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.



New Mpox Strain Is Changing Fast; African Scientists Are ‘Working Blind’ to Respond 

Dr. Robert Musole, medical director of the Kavumu hospital (R) consults an infant suffering from a severe form of mpox at the Kavumu hospital, 30 km north of Bukavu in eastern Democratic Republic of Congo, August 24, 2024. (AFP)
Dr. Robert Musole, medical director of the Kavumu hospital (R) consults an infant suffering from a severe form of mpox at the Kavumu hospital, 30 km north of Bukavu in eastern Democratic Republic of Congo, August 24, 2024. (AFP)
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New Mpox Strain Is Changing Fast; African Scientists Are ‘Working Blind’ to Respond 

Dr. Robert Musole, medical director of the Kavumu hospital (R) consults an infant suffering from a severe form of mpox at the Kavumu hospital, 30 km north of Bukavu in eastern Democratic Republic of Congo, August 24, 2024. (AFP)
Dr. Robert Musole, medical director of the Kavumu hospital (R) consults an infant suffering from a severe form of mpox at the Kavumu hospital, 30 km north of Bukavu in eastern Democratic Republic of Congo, August 24, 2024. (AFP)

Scientists studying the new mpox strain that has spread out of Democratic Republic of Congo say the virus is changing faster than expected, and often in areas where experts lack the funding and equipment to properly track it.

That means there are numerous unknowns about the virus itself, its severity and how it is transmitting, complicating the response, half a dozen scientists in Africa, Europe and the United States told Reuters.

Mpox, formerly known as monkeypox, has been a public health problem in parts of Africa since 1970, but received little global attention until it surged internationally in 2022, prompting the World Health Organization to declare a global health emergency. That declaration ended 10 months later.

A new strain of the virus, known as clade Ib, has the world's attention again after the WHO declared a new health emergency.

The strain is a mutated version of clade I, a form of mpox spread by contact with infected animals that has been endemic in Congo for decades. Mpox typically causes flu-like symptoms and pus-filled lesions and can kill.

Congo has had more than 18,000 suspected clade I and clade Ib mpox cases and 615 deaths this year, according to the WHO. There have also been 222 confirmed clade Ib cases in four African countries in the last month, plus a case each in Sweden and Thailand in people with a travel history in Africa.

"I worry that in Africa, we are working blindly," said Dr. Dimie Ogoina, an infectious diseases expert at Niger Delta University Hospital in Nigeria who chairs the WHO's mpox emergency committee. He first raised the alarm about potential sexual transmission of mpox in 2017, now an accepted route of spread for the virus.

"We don’t understand our outbreak very well, and if we don't understand our outbreak very well, we will have difficulty addressing the problem in terms of transmission dynamics, the severity of the disease, risk factors of the disease," Ogoina said. "And I worry about the fact that the virus seems to be mutating and producing new strains."

He said it took clade IIb in Nigeria five years or more to evolve enough for sustained spread among humans, sparking the 2022 global outbreak. Clade Ib has done the same thing in less than a year.

MUTATING 'MORE RAPIDLY'

Mpox is an orthopoxvirus, from the family that causes smallpox. Population-wide protection from a global smallpox vaccine campaign 50 years ago has waned, as the vaccinating stopped when the disease was eradicated.

Genetic sequencing of clade Ib infections, which the WHO estimates emerged mid-September 2023, show they carry a mutation known as APOBEC3, a signature of adaptation in humans.

The virus that causes mpox has typically been fairly stable and slow to mutate, but APOBEC-driven mutations can accelerate viral evolution, said Dr. Miguel Paredes, who is studying the evolution of mpox and other viruses at Fred Hutchison Cancer Center in Seattle.

"All the human-to-human cases of mpox have this APOBEC signature of mutations, which means that it's mutating a little bit more rapidly than we would expect," he said.

Paredes and other scientists said a response was complicated by several mpox outbreaks happening at once.

In the past, mpox was predominantly acquired through human contact with infected animals. That is still driving a rise in Congo in clade I cases – also known as clade Ia - likely due in part to deforestation and increased consumption of bushmeat, scientists said.

The mutated versions, clade Ib and IIb, can now essentially be considered a sexually transmitted disease, said Dr. Salim Abdool Karim, a South African epidemiologist and chair of the Africa CDC’s mpox advisory committee. Most of the mutated clade Ib cases are among adults, driven at first by an epidemic among female sex workers in South Kivu, Congo.

The virus also can spread through close contact with an infected person, which is likely how clusters of children have been infected with clade Ib, particularly in Burundi and in eastern Congo’s displacement camps, where crowded living conditions may be contributing.

Children, pregnant women and people with weakened immune systems or other illnesses may be at greater risk of serious mpox disease and death, say the WHO and mpox scientists.

Clade I has typically caused more severe disease, with fatality rates of 4%-11%, compared to around 1% for clade II. Ogoina said data from Congo suggests few have died of the new Ib version, but he feared some data is being mixed up.

More research is urgently needed, but three teams tracking mpox outbreaks in Africa say they cannot even access chemicals needed for diagnostic tests. Clade Ib can also be missed by some diagnostic tests.

Planning a response, including vaccination strategies, without this is difficult, the scientists said.

Karim said around half of cases in eastern Congo, where Ib is particularly prevalent, are only being diagnosed by doctors, with no laboratory confirmation.

Getting samples to labs is difficult because the healthcare system is already under pressure, he said. And around 750,000 people have been displaced amid fighting between the M23 rebel group and the government.

Many African laboratories cannot get the supplies they need, said Dr. Emmanuel Nakoune, an mpox expert at the Institut Pasteur in Bangui, Central African Republic, which also has clade Ia cases.

"This is not a luxury," he said, but necessary to track deadly outbreaks.