Multistate cholera outbreak in Sudan amid ongoing armed conflict, 2023-2024

Background: In 2023, Sudan experienced a major cholera outbreak affecting 10 states amidst armed conflict that severely disrupted health services. Objectives: This study aimed to describe the magnitude and pattern of the cholera outbreak in Sudan amidst the armed conflict and provide timely insights. Methods: This was a retrospective record-based descriptive (cross-sectional) study. The study used surveillance data available at the national level (from August 2023 - February 2024). Epidemiological measurements were calculated, and data were analysed using Epi Info 7 software. Results: A total of 9,581 cases were reported in 10 states (with an overall attack rate (AR) of 3.5/10,0 0 0 people) and 238 reported deaths (with a crude case fatality ratio (CFR) of 2.48%). There was an observable variation in AR and CFR between the states. The duration of the outbreak varied across states, ranging from 4 to 18 weeks. Conclusions: Cholera caused significant mortality and morbidity, facilitated by conflict. To better address recurrent cholera and the challenges imposed by conflict, health authorities need to invest in communities through strengthening engagement, rising awareness and adopting community-based preparedness and response strategies. In addition, ensuring the readiness of the primary healthcare level requires training for healthcare workers and maintaining the flow of supplies. (c) 2025 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND IGO license ( http://creativecommons.org/licenses/by-nc-nd/3.0/igo/ )