What has caused the cholera outbreak in Sudan?

More than 350 cases of cholera have been recorded in a new outbreak in Sudan in just a few weeks.

The difficulties in reaching and registering victims amid the continuing humanitarian crisis caused by the country’s civil war have led experts to speculate that many more people than this may have been infected, however.

Health Minister Haitham Mohamed Ibrahim said at least 22 people have died from the disease and declared a cholera epidemic after several weeks of heavy rain, which has contaminated drinking water.

The cholera epidemic is just the latest crisis for Sudan, where fighting between the army and the Rapid Support Forces (RSF), a paramilitary group, has been spreading around the country since April 2023.

Cholera is not new to Sudan. In 2017, a previous outbreak killed at least 700 people and infected about 22,000 in less than two months.

Outside of this latest outbreak, the World Health Organization (WHO) has recorded 78 deaths from cholera between the start of this year and July 28 in Sudan, while some 2,400 people have been infected across the country as a whole.

But what is behind this latest outbreak, and how far has it spread? Here’s what we know so far:

Where has cholera broken out?

The Sudanese health ministry first reported this latest outbreak two weeks ago, when 17 people had died from the disease and 268 cases had been reported in Kassala, El Gezira and Khartoum. This has now risen to 22 deaths and 354 cases.

Sudan has been experiencing particularly heavy seasonal rains since June, with floods killing dozens of people. According to the UN International Organization for Migration (IOM), more than 20,000 people have been displaced by the flooding across 11 of Sudan’s 18 states since June.

Water supplies have also become contaminated with cholera due to the floodwaters mixing with sewage.

WHO spokesperson Tarik Jasarevic told the Associated Press that data showed that most of the detected cases were in people who had not been vaccinated against cholera.

He added the WHO was working with the Sudanese health authorities and partners to implement a vaccination campaign across the nine localities in five provinces where the disease has been recorded.

What is cholera?

Cholera is a bacterial disease usually spread through contaminated water. It is spread when people drink infected water, when people with open wounds have direct contact with the contaminated water, and, in some cases, when they eat raw shellfish.

It cannot be transmitted from person to person, so casual contact with a person who has the disease is not a risk.

The disease causes severe diarrhoea and dehydration. If the disease is left untreated, cholera can kill within hours – even people who were previously healthy.

While the disease might not cause illness to everyone exposed to it, infected people can still pass the bacteria in their stool, contaminating food and water supplies. This is a particular problem where there are no working sanitation facilities.

How is cholera treated?

Treatment for cholera includes rehydration to replace the lost fluids.

According to the Mayo Clinic, a US academic medical centre, without rehydration, “half the people with cholera die. With treatment, fatalities drop to less than 1 percent”.

Other treatments include intravenous fluids, antibiotics and zinc supplements.

Children under the age of five have the highest rates of infection, but all age groups are at risk, especially those suffering from malnutrition, those who are immunocompromised or who lack prior vaccination.

Why is cholera spreading in Sudan?

The war in Sudan has damaged and destroyed much of the country’s civilian infrastructure, including sewage and water treatment works, and turned many places, including the capital, Khartoum, into battlefields.

Many hospitals and medical facilities have been forced to close their doors as they have minimal or no supplies.

While the overall death toll resulting from the conflict remains unclear, some estimates, according to US envoy to Sudan Tom Perriello, are as high as 150,000 people so far.

In June, the IOM reported that more than 10 million people had been displaced within Sudan due to the conflict. Cholera spreads more quickly when populations are displaced and sanitation and hygiene become poor, making war zones the perfect climate for the disease to spread.

On top of this, according to the World Food Programme (WFP), the heavy rainy season has heavily exacerbated the already dire situation, making it harder for aid convoys to pass through the muddy, flooded roads.

The WFP reported on Monday that the organisation originally aimed to reach half a million people, but convoys are “currently stranded on the Chad side, with heavy rainfall making it largely impassable – some trucks have been stuck for up to two weeks”.

“Preventable diseases [are spreading] quickly in areas where critical infrastructure, like clean water and sanitation systems, has been damaged by conflict and in overcrowded displacement camps,” the WFP said.

Will the cholera epidemic in Sudan get worse?

According to the WFP, the heavy rainfall is forecast to last until September.

Some forecasts warn that “flooding could surpass the historic 2020 floods that hit Khartoum,” the organisation said.

Despite the WFP’s warning of the dire humanitarian situation in the country, the war is continuing.

On Sunday, the army said it would send a delegation to meet with US officials in Cairo following US pressure to join the ongoing peace talks in Switzerland, which aim to end the conflict and the subsequent humanitarian crisis.

Director of John Hopkins Center for Humanitarian Health, Paul Spiegel, also told Al Jazeera that cholera “thrives during conflict and forced displacement”.

“These conditions make it incredibly challenging to control cholera outbreaks, leading to rapid transmission and devastating consequences for affected communities,” he said.

Spiegel added while an active conflict makes traditional methods of controlling an outbreak difficult, health officials “must be flexible and innovative, and take advantage of the different contexts” within Sudan to mitigate the spread of disease.

Are other diseases on the rise in Sudan?

On Friday, WHO official Margaret Harris said that dengue fever and meningitis infections were also on the rise in Sudan due to dire living conditions as a result of the 16-month-long war.