Agencies consider new aid route into Sudan from S. Sudan as humanitarian crisis worsens, cholera spreads

FIGHTING AND RED TAPE have hampered aid access in Sudan. Hunger and diseases including cholera are spreading. Aid agencies are looking at delivering aid to Sudan on a new route from South Sudan as they struggle to access much of the country. 

The war between the army and the paramilitary Rapid Support Forces (RSF) has left nearly half of Sudan's 49 million people requiring aid. More than 7.5 million people have fled their homes, making Sudan the biggest displacement crisis globally, and hunger is rising. 

Aid supplies have been looted and humanitarian workers attacked, while international agencies and NGOs have long complained about bureaucratic obstacles to get into the army-controlled hub of Port Sudan and obtain travel permits for access to other parts of the country. Read more.

From Reuters

Reporting by Aidan Lewis

Editing by Christina Fincher

Dated Monday, 15 January 2024, 5:51 PM GMT - here is a copy in full:

Agencies consider new aid route into Sudan as humanitarian crisis worsens

Jan 15 (Reuters) - Aid agencies are looking at delivering aid to Sudan on a new route from South Sudan as they struggle to access much of the country, a senior U.N. official said on Monday, nine months into a war that has caused a major humanitarian crisis.

The war between the army and the paramilitary Rapid Support Forces (RSF) has left nearly half of Sudan's 49 million people requiring aid. More than 7.5 million people have fled their homes, making Sudan the biggest displacement crisis globally, and hunger is rising.

Aid supplies have been looted and humanitarian workers attacked, while international agencies and NGOs have long complained about bureaucratic obstacles to get into the army-controlled hub of Port Sudan and obtain travel permits for access to other parts of the country.

"There's a very, very difficult operating environment, very hard," Rick Brennan, regional emergencies director for the World Health Organization (WHO), said in a press briefing in Cairo on Monday.

Aid agencies lost access to Wad Madani, a former aid hub in the important El Gezira agricultural region southeast of Khartoum, after the RSF seized it from the army last month.

The RSF's advance into El Gezira state and fighting that erupted recently involving the army, the RSF and Sudan's third-most powerful military force, the SPLM-North, in South Kordofan, have sparked new displacement.

U.N. and other agencies have been largely restricted to operating out of Port Sudan on the Red Sea coast, and delivering aid from Chad into the western region of Darfur, where there have been waves of ethnically-driven killings.

"We're also looking at establishing cross-border operations from South Sudan into the southern parts of the Kordofan states of Sudan," said Brennan.

DISEASE OUTBREAKS

Health services, already badly weakened when the war broke out in mid-April, have been further eroded.

"We have at least six major disease outbreaks, including cholera," said Brennan.

"We've also got outbreaks of measles and dengue fever, of vaccine-derived polio, of malaria and so on. And hunger levels are soaring as well because of the lack of access of food."

Diplomats and aid workers say that the army and officials aligned with it have hampered humanitarian access as both sides pursue their military campaigns. Activists say neighbourhood volunteers have been targeted.

They say the RSF does little to protect aid supplies and workers, and that its troops have been implicated in cases of looting. Read more.

Both sides have denied impeding aid.

The army and the RSF shared power with civilians after a popular uprising in 2019, staged a coup together in 2021, then came to blows over their status in a planned transition towards elections.

U.N. humanitarian chief Martin Griffiths said in a statement last week that the reasons aid was not getting through were "frankly outrageous".

Customs clearances for supplies coming into the country could take up to 18 days, with further inspections under military supervision that could take even longer, he said.

Photo: A volunteer stirring food to be distributed to people in Omdurman, Sudan, September 3, 2023. REUTERS/El Tayeb Siddig/File Photo

Photo: People hold pots as volunteers distribute food in Omdurman, Sudan, September 3, 2023. REUTERS/El Tayeb Siddig/File Photo

View original: https://www.reuters.com/world/africa/agencies-consider-new-aid-route-into-sudan-humanitarian-crisis-worsens-2024-01-15/

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Sudan: 500,000 Sudanese refugees in Chad in dire need of aid. Testimonies recount unspeakable horrors

“Testimonies recount unspeakable horrors - family members killed, women enduring heinous acts of abduction and sexual violence, and homes reduced to ashes. Despite the tireless efforts of humanitarian organisations and the welcoming gestures from the host communities and the government of Chad, the situation is close to catastrophic.” -Stephen Cornish, MSF Director General 

“They told us that this wasn’t our country and gave us two options: immediately leave for Chad or be killed. They took some men and I saw them shooting them in the streets, with no one to bury the corpses.” -H., A refugee who fled to Adre from El Geneina X

Source: Médecins Sans Frontières (MSF) aka Doctors Without Borders

Statement by Stephen Cornish, MSF Director General 

Dated 22 December 2023 - here is a copy in full:

Half a million Sudanese refugees in Chad in dire need of humanitarian aid

This week, I visited the camps in eastern Chad to witness the living conditions of Sudanese refugees. 

I have worked as a humanitarian worker in countries across the globe, but what I saw in Chad in this emergency has shocked me to my core.

With such a rapid and vast displacement of people fleeing harrowing violence, the overwhelming nature of how many people have sought refuge here and knowing what made them flee is really hard on the heart.

So many people seeking refuge in the desert are relying on humanitarian aid, which is inadequate and sporadic. This cannot go on. 

Despite the tireless efforts of humanitarian organisations and the welcoming gestures from the host communities and the government of Chad, the situation is close to catastrophic.

From insufficient access to food, water and shelter, to concerns about proper hygiene, it’s a daily struggle for those who have left almost everything behind. Approximately 150,000 individuals in Adre transit camp and the surrounding areas live week to week, navigating through precarious conditions to survive.  

The limited food distributions happen irregularly and the amount distributed typically lasts only a couple of weeks. On top of that, not everyone is receiving these distributions.

In Adre, there’s one latrine for 300 to 400 people - far below the recommend standards. Despite tremendous efforts put forth by Médecins Sans Frontières (MSF) and local partners, delivering half a million litres of water daily, refugees only receive between six to eight litres per day.

People don't have enough water to bathe, to clean, or to cook. They don’t have suitable jerry cans in order to be able to collect and store water properly.

We've already seen a very high incidence of malnutrition, as well as high numbers of people suffering from diarrhoea and malaria. Speaking with the doctors here this week, the number of cases of malaria has decreased but it is still widespread.  

Our role now is to ensure enough assistance together with other partners going forward so we don't end up in another catastrophic situation several months down the road. Today, people can survive for the next couple of months, but what will happen after that?  

An elderly person collects water from a distribution point. Refugees here only receive between six to eight litres per day for drinking, bathing, cooking and cleaning. Chad, 7 December 2023. 

RENAUD MASBEYE/MSF

There are many organisations here on the ground, but they don't have the financial resources to meet the needs of the people. So, we need governments, we need donor countries to help organisations on the ground to scale up and meet the emergency needs, from shelter to water to food.  

The people suffering in this crisis are predominantly women and children, while many are also victims of large-scale violence.

Their testimonies recount unspeakable horrors - family members killed, women enduring heinous acts of abduction and sexual violence, and homes reduced to ashes. Their sole aspiration is to find a safe haven in Chad and be able to live in decent and dignified conditions.  

These people, relocated in the desert, cannot face this ordeal alone. This cannot be put aside and forgotten as just another crisis. Solid and sustained humanitarian commitments, and an urgent scale up of aid efforts on the ground are urgently required to avoid a catastrophic crisis and large-scale misery in the months to come. 

View the original report:

English  https://www.msf.org/half-million-sudanese-refugees-chad-dire-need-humanitarian-aid

Arabic https://www.msf.org/ar/نصف-مليون-لاجئ-سوداني-في-تشاد-في-حاجة-ماسة-للمساعدات-الإنسانية

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Sudan & South Sudan: Cholera crosses the Sudanese border and bursts into South Sudan refugee camps

THANKS to Lola Hierro (Hola Lola!) for informative reports and photos from Renk, South Sudan. At the Renk Transit Center, which has a capacity of 3,000 people, there are more than 16,000 current residents, and the roads that connect this out-of-the-way corner to the rest of the country are waterlogged by floods caused by end-of-summer rains. Renk’s risk lies in the fact that this [Vibrio cholerae] bacillus is transmitted through contact with contaminated foods and liquids, in conditions of overcrowding and lack of safe access to water and sanitation. Read more in this report.

From EL PLAIS

By LOLA HIERRO (Renk / Madrid)
Dated Tuesday, 12 December 2023 - 23:40 WET - full copy:

Cholera crosses the Sudanese border and bursts into South Sudan refugee camps

The Ministry of Health confirms a positive case in the Renk Transit Center, located in the north of the country, where thousands of displaced people are living shoulder to shoulder

Waiting room of the clinic located at the Renk Transit Center in northern South Sudan. ALA KHEIR (UNHCR)

South Sudan’s Ministry of Health has confirmed the first case of cholera in Renk, a city in the far north of the country that is suffering a humanitarian crisis amidst the thousands of people from Sudan who have been displaced since war broke out last April. Sudan has been struggling against an outbreak of the diarrheal disease since September 26 and to date has documented 4,000 cases and 130 deaths.

“The public is advised not to panic, as measures have been put in place to respond to this threat,” the ministry has announced. Nonetheless, in Renk, general sentiment is very different, as described via WhatsApp by Atsuhiko Ochiai, coordinator of a Doctors Without Borders (DWB) clinic located in the Zero settlement of Renk, which has more than 3,500 residents. “[The situation] is getting worse. More people come from Sudan all the time and the water, latrines, food, plastic sheets, hygiene kits, etcetera, are just not enough. Open-air defecation is common,” he warns.

Doctor Ochiai’s fears are due to a minimal health infrastructure. More than 400,000 people have crossed the border in the last eight months. They arrive in impoverished conditions, without money, without a home in which to stay, with no hope of feeding or cleaning themselves or accessing any service beyond what meager humanitarian aid they can obtain. That’s because all the most important United Nations agencies and nonprofits are present in Renk, but the funds available to help the population are not sufficient: only 32% of the more than 225 million euros required by the UN refugee agency (UNHCR) have been covered. At the Renk Transit Center, which has a capacity of 3,000 people, there are more than 16,000 current residents, and the roads that connect this out-of-the-way corner to the rest of the country are waterlogged by floods caused by end-of-summer rains.

A woman cares for her son, who has been admitted to the hospital in Renk, northern South Sudan. ALA KHEIR (UNHCR)

Cholera presents a public health problem in 47 of the world’s poorest countries, where between 1.3 and four million cases are registered annually. The illness is caused by the Vibrio cholerae bacteria, which provokesd intense diarrhea, up to 20 liters a day, which can kill a person within four hours. With adequate treatment — rehydration and antibiotics in the most severe of cases— the death rate does not rise above 1%, but without it, it can soar to 50%.

Renk’s risk lies in the fact that this bacillus is transmitted through contact with contaminated foods and liquids, in conditions of overcrowding and lack of safe access to water and sanitation. This is precisely the scenario in the far north of South Sudan. If the region was already living in poverty and had been punished by nearly a decade of violence caused by internal conflicts, with 74% of the population in need of humanitarian aid, the waves of Sudanese and South Sudanese returnees from the new war have only worsened the situation.

The cholera patient identified at the transit center, a 38-year-old man who had recently crossed the border between the two states, has recovered. For the time being, no other positive cases have been reported. But the fear of new cases is very present. “When community-wide transmission of cholera happens in Renk, it will be catastrophic,” Ochiai predicts.

Doctor Francisco Luquero is the head of the team responsible for high-risk epidemic programs at the Global Alliance for Vaccines and Immunization (GAVI) and was in South Sudan during the 2014-2017 outbreak that affected more than 28,000 people. The doctor explains that since 2019 there have been hardly any cases, and those that have appeared have been very mild thanks to the country’s efforts to control the previous outbreak and the prevention campaigns that have been orchestrated “We know that in these scenarios there is a high risk of transmission and that in these areas it is difficult to provide adequate treatment, so there is concern,” he says over the phone.

With Sudan’s outbreak in mind, World Health Organization (WHO) mechanisms have been activated to avoid cholera’s arrival. These mainly involve the promotion of personal hygiene, especially hand-washing, raising awareness in communities, and distributing hygiene supplies to 3,000 households, including domestic items for transporting water like disinfectants and purifiers. But such measures are nearly impossible to implement when there are thousands of people sleeping outdoors, on muddy ground where rainwater stagnates and forms putrid puddles, and where there is no sewage system or toilets.

Water stagnates between tents where thousands of refugees survive in Renk. ALA KHEIR

A month before cholera had its opening act, fears were already present. In Zero’s mobile clinic, doctor Ferida Manoah hardly had time for a break: many small patients required her attention. Patients like Nya, María’s daughter. The little girl, at just over a year old, was due for a medical check-up. Her mother brought her to the health center, accessible only by a long row of sandbags that had been placed over the stagnant water.

Since she was apparently healthy, María only received some tips on nutrition and hygiene. Above all, the latter. “We have a large number of diarrhea cases and we’ve suspected the presence of typhus, but we aren’t able to test,” said Mahoah. Before the cholera outbreak, diarrhea was the third leading cause of mortality in Renk, after malaria and pneumonia.

A simple, but elusive remedy

The plan to address cholera begins with giving specific information to all health staff and community workers on how to inform authorities if they detect a suspicious case. Until there is confirmation, an outbreak is not announced, but independent of test results, it’s very important to provide treatment to patients to avoid death by dehydration.

Blocking the entrance of the illness at the border would be ideal, but in practice that turns out to be nearly impossible. The International Organization for Migration (IOM) has health stations open from 6 a.m. to 8 p.m., which means that for 10 hours a day there is no one available to test. Not to mention, with 2,000 to 3,000 people crossing every day, even if the stations were open 24 hours, it would be very difficult to evaluate everyone who passes through.

Drinking water station in the field of Joda, where thousands of people wait weeks to be transported to the Renk Transit Center in South Sudan. 

LOLA HIERRO

Luquero thinks that prevention at the border is not realistic because similar to people affected by Covid-19, a patient can be contagious and also asymptomatic, something that occurs in 80% of cases. Nonetheless, for him it “is super necessary to replenish kits to treat the sick, because rehydration saves lives.”

The GAVI leader trusts in the skills South Sudan showed in the past thanks to its prevention strategy. “South Sudan has taken a lot of initiative in vaccination, reactive as well as preventative,” he says. They have implemented various campaigns and since 2019, received more than three million doses through the Global Task Force on Cholera Control. “It’s true that it’s a very fragile country, but it’s also a case in which they’ve been able to successfully control a national outbreak,” he says.

Immunization campaigns, however, have not yet arrived to Renk. Luquero thinks it would be best to solicit them as soon as possible from the International Coordinating Group (ICG) on Vaccine Provision, which is in charge of emergency requests. “It’s one method that can be used to access the doses more quickly, linked to the humanitarian crisis in the north, without having to make a global vaccination plan,” he says. “What we need to do is to make a good epidemiological assessment as quickly as possible and, based on that, send the vaccine request as quickly as possible. And I emphasize speed.”

View original: https://english.elpais.com/international/2023-12-12/cholera-crosses-the-sudanese-border-and-bursts-into-south-sudan-refugee-camps.html

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Conflict in Sudan is world’s largest displacement crisis

ABOUT 19 MILLION SUDANESE CHILDREN are awaiting schools to re-open. For children, education is about more than the right to learn. Schools can protect children from the physical dangers around them – including abuse, exploitation, and recruitment into armed groups. Should the conflict result in schools remaining closed, this will have devastating impacts on children’s development and psychosocial well-being. Read more.

News and Press Release 

Source OCHA 

Posted 2 Nov 2023 

Originally published 2 Nov 2023

Sudan: Humanitarian Key Messages (November 2023)

● More than six months since fighting erupted on 15 April, Sudan is experiencing a humanitarian crisis of epic proportions. Civilians are paying the price of the ongoing fighting. About half of the population – 24.7 million people, including 14 million children – needs humanitarian aid and protection assistance.
About 5.8 million people are displaced inside Sudan or have fled to neighbouring countries, half of whom are children. Women make up 69 per cent of the internally displaced persons (IDPs), including those in war zones, and data from Chad indicates that 90 per cent of the refugees crossing the borders are women and girls. Similarly in Egypt, the UN Refugee Agency (UNHCR) has recorded that most of the registered households upon crossing the borders were female-headed ones. The conflict – and surging hunger, disease and displacement – threatens to consume the entire country. It is time to silence the guns.

● Millions of people – especially in Khartoum, Darfur and Kordofan – lack access to food, water, shelter, electricity, education, health care and nutrition. As the humanitarian situation deteriorates, the communities’ coping capacity has weakened. Hunger and malnutrition were already at record levels before the fighting, now, an estimated 20.3 million people – 42 per cent of the population – face acute food insecurity. Of these, 6.3 million people are at emergency levels of hunger, only one step away from famine. Over 18 million people lack access to improved sanitation and around 8 million people practice open defecation. About 3.5 million children under five years are acutely malnourished, of whom 700,000 suffer from severe acute malnourishment and are at 11 times higher risk of death compared with their healthy peers. This adds to the burden of care on women and girls and exposes them to multiple risks in the context of the armed conflict.

● Parties to the conflict must put an end to harming civilians and respect international humanitarian law, as agreed under the Jeddah Declaration of Commitment to Protect the Civilians of Sudan. The parties must allow civilians safe passage. People fleeing conflict – especially women, children and those with special needs – must be able to do so safely. Attacks on hospitals, schools and other essential civilian infrastructure must stop. Access to critical items and services must be guaranteed. All health facilities occupied by parties to the conflict must be vacated. De-escalation, dialogue and a cessation of hostilities are essential to resolve the crisis.

● The spread and escalation of fighting is deeply concerning, especially as the conflict reaches new areas. Hostilities have started to spill over into Aj Jazirah State, Sudan’s breadbasket, which could have grave consequences for the harvest season and agricultural productivity. Shortages of critical inputs like seeds and fertilizers coupled with erratic weather patterns threaten both planting and harvesting. A below average harvest in the coming months would push more people into hunger and others into more severe levels of hunger.

● Protection remains an urgent priority, with an increasing number of reports of sexual and genderbased violence, enforced disappearance, arbitrary detention, and grave violations of human and children’s rights. Parties to the conflict should not use rape as a weapon of war and those accused of it should be held accountable. As inter-communal tensions mount, the ability to access protection services and support systems reduces. Civilians are at risk of explosive hazards, though the extent and level of new contamination is unknown. Parties to the conflict must protect civilians, including children, from grave violations of their rights.

● The war in Sudan is now the world’s largest displacement crisis. As more refugees flee across Sudan’s borders, host communities in neighbouring countries are struggling. A protracted conflict in Sudan could tip the entire region into a humanitarian catastrophe. Humanitarian partners are working closely with governments in neighbouring countries to respond. New arrivals need protection and assistance.
Moreover, host communities in remote border areas, where services and infrastructure are scarce or non-existent, were already suffering due to climate shocks and food scarcity.

● Outbreaks of diseases pose a growing threat, particularly in overcrowded shelter sites and sites with poor water, sanitation and hygiene. Sudan is already facing outbreaks of cholera, dengue, measles, and malaria. Even in relatively safe locations hosting displaced populations, living conditions are deteriorating. Displacement sites have been flooded during the rainy season, raising the risk of further spread of deadly diseases. Partners must step up to contain ongoing disease outbreaks and mitigate the risks of potential outbreaks. Projections based on Johns Hopkins’ Lives Saved Tool modelling indicate that at least 10,000 children under five years may die by the end of 2023 due to an increase in food insecurity, and disruptions to essential services.

● About 19 million children are awaiting schools to re-open. For children, education is about more than the right to learn. Schools can protect children from the physical dangers around them – including abuse, exploitation, and recruitment into armed groups. Schools serve as centres for multiple services. Children can be reached with life-saving information, food, water, immunizations, healthcare, and hygiene supplies. Teachers and other education personnel can support children’s mental health, providing children with stability and structure to help them cope with the trauma they experience every day and referring children for any necessary additional support. Should the conflict result in schools remaining closed, this will have devastating impacts on children’s development and psychosocial well-being.

● Humanitarians continue to face immense obstacles to assist people in need. Bureaucratic and administrative impediments must be lifted so that aid workers can move supplies more swiftly. Visas, travel permits, and other procedures required to move staff and assistance inside the country delay the delivery of assistance. Looting and attacks against humanitarian personnel, facilities and supplies further compromise the ability of partners to deliver aid and services. The parties to the conflict must adhere to international humanitarian law and guarantee unhindered access for humanitarian personnel and supplies. Aid convoys face threats, roadblocks, restrictions and bureaucratic impediments, while intensified airstrikes and shelling in Khartoum make safe access almost impossible.

● Despite the challenges, humanitarian agencies in Sudan have made strides in accessing people across Sudan, including in hard-to-reach areas. Through both crossline and cross-border movements, convoys have reached East Darfur, North Darfur, South Darfur, West Darfur, North Kordofan states, Jabal Awlia in Khartoum, and other areas. More than 3.7 million people have received lifesaving food, emergency shelter, health, nutrition, protection, water, sanitation and hygiene (WASH) and other assistance since 15 April. An estimated 5.2 million people received livelihood assistance. Aid must be scaled up and sustained to reach more people in desperate need. To expand assistance to people in hard-to-reach areas, innovative approaches to working with communities are critical.

● Additional resources are urgently required to support a humanitarian response that was already significantly underfunded prior to the current conflict. Humanitarian actors require US$2.6 billion to provide life-saving multi-cluster assistance and protection services to 18.1 million people through the end of this year. So far, only 33.6 per cent has been received. Additional funds are urgently needed to meet immense needs, including critical funding to national NGOs on the frontlines of the response.

Disclaimer

UN Office for the Coordination of Humanitarian Affairs (OCHA)

To learn more about OCHA's activities, please visit https://www.unocha.org/

View full story and map: https://reliefweb.int/report/sudan/sudan-humanitarian-key-messages-november-2023

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Infographic: Sudan Key Figures (1 November 2023)

Source OCHA 

Posted 2 Nov 2023 

Originally published 2 Nov 2023

Download Infographic(PDF | 518.65 KB)

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