“We’ve already seen over 560,000 people crossing into neighbouring countries…[and] nearly two million people displaced internally,” said Raouf Mazou, UNHCR’s Assistant High Commissioner for Operations, following a visit to Sudan.

Since conflict erupted there on 15 April when rival militaries clashed, more than half a million people have reached neighbouring countries in a bid to escape the fighting, with Egypt receiving the most refugees followed by Chad, South Sudan, Ethiopia, and the Central African Republic. 

Reaching one million marker

Based on the continuing violence, the UN agency now expects that its previous estimate of one million refugees will be surpassed.

In response to the crisis, UNHCR and other UN agencies, humanitarian partners, and host communities have increased efforts to provide emergency shelter, clean water, health care services, psychosocial support, and other vital assistance to help displaced populations inside and outside Sudan. 

Host communities unaffected by the conflict until now are also “seeing the consequences”, Mr. Mazou said.

“All are in need of protection and assistance,” he added. “What is also quite striking, and which needs to be underlined, is how welcoming the host populations are.”

West Darfur horror

Although violence has erupted across multiple fronts, UNHCR raised particular concerns about West Darfur. Aid access is “limited” amid reports of “wanton killings” by militia that the UN human rights office, OHCHR, has condemned.

Bordering West Darfur, Chad has seen 170,000 people crossing its borders to flee the conflict, according to the UN refugee agency. Many, including women and children, have arrived needing treatment for their injuries, the agency said. 

At the same time, the rainy season has thwarted aid workers from reaching those crossing the border and transporting them to refugee camps, the agency said.

South Sudan returnees

More than 120,000 people crossed the border into South Sudan, where sparse infrastructure and security concerns represent significant challenges that are preventing new arrivals from moving on, the agency warned. Much of the assistance they need will have to be airlifted, which is both costly and complex. 

Meanwhile, UNHCR teams are registering new arrivals, providing them with emergency relief, and helping them to reach different locations as quickly as possible.

Most of the arrivals are South Sudanese, returning to their country, Mr. Mazou said.

“They are part of the 800,000 South Sudanese refugees who were in Sudan, but they are now going back,” he said.

Strained resources

Capacity at border reception and transit facilities in neighbouring countries have been strained by the sheer numbers of people arriving, leading to overcrowding and further stretching of already limited resources, the UN refugee agency said.

Those fleeing Sudan arrive exhausted after days or sometimes weeks on the road, shocked by the violence they have witnessed and in need of food, medical care, and relief items, UNCHR reported.

During a donor conference for Sudan in Geneva on 19 June, $1.52 billion in pledges were received against an appeal for $3 billion to address the current situation.

Learn more about how UNHCR is helping the people of Sudan and those fleeing the violence here.

“About five million children under the age of five are estimated to be facing acute malnutrition in 2023 in the Horn region, in the Greater Horn. That is about 10.4 million, that is just a staggering figure,” said Liesbeth Aelbrecht, the World Health Organization’s (WHO) incident manager for the greater Horn of Africa emergency.

Three year high

“What our colleagues are seeing in clinics and in hospitals, since the beginning of this year, are the highest level of severely malnourished children who are now coming to these facilities with medical complications since the crisis began three years ago.”

Echoing that alert, World Food Programme (WFP) Senior Emergency Officer Dominique Ferretti said that almost three years of drought had given way to rains and devastating flash floods: “While we just concluded a rainy season which performed better than predicted, one rainy season is not enough to bring an end to the crisis.”

Although long-awaited rains arrived in March across the eight-member Intergovernmental Authority on Development (IGAD) region – encompassing Djibouti, Eritrea, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda – and with it the hope of relief, flash-flooding inundated homes and farmland, washed away livestock and closed schools and health facilities.

The result was the highest number of reported disease outbreaks in the greater Horn of Africa so far this century. Their frequency can be linked directly to extreme climate events, according to the UN health agency.

Ms. Aelbrecht noted ongoing outbreaks of cholera and measles, together with “very high numbers” last year and this year, including malaria cases.

“So, with the impact of flooding, we see these diseases worsening. Malaria, I would like to remind you, is one of the biggest killers in the region.”

Climate complications

Climate concerns are key to food security in the coming months, the UN Food and Agriculture Agency (FAO) noted at a press conference in Geneva.

Global forecasts indicate that El Niño weather pattern conditions are already present and will strengthen through the rest of the year, which could bring above-average rains during the October to December rainy season across eastern parts of the region, including much of Kenya, the Somali region of Ethiopia and Somalia.

“El Niño may somewhat reduce the risk of flooding in flood-prone areas such as South Sudan,” said Brenda Lazarus, Food Security and Early Warning Economist at FAO’s Subregional Office for Eastern Africa.

Nevertheless, she indicated that “on the risk’ side, below-average rains and dry spells, along with other drivers of food insecurity would likely negatively impact agricultural production and increase already alarming levels.

Investing is key

FAO emphasized the need to shift from a system focused mainly on emergency response, to anticipating and mitigating crises through investments such as in rainwater harvesting, soil and water conservation, or the use of more drought tolerant crops – and ensuring seeds are locally available.

Involving young people in building silos could also boost community resilience, the UN agency noted.

The 60 million severely food insecure include more than 15 million women of reproductive age, 5.6 million adolescent girls and close to 1.1 million pregnant women.

Close to 360,000 of them are expected to give birth in the next three months, according to the United Nations Population Fund (UNFPA).

Women who are forced to look for food just to survive “do so on the expense of their own health,” said Michael Ebele, UNFPA Regional Humanitarian Adviser for East and Southern Africa.

Increased risk of deaths

“So, we are seeing pregnant women not being able to go for antenatal care, not attending to other illnesses they may be having. And then, that comes with risks of complications…then the risks of maternal deaths increase.”

Malnutrition among pregnant and lactating mothers puts their unborn and breast-feeding children at risk of malnutrition and propagates malnutrition through entire life cycles in communities.

Malnourished mothers are also less able to withstand complications in pregnancy which put them at greater risk of losing their child.

“Because of the limited amount of resources, we have seen an increase in the risks of survival sex”, said Ms. Ebele, “increasing the risk of sexual exploitation and abuse, particularly of women and girls”.

Grain initiative threat

Asked by journalists how badly the Horn of Africa would be affected if the UN-brokered Black Sea Initiative to facilitate Ukrainian grain exports to the world’s markets is not renewed next month, WFP’s Mr. Ferretti replied that “the reality is that Ukraine is the breadbasket, it is a major supplier and it would hit us hard if this Black Sea initiative was not renewed”.