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War-Ravaged Sudan Battles Cholera Epidemic 

A sanitation worker sprays disinfectant, part of a campaign by Sudan's Health Ministry to combat the spread of disease, in Kassala state in eastern Sudan on August 20, 2024. (AFP)
A sanitation worker sprays disinfectant, part of a campaign by Sudan's Health Ministry to combat the spread of disease, in Kassala state in eastern Sudan on August 20, 2024. (AFP)
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War-Ravaged Sudan Battles Cholera Epidemic 

A sanitation worker sprays disinfectant, part of a campaign by Sudan's Health Ministry to combat the spread of disease, in Kassala state in eastern Sudan on August 20, 2024. (AFP)
A sanitation worker sprays disinfectant, part of a campaign by Sudan's Health Ministry to combat the spread of disease, in Kassala state in eastern Sudan on August 20, 2024. (AFP)

Lying on a hospital bed, Aisha Mohammed said she is "suffering" from cholera symptoms, an increasingly common ailment in Sudan where a prolonged war has ravaged the healthcare system.

Cholera, caused by contaminated water or food, had been common in Sudan particularly during the rainy season even before war broke out in April 2023 between rival generals.

But more than 16 months of fighting have forced most hospitals out of service, leaving the country of 48 million people struggling to control the sometimes deadly but treatable disease.

In the southeastern Sudanese town of Wad al-Hulaywah, 40-year-old Mohammed receives intravenous medicine to ease her crippling symptoms.

"I'm suffering from acute diarrhea," she whispered.

Sudanese authorities and the United Nations have reported a surge in cholera cases amid several weeks of torrential rains that have battered parts of Sudan and displaced thousands.

Rains and floods have contributed to a resurgence of the largely waterborne disease, which can cause severe dehydration and lead to death within hours if not treated.

The health ministry on Monday declared an epidemic, later reporting 556 cholera cases including 27 deaths, most in Kassala state where Wad al-Hulaywah is located.

Nearby Gedaref state has also been hit particularly hard, the ministry said.

The World Health Organization said Sudan has had at least 11,327 cholera cases, 316 of them deadly, since June 2023.

Sudan's Health Minister Haitham Ibrahim said "climatic conditions and water contamination" were behind the epidemic.

In Wad al-Hulaywah alone, "we've counted 150 cases so far, among them seven dead" since late July, local health official Adam Ali told AFP.

- 'Polluted water' -

Before the start of the war between Sudan's army and paramilitary forces, the UN had said that about 40 percent of Sudanese did not have access to clean water. Conditions have since worsened.

"Our problem is drinking water," said Ali.

Most residents of Wad al-Hulaywah "drink water directly from the river -- polluted water", he said.

During the rainy season, large amounts of silt are washed into the Setit river, which begins in neighboring Ethiopia, increasing pollution levels, the health official added.

Near the local hospital, workers spray insecticide to fight the proliferation of flies, which Ali said was a symptom of poor sanitation.

Dam construction in 2015 on the Setit river had displaced "entire villages", he said, and their inhabitants "dug makeshift latrines, which attract flies because they are not maintained".

Access to clean water has been hampered across the country, in areas under either the army or the paramilitary Rapid Support Forces, both vying for control of Sudan.

- 'I will have no one' -

The paramilitaries have laid siege to entire areas, preventing the entry of fuel needed to pump clean water, while bureaucratic hurdles and fighting have blocked aid operations, putting key water stations out of service.

The war has killed tens of thousands of people, displaced more than 10 million and shuttered more than 70 percent of Sudan's healthcare facilities, according to the UN.

The rival forces have both been accused of war crimes, including targeting civilians and looting or obstructing humanitarian aid.

With Sudan facing what the UN has called "one of the worst humanitarian crises in recent memory" and aid groups unable to help, many feel they have to fend for themselves.

Sitting outside a hospital in Kassala, 49-year-old Hassan al-Junaid said he has been displaced by the war, and now "we are living in very bad conditions, which caused my sister to get cholera."

"I am the only one with her, but I can't go with her inside because she has been placed in quarantine," he said.

"So I'm staying here, worried for her and afraid that I might be infected myself," added Junaid.

"If that happens, I will have no one to buy me the medicine I would need."

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The Fragile Israel-Hezbollah Truce is Holding so Far, Despite Violations

Mariam Kourani removes a toy car from the rubble of her destroyed house after returning with her family to the Hanouiyeh village in southern Lebanon, on Nov. 28, 2024, following a ceasefire between Israel and Hezbollah. (AP Photo/Hussein Malla, File)
Mariam Kourani removes a toy car from the rubble of her destroyed house after returning with her family to the Hanouiyeh village in southern Lebanon, on Nov. 28, 2024, following a ceasefire between Israel and Hezbollah. (AP Photo/Hussein Malla, File)
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The Fragile Israel-Hezbollah Truce is Holding so Far, Despite Violations

Mariam Kourani removes a toy car from the rubble of her destroyed house after returning with her family to the Hanouiyeh village in southern Lebanon, on Nov. 28, 2024, following a ceasefire between Israel and Hezbollah. (AP Photo/Hussein Malla, File)
Mariam Kourani removes a toy car from the rubble of her destroyed house after returning with her family to the Hanouiyeh village in southern Lebanon, on Nov. 28, 2024, following a ceasefire between Israel and Hezbollah. (AP Photo/Hussein Malla, File)

A fragile ceasefire between Israel and the Lebanon's Hezbollah has held up for over a month, even as its terms seem unlikely to be met by the agreed-upon deadline.

The deal struck on Nov. 27 to halt the war required Hezbollah to immediately lay down its arms in southern Lebanon and gave Israel 60 days to withdraw its forces there and hand over control to the Lebanese army and UN peacekeepers.

So far, Israel has withdrawn from just two of the dozens of towns it holds in southern Lebanon. And it has continued striking what it says are bases belonging to Hezbollah, which it accuses of attempting to launch rockets and move weapons before they can be confiscated and destroyed, The AP reported.

Hezbollah, which was severely diminished during nearly 14 months of war, has threatened to resume fighting if Israel does not fully withdraw its forces by the 60-day deadline.

Yet despite accusations from both sides about hundreds of ceasefire violations, the truce is likely to hold, analysts say. That is good news for thousands of Israeli and Lebanese families displaced by the war still waiting to return home.

“The ceasefire agreement is rather opaque and open to interpretation,” said Firas Maksad, a senior fellow with the Middle East Institute in Washington. That flexibility, he said, may give it a better chance of holding in the face of changing circumstances, including the ouster of Syria's longtime leader, Bashar Assad, just days after the ceasefire took effect.

With Assad gone, Hezbollah lost a vital route for smuggling weapons from Iran. While that further weakened Hezbollah’s hand, Israel had already agreed to the US-brokered ceasefire.

Hezbollah began firing rockets into Israel on Oct. 8, 2023 — the day after Hamas launched a deadly attack into Israel that ignited the ongoing war in Gaza. Since then, Israeli air and ground assaults have killed more than 4,000 people in Lebanon, including hundreds of civilians. At the height of the war, more than 1 million Lebanese people were displaced.

Hezbollah rockets forced some 60,000 from their homes in northern Israel, and killed 76 people in Israel, including 31 soldiers. Almost 50 Israeli soldiers were killed during operations inside Lebanon.

Here’s a look at the terms of the ceasefire and its prospects for ending hostilities over the long-term.

What does the ceasefire agreement say? The agreement says that both Hezbollah and Israel will halt “offensive” military actions, but that they can act in self-defense, although it is not entirely clear how that term may be interpreted.

The Lebanese army is tasked with preventing Hezbollah and other militant groups from launching attacks into Israel. It is also required to dismantle Hezbollah facilities and weapons in southern Lebanon — activities that might eventually be expanded to the rest of Lebanon, although it is not explicit in the ceasefire agreement.

The United States, France, Israel, Lebanon and the UN peacekeeping force in Lebanon, known as UNIFIL, are responsible for overseeing implementation of the agreement.

“The key question is not whether the deal will hold, but what version of it will be implemented,” Maksad, the analyst, said.

Is the ceasefire being implemented? Hezbollah has for the most part halted its rocket and drone fire into Israel, and Israel has stopped attacking Hezbollah in most areas of Lebanon. But Israel has launched regular airstrikes on what it says are militant sites in southern Lebanon and in the Bekaa Valley.

Israeli forces have so far withdrawn from two towns in southern Lebanon - Khiam and Shamaa. They remain in some 60 others, according to the International Organization for Migration, and around 160,000 Lebanese remain displaced.

Lebanon has accused Israel of repeatedly violating the ceasefire agreement and last week submitted a complaint to the UN Security Council that says Israel launched some 816 “ground and air attacks” between the start of the ceasefire and Dec. 22, 2024.

The complaint said the attacks have hindered the Lebanese army's efforts to deploy in the south and uphold its end of the ceasefire agreement.

Until Israel hands over control of more towns to the Lebanese army, Israeli troops have been destroying Hezbollah infrastructure, including weapons warehouses and underground tunnels. Lebanese authorities say Israel has also destroyed civilian houses and infrastructure.

What happens after the ceasefire has been in place for 60 days? Israel's withdrawal from Lebanese towns has been slower than anticipated because of a lack of Lebanese army troops ready to take over, according to Lt. Col. Nadav Shoshani, a military spokesman. Lebanon disputes this, and says it is waiting for Israel to withdraw before entering the towns.

Shoshani said Israel is satisfied with the Lebanese army's control of the areas it has already withdrawn from, and that while it would prefer a faster transfer of power, security is its most important objective.

Israel does not consider the 60-day timetable for withdrawal to be “sacred,” said Harel Chorev, an expert on Israel-Lebanon relations at Tel Aviv University who estimates that Lebanon will need to recruit and deploy thousands more troops before Israel will be ready to hand over control.

Hezbollah officials have said that if Israeli forces remain in Lebanon 60 days past the start of the ceasefire, the militant group might return to attacking them. But Hezbollah Secretary General Naim Kassem said Wednesday that, for now, the group is holding off to give the Lebanese state a chance to "take responsibility” for enforcing the agreement.

Over the final two months of the war, Hezbollah suffered major blows to its leadership, weapons and forces from a barrage of Israeli airstrikes, and a ground invasion that led to fierce battles in southern Lebanon. The fall of Assad was another big setback.

“The power imbalance suggests Israel may want to ensure greater freedom of action after the 60-day period,” Maksad, the analyst, said. And Hezbollah, in its weakened position, now has a “strong interest” in making sure the deal doesn't fall apart altogether “despite Israeli violations,” he said.

While Hezbollah may not be in a position to return to open war with Israel, it or other groups could mount guerilla attacks using light weaponry if Israeli troops remain in southern Lebanon, said former Lebanese army Gen. Hassan Jouni. And even if Israel does withdraw all of its ground forces, Jouni said, the Israeli military could could continue to carry out sporadic airstrikes in Lebanon, much as it has done in Syria for years.