces (RSF) reportedly shot at civilians indiscriminately and committed acts of sexual violence against women and girls, torching farms, and the widespread looting of homes and markets. In a flash update, UN OCHA reported that an estimated 119,400 people fled the fighting to Gedaref, Kassala and River Nile states, with more displaced people likely to be on the move to reach safety and shelter.
The Humanitarian Coordinator in Sudan, Clementine Nkweta-Salami, said in a statement that she is “shocked and deeply appalled that human rights violations of the kind witnessed in Darfur last year – including rape, targeted attacks, sexual violence and mass killings – are being repeated in Aj Jazirah State”.
The Acting Under-Secretary-General for Humanitarian Affairs, Joyce Msuya, said the UN has received horrific reports of entire villages being attacked, with civilians killed, detained and displaced in huge numbers. Many of those wounded urgently need medical treatment.
In his address to the Security Council on 28 October, the UN Secretary-General said that “the people of Sudan are living through a nightmare of violence — with thousands of civilians killed, and countless others facing unspeakable atrocities, including widespread rape and sexual assaults.”
The UN High Commissioner for Human Rights Volker Türk called on all parties to strictly respect their obligations under international humanitarian law and international human rights law, in particular by ensuring the protection of civilians. The UN and humanitarian partners are mobilizing resources and scaling up assistance to people displaced from Aj Jazirah in several locations in Gedaref and Kassala states.
Escalating conflict and displacement in other parts of the country Sudan continues to spiral into chaos, with the humanitarian crisis worsening and the horrific toll of the conflict between SAF and RSF on civilians in hotspots across the country. In North Darfur’s Al Fasher locality, fighting between SAF and RSF intensified in April 2024. Since then, an estimated 410,400 people have been displaced from the locality as of 9 October 2024, the International Organization for Migration Displacement Tracking Matrix (IOM DTM) reported. This includes people displaced before the escalation of the conflict in April who then experienced secondary displacement. Over half of the displaced people (54 per cent or 221,630 people) were displaced to locations within Al Fasher locality, while the others fled to 22 different localities in the Darfur region, including Tawila (15 per cent) and Dar As Salam (14 per cent) in North Darfur and North Jabal Marrah (7 per cent) in Central Darfur. An additional 1,300 people were displaced from Al Fasher locality following continued clashes between SAF and RSF on 18 and 19 October, IOM DTM reported on 20 October.
Fighting also escalated in West Darfur State, with reports of an estimated 64,000 people having fled their homes in Jabal Moon and Sirba localities. On 14 October, OCHA received reports that the entire population of Selea town – an estimated 27,500 people – in Jabal Moon locality had fled their homes due to insecurity and safety concerns following the presence of armed fighters in the outskirts of the town and alleged airstrikes in the area. Local sources estimated that about 5,000 people from Selea town crossed the border into Chad, while others took refuge in several villages in the locality. The actual numbers and needs of the displaced people have yet to be verified. Since 15 April 2023, about 198,000 people have been displaced in West Darfur, according to the IOM Mobility Sudan Update (09).
In Sirba locality, about 36,300 people (7,255 families) were reportedly displaced on 3 October following clashes between the RSF and the Juba Peace Agreement Joint Forces (JPA Forces) in Abu Surug and Bersiliba towns, IOM DTM reported. The report says that about 20,250 people (4,050 families) fled Abu Surug town and about 16,000 people (3,200 families) fled Bersiliba town. The displaced people reportedly took refuge in areas within Sirba locality and across the border in Chad.
About 11.2 million people displaced within and beyond Sudan since April 2023 The conflict that started in mid-April 2023 and previous conflicts in parts of Sudan since 2003 have made Sudan the largest internally displaced population crisis in the world, with about 11.2 million people – or one in every five people in the country – displaced (IOM DTM Mobility Update, 09). This includes 8.16 million people displaced since mid-April 2023 and 2.75 million people displaced prior to April 2023. In addition, the reported number of people who crossed into neighbouring countries (Central African Republic (CAR), Chad, Egypt, Ethiopia and South Sudan) has reached 3 million, an increase of about 738,000 people following a recent revision of the number of Sudanese refugees in Egypt by Egyptian authorities from about 500,000 to over 1.2 million, reports the UN Refugee Agency (UNHCR). This brings the total number of people who are displaced within Sudan and who fled into neighbouring countries after mid-April 2023 to about 11.2 million.
While civilian displacement before mid-April 2023 was primarily concentrated within Darfur and Kordofan regions, afterwards it was more widespread. Over a third (33 per cent or 3.6 million) of all displaced people reportedly originated from Khartoum. This is a stark difference compared to the 2003-2023 period when the majority of displaced people originated from rural areas and were mainly sheltering in IDP camps or camp-like situations in and around the main urban centres in Darfur. The displaced people have taken refuge in 9,269 different locations in 183 localities across all 18 states. The states hosting the most IDPs are South Darfur (17 per cent), North Darfur (14 per cent) and Gedaref (9 per cent).
Nearly 25,000 people reportedly killed since mid-April 2023, ACLED On 4 October, the Armed Conflict Location and Event Data (ACLED) reported that about 24,850 reported fatalities had been recorded in Sudan after the conflict broke out between SAF and RSF on 15 April 2023. From 7 September to 4 October 2024, ACLED recorded over 1,810 reported fatalities, with most of the fatalities reported from Khartoum and North Darfur (345 and 1,061 fatalities respectively). ACLED states that its fatality figure is a conservative estimate due to methodological limitations of real-time reporting in a fast-moving conflict context, with real fatality numbers likely ranging significantly higher.
HUMANITARIAN RESPONSE
Overall Response Update
Humanitarian partners continue to scale up response across the country and during September 2024 about 2.5 million people received multi-cluster assistance, bringing the total number of people reached with some form of humanitarian assistance since 1 January 2024 to 12.6 million. While this represents about 86 per cent of the 14.7 million people that the Sudan Humanitarian Needs and Response Plan (HNRP) partners are aiming to reach throughout 2024, the number of people and ratio of reached versus targeted people show major variations between clusters, largely due to major difference in levels of funding made available. For instance, the Food Security and Livelihoods (FSL) Cluster reached 10.3 million people with food and livelihood support (about 90 of the overall target), with more than 100 per cent of the requested funds received. The Water, Sanitation and Hygiene (WASH) Cluster reports that between January and September, its partners reached 8.2 million people (92 per cent of the target), with 34 per cent of the required funds received.
Meanwhile, the Protection Cluster has reached only 160,400 people (less than 5 per cent of the targeted 3.6 million people), while the cluster funding is at 67 per cent.
Only 27 per cent of people in need of food and livelihood assistance reached in Darfur and Khartoum The FSL Cluster has only reached about 10.3 million people targeted for food and livelihood assistance in parts of Sudan that have been most affected by conflict, mainly in the Greater Darfur area and in Khartoum State, according to the Sudan Humanitarian Response Dashboard. Between 1 January and 31 September 2024, FSL partners managed to reach only 600,000 people, which is 34 of the 2.5 million people in Khartoum State who urgently need FSL assistance. In Darfur, they reached about 1.6 million of the 8.2 million people in need. In the Greater Kordofan region, about 1.7 million of the 2.4 million people in need of food and livelihood assistance. Despite reaching 10.3 million beneficiaries this year, only 1.8 million people received assistance in September. A sustained response is essential to support the people in need of FSL assistance to prevent the deterioration of their food security. Meanwhile, in SAF-controlled areas in eastern and northern states of the country, close to 99 per cent of people in need received FSL assistance.
More than 520 aid trucks delivered cross-border and cross-line assistance since August While cross-border relief supply movement is considered one of the most effective and shortest routes to deliver humanitarian assistance to the eastern areas of Sudan, cross-line from Port Sudan and other areas is more efficient to deliver humanitarian supplies to other areas across the country
Aid convoys loaded with lifesaving and essential supplies have continued to cross from Chad to Sudan via the Adre and Tine border crossing points. Between 20 August and 14 October, 202 aid trucks crossed Adre transporting 6,265 metric tonnes (MT) of food, nutrition, medical, emergency shelter and essential household supplies. These supplies are enough to cater for the needs of up to 615,500 vulnerable people, including people acutely food insecure and at risk of famine. While 113 trucks carrying 3,400 MT of humanitarian supplies enough to cater for the needs of 802,000 people crossed into North Darfur from Chad, through the Tine border crossing between August and October. Cross-line assistance was provided via 209 trucks carrying 43,253 MT of relief supplies enough to cater for the needs of up to 1.48 million people.
HUMANITARIAN FUNDING
By 31 October 2024, the Sudan Country-Based Pooled Fund (SHF) received US$106 million in contributions, the highest amount received by an OCHA-managed country-based pooled fund this year. Between January-September 2024, the SHF has allocated $114.3 million for frontline response. The September allocation of $15 million is underway, with funds anticipated to be disbursed in the coming weeks. This allocation targeted the cholera outbreak, the Arba’at dam collapse and floods in Red Sea, and the destruction of hospitals in East Darfur and North Darfur. There is a planned allocation for in-kind food distributions in Zamzam IDP camp in North Darfur in response to the famine confirmation in the camp.
Over the same period, the UN Central Emergency Fund (CERF) allocated $41.2 million, making Sudan the largest recipient of CERF funding in 2024 (Central Emergency Response Fund 2024 | Financial Tracking Service). Overall, the country-based pooled fund donor contributions and CERF funding provided $147.2 million for Sudan response.
The 2024 Sudan Humanitarian Needs and Response Plan requires US$2.7 billion to provide life-saving multi-cluster and protection assistance to 14.7 million people across Sudan. As of 31 October 2024, the appeal is 56.6 per cent funded, with $1.52 billion received, according to the Financial Tracking Service (FTS).
(unocha)