Sudan’s War Began a Year Ago. Children Are among Its Most Fragile Survivors

Children walk at the school housing displaced Sudanese who fled violence in war-torn Sudan, near the eastern city of Gedaref, on March 10, 2024. (AFP)
Children walk at the school housing displaced Sudanese who fled violence in war-torn Sudan, near the eastern city of Gedaref, on March 10, 2024. (AFP)
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Sudan’s War Began a Year Ago. Children Are among Its Most Fragile Survivors

Children walk at the school housing displaced Sudanese who fled violence in war-torn Sudan, near the eastern city of Gedaref, on March 10, 2024. (AFP)
Children walk at the school housing displaced Sudanese who fled violence in war-torn Sudan, near the eastern city of Gedaref, on March 10, 2024. (AFP)

The war in Sudan began a year ago. Here in a remote camp for tens of thousands of people who have fled into neighboring Chad, the anniversary is marked by near starvation.

Assadig Abubaker Salih is a 42-year-old mother of six. The family survived the hot, dusty journey from their home to this sprawling camp of wind-whipped blue tents stretching in rows toward the horizon.

“We are in a very bad situation. We have suffered since we left our country. My husband died," she said. “There is nothing here. We need the essentials. We don’t even have sugar.”

Back home, Sudan's military, led by Gen. Abdel Fattah Burhan, is fighting the paramilitary group known as Rapid Support Forces, commanded by Gen. Mohammed Hamdan Dagalo, for greater resources. Sudan is home to around 45 million people.

Close to 9 million people have fled their homes, according to the United Nations, and more than 1 million have left the country. Thousands have been killed in a conflict overshadowed by the ones in Gaza and Ukraine. The UN says it has asked for $2.7 billion in funding to respond to humanitarian needs but has received $155 million — or 6%.

“It has been everyday Sudanese who have — often at great personal risk —stepped up to support each other,” Eatizaz Yousif, country director with the International Rescue Committee, said in a joint statement by aid groups urging the world to give more.

The UN has warned of an impending generational catastrophe. An estimated 3 million Sudanese children are malnourished. About 19 million children are out of school. A quarter of Sudan's hospitals are no longer functioning.

Aid organizations say women and children are bearing the worst of the conflict.

Even here, across the border, resources are stretched thin after more than 570,000 Sudanese arrived over the past year. Aid workers warn they are set to run out of some supplies within weeks. Shortages of water and ways to keep clean mean a growing risk of disease.

A growing number of children are arriving at the pediatric unit run by the Doctors Without Borders charity with pulmonary complications, a result of the harsh environment. The organization has also documented rising cases of hepatitis E, which can be deadly for pregnant women.

"Many, many of our babies are severely malnourished,” said Cordula Haffner, the Doctors Without Borders hospital coordinator at the camp. “The reason is hygiene, not enough food, not enough water. This is a crisis that will continue. We will see even more children like this.”

More than 16,000 children younger than 5 arriving in Chad from Sudan have had severe acute malnutrition, according to the UN — a stage where the effects of hunger are clearly visible.

Many people in this camp fled some of the conflict’s worst fighting in Sudan’s vast western region of Darfur. But the most desperate are trapped behind the front lines.

“We are seeing a catastrophe unfolding in North Darfur, where our teams have estimated that 13 children are dying each day of malnutrition and related health conditions at a camp for displaced people,” Avril Benoît, executive director of Doctors Without Borders in the US, said in a statement. She urged Sudanese authorities to stop blocking aid.

Some Sudanese manage to get help in time. One mother of six, Rachid Yaya Mohammed, said she came to the hospital at this camp in Chad because she is six months pregnant.

Two of her smallest children — twins — slept beside her.

Conditions are expected to worsen in the coming lean season between harvests, when food reserves are depleted and rains drive up rates of malaria.

Sudan plunged into chaos a year ago when clashes erupted in the capital, Khartoum, and spread.



Experts: Baby in Gaza Has Strain of Polio Linked to Mistakes in Eradication Campaign

The mother of Palestinian boy Abdul Rahman Abu Al-Jidyan, who is the first person to contract polio in Gaza in 25 years, gestures as she looks after him in their tent, in Deir Al-Balah, in the central Gaza Strip August 28, 2024. REUTERS/Ramadan Abed
The mother of Palestinian boy Abdul Rahman Abu Al-Jidyan, who is the first person to contract polio in Gaza in 25 years, gestures as she looks after him in their tent, in Deir Al-Balah, in the central Gaza Strip August 28, 2024. REUTERS/Ramadan Abed
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Experts: Baby in Gaza Has Strain of Polio Linked to Mistakes in Eradication Campaign

The mother of Palestinian boy Abdul Rahman Abu Al-Jidyan, who is the first person to contract polio in Gaza in 25 years, gestures as she looks after him in their tent, in Deir Al-Balah, in the central Gaza Strip August 28, 2024. REUTERS/Ramadan Abed
The mother of Palestinian boy Abdul Rahman Abu Al-Jidyan, who is the first person to contract polio in Gaza in 25 years, gestures as she looks after him in their tent, in Deir Al-Balah, in the central Gaza Strip August 28, 2024. REUTERS/Ramadan Abed

The baby in Gaza who was recently paralyzed by polio was infected with a mutated strain of the virus that vaccinated people shed in their waste, according to scientists who say the case is the result of “an unqualified failure” of public health policy.
The infection, which marked the first detection of polio in the war-torn Palestinian territory in more than 25 years, paralyzed the lower part of one leg in the unvaccinated 10-month-old child. The baby boy was one of hundreds of thousands of children who missed vaccinations because of the fighting between Israel and Hamas.
Scientists who have been monitoring polio outbreaks said the baby's illness showed the failures of a global effort by the World Health Organization and its partners to fix serious problems in their otherwise largely successful eradication campaign, which has nearly wiped out the highly infectious disease. Separately, a draft report by experts deemed the WHO effort a failure and “a severe setback.”
The polio strain in question evolved from a weakened virus that was originally part of an oral vaccine credited with preventing millions of children worldwide from being paralyzed. But that virus was removed from the vaccine in 2016 in hopes of preventing vaccine-derived outbreaks.
Public health authorities knew that decision would leave people unprotected against that particular strain, but they thought they had a plan to ward off and quickly contain any outbreaks. Instead, the move resulted in a surge of thousands of cases, The Associated Press reported.
“It was a really horrible strategy,” said Columbia University virologist Vincent Racaniello, who was not involved with the report or the WHO. “The decision to switch vaccines was based on an incorrect assumption, and the result is now we have more polio and more paralyzed children.”
A draft copy of the report commissioned by the WHO and independent experts said the plan underestimated the amount of the strain in the environment and overestimated how well officials would be able to squash outbreaks.
The plan led to vaccine-linked polio outbreaks in 43 countries that paralyzed more than 3,300 children, the report concluded.
Even before the Gaza case was detected, officials reviewing the initiative to tinker with the vaccine concluded that “the worst-case scenario has materialized,” the report said.
The report has not yet been published, and some changes will likely be made before the final version is released next month, the WHO said.
The strain that infected the baby in Gaza had lingered in the environment and mutated into a version capable of starting outbreaks. It was traced to polio viruses spreading last year in Egypt, according to genetic sequencing, the WHO said.
In 2022, vaccine-linked polio viruses were found to be spreading in Britain, Israel and the US, where an unvaccinated man was paralyzed in upstate New York.
Scientists now worry that the emergence of polio in a war zone with an under-immunized population could fuel further spread.
Racaniello said the failure to track polio carefully and to sufficiently protect children against the strain removed from the vaccine has had devastating consequences.
“Only about 1% of polio cases are symptomatic, so 99% of infections are silently spreading the disease,” he said.
The oral polio vaccine, which contains a weakened live virus, was withdrawn in the US in 2000. Doctors continued to vaccinate children and eventually moved to an injected vaccine, which uses a dead virus and does not come with the risk that polio will be present in human waste. Such waste-borne virus could mutate into a form that triggers outbreaks in unvaccinated people.
The report's authors faulted leaders at the WHO and its partners, saying they were unable or unwilling “to recognize the seriousness of the evolving problem and take corrective action.”
WHO spokesman Oliver Rosenbauer acknowledged that the vaccine strategy “exacerbated” the risk of epidemics linked to the vaccine.
He said in an email that immunization “was not implemented in such a way to rapidly stop outbreaks or to prevent new strains from emerging.” Rosenbauer said not hitting vaccination targets was the biggest risk for allowing vaccine-linked viruses to emerge.
“You need to reach the children with the vaccines ... regardless of which vaccines are used,” he said.
The WHO estimates that 95% of the population needs to be immunized against polio to stop outbreaks. The UN health agency said only about 90% of Gaza’s population was vaccinated earlier this year.
To try to stop polio in Gaza and the wider region, the WHO and its partners plan two rounds of vaccination campaigns later this week and next month, aiming to cover 640,000 children. Authorities will use a newer version of the oral polio vaccine that targets the problematic strain. The weakened live virus in the new vaccine is less likely to cause vaccine-derived outbreaks, but they are still possible.
Racaniello said it was “unethical” that the WHO and its partners were using a vaccine that is unlicensed in rich countries precisely because it can increase the risk of polio in unvaccinated children.
The oral polio vaccine, which has reduced infections globally by more than 99%, is easy to make and distribute. Children require just two drops per dose that can be administered by volunteers. The oral vaccine is better at stopping transmission than the injected version, and it is cheaper and easier to administer.
But as the number of polio cases caused by the wild virus have plummeted in recent years, health officials have been struggling to contain the increasing spread of vaccine-linked cases, which now comprise the majority of polio infections in more than a dozen countries, in addition to Afghanistan and Pakistan, where transmission of the wild virus has never been stopped.
“This is the result of the Faustian bargain we made when we decided to use" the oral polio vaccine, said Dr. Paul Offit, director of the Vaccine Education Center at the University of Philadelphia. “If we really want to eradicate polio, then we need to stop using the vaccine with live (weakened) virus.”