Sudan war hits 1,000 days as WHO calls it the world’s worst health crisis

The war in Sudan has entered its thousandth day with a stark new designation from the United Nations’ top health agency: the world’s worst health and humanitarian crisis.

Nearly 34 million people in Sudan — about two-thirds of the country’s prewar population — are expected to need some form of aid this year, according to the World Health Organization and other U.N. agencies. More than 13 million have been forced from their homes, in what the United Nations now calls the largest displacement crisis on the planet.

In a statement issued Jan. 9 to mark 1,000 days since fighting erupted between Sudan’s rival military factions, WHO said the conflict has “deepened the world’s worst health and humanitarian crisis,” with millions of people cut off from medical care, food and clean water as disease outbreaks spread across the country.

“Sudan has become the worst humanitarian crisis globally,” the agency said, warning that a convergence of war, hunger and epidemic disease is overwhelming what remains of the health system and pushing parts of the country toward famine.

A health system under attack

Sudan’s health system, already fragile before the war, has been gutted by almost three years of violence.

WHO estimates that 37% of health facilities nationwide are nonfunctional, with many others operating only partially because of damage, looting, staff flight and shortages of fuel, electricity and supplies. Since fighting began in April 2023, there have been at least 201 verified attacks on health care, including strikes on hospitals and clinics, resulting in 1,858 deaths and 490 injuries, the agency said.

Hospitals that are still open are struggling to cope with surging numbers of wounded patients and people suffering from preventable diseases. Doctors report operating without anesthesia, ventilators or basic medicines, and say some facilities have been occupied by fighters from both sides of the conflict.

WHO says it and its partners have delivered more than 3,000 metric tons of medicines and supplies into Sudan since the war began and have supported at least 48 health organizations. The agency estimates that about 3.3 million people have received treatment at WHO-backed health facilities and mobile clinics. But with more than 20 million Sudanese now in need of health assistance, officials acknowledge the response is far from meeting the scale of the emergency.

“This is an extreme health and humanitarian crisis,” WHO Director-General Tedros Adhanom Ghebreyesus said after a visit to Port Sudan last year. He warned that the country was “living through a nightmare” and urged donors “not to forget the people of Sudan.”

Layered epidemics: cholera, dengue, malaria and measles

The collapse of basic services has fueled a cascade of disease outbreaks.

Cholera has been reported in all 18 states, WHO says, driven by contamination of water sources, damage to sanitation infrastructure and overcrowded displacement camps. Health agencies and local authorities have carried out one of the largest cholera vaccination campaigns ever mounted in an active conflict, reaching nearly 24 million people with oral vaccines. Even so, suspected cases continue to climb, and aid groups report that some treatment centers are overwhelmed.

Dengue fever, carried by mosquitoes breeding in stagnant water and refuse, has spread to at least 14 states. Malaria, already endemic in Sudan, is reported in 16 states, exacerbated by the breakdown of mosquito-control programs and shortages of bed nets and diagnostics.

At the same time, measles and other vaccine-preventable diseases are resurging as immunization campaigns falter. U.N. agencies say millions of children have missed routine vaccinations since the war began, leaving large pockets of unprotected children in displacement sites and besieged communities.

Malnutrition is compounding the crisis. WHO reports that more than 112,000 children with severe acute malnutrition and medical complications have been treated in stabilization centers it supports, but warns many more are unable to reach care. Humanitarian assessments indicate several areas — particularly in parts of Darfur and the Nuba Mountains — have crossed into famine conditions, with children and older people dying from hunger-related causes.

A nation uprooted

The war has uprooted Sudan on a scale U.N. officials say now surpasses the displacement crises in Syria, Ukraine and other recent conflicts.

WHO and other agencies estimate about 13.6 million people have been forced to flee their homes since April 2023, including those displaced inside Sudan and refugees who have crossed into neighboring countries. The U.N. describes it as the largest displacement crisis in the world, with roughly one in three Sudanese now living away from their original communities.

Families have fled intense fighting in the capital, Khartoum, and in central regions such as Gezira and Sennar, as well as longstanding conflict zones in Darfur and Kordofan. Many have been displaced multiple times as front lines shift. Some have returned to devastated neighborhoods with no functioning services, a choice they describe as one between insecurity and destitution.

Children have borne a heavy share of the disruption. UNICEF says about 17 million children in Sudan are currently out of school, effectively shutting down the country’s education system. Aid groups warn of rising child labor, recruitment by armed groups, and heightened risks of sexual and gender-based violence in and around camps and overcrowded settlements.

How the war unfolded

The crisis stems from a power struggle that erupted into open warfare on April 15, 2023, between the Sudanese Armed Forces, led by Gen. Abdel Fattah al-Burhan, and the Rapid Support Forces, a powerful paramilitary group commanded by Gen. Mohamed Hamdan Dagalo, widely known as Hemedti.

The two men had jointly seized power in a 2021 coup that derailed Sudan’s fragile transition toward civilian rule. But tensions deepened over plans to integrate the RSF into the regular army and over control of key economic and security structures. When fighting broke out in Khartoum, it quickly spread.

In the first months of the war, residents of the capital endured artillery exchanges, airstrikes and street battles as both sides sought to control government institutions, airports and military bases. The RSF consolidated positions in Khartoum and extended its reach across much of Darfur and parts of Kordofan and Gezira. The army retained influence in the northeast and in some garrison towns, while relying on air power and allied militias.

Rights groups and U.N. investigators have documented widespread violations by both parties, including indiscriminate shelling of populated areas, looting, arbitrary detentions and sexual violence. In Darfur, researchers and officials have reported mass killings, destruction of entire neighborhoods and what some have described as a second wave of ethnic cleansing targeting non-Arab communities, especially the Masalit.

In and around the city of El Fasher in North Darfur, months of siege and fighting culminated in a large-scale assault in late 2025. Local medical workers and aid agencies have reported thousands of civilian deaths there and in nearby displacement camps. Overall casualty estimates vary widely, with confirmed figures in the tens of thousands but modeling studies suggesting that direct violence, hunger and disease together may have already killed well over 100,000 people.

A regional emergency

Sudan’s war is reshaping the humanitarian landscape across a swath of northeast and central Africa.

Chad has received hundreds of thousands of Sudanese refugees, many arriving in remote desert areas with little infrastructure. Health workers there report rising cases of malaria, measles and hepatitis E in crowded camps and host communities, on top of severe malnutrition.

South Sudan has seen more than 1.5 million people arrive from Sudan, including both Sudanese refugees and South Sudanese returning after years away. Its already-strained health system has struggled with outbreaks of cholera, with tens of thousands of cases and hundreds of deaths recorded since late 2024.

Egypt has absorbed approximately 1.5 million Sudanese people since the war began, according to U.N. figures. While Egypt’s public health system formally offers services under its national insurance scheme, advocacy groups say Sudanese refugees often face higher costs, bureaucratic hurdles and overcrowded facilities.

U.N. officials warn that if the war and humanitarian crisis in Sudan continue unchecked, they risk further destabilizing fragile neighbors and fueling new cycles of conflict and displacement.

Funding falls as needs surge

Despite the scale of the emergency, aid agencies say they are struggling to secure the funding and access needed to respond.

The 2025 Sudan Humanitarian Response Plan, coordinated by the U.N. Office for the Coordination of Humanitarian Affairs, requested about $4.2 billion to assist roughly 21 million of the most vulnerable people. By March 2025, it was only about 6% funded, and even by midyear had reached just over one-fifth of the required amount.

A separate regional plan to support Sudanese refugees and returnees in seven neighboring countries sought roughly $1.18 billion for 2025. That appeal also lagged badly, with only a small fraction of the target financed in its early months.

Senior U.N. officials have warned some donors have reduced or delayed contributions as humanitarian budgets worldwide come under pressure from conflicts in Ukraine and Gaza, economic slowdowns and rising domestic costs. The global humanitarian appeal for 2026 was trimmed from an initial $47 billion to around $33 billion, reflecting what aid leaders describe as a widening gap between escalating needs and available resources.

“The reduction in life-saving funding comes as 21 million people in Sudan require humanitarian assistance,” the U.N.’s top official in the country said in an appeal last year, calling the cuts a “catastrophic blow” to efforts to stave off famine and disease.

A test of the world’s resolve

WHO’s decision to label Sudan the world’s worst health and humanitarian crisis underlines the gravity of the situation — and a broader concern among aid officials that even emergencies of this magnitude can slip from the forefront of international attention.

For people inside Sudan, the designation changes little in the short term. What matters most, humanitarian workers say, is whether it spurs sustained access for relief convoys, stronger protections for health care and civilians, and the resources needed to keep hospitals, feeding centers and water systems functioning under fire.

For governments and institutions watching from afar, the crisis has become a test of how the international system responds when the worst-case scenario is not a sudden catastrophe but a slow, grinding combination of war, hunger and preventable disease. As the conflict pushes deeper into its third year, the question is whether the warning from the world’s health agency will be followed by the political and financial commitments needed to change the trajectory — or remembered as another alarm raised too late, in a country where the cost of inaction is measured in lives lost far from the headlines.