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The spike in tropical diseases in Sudan reflects a poor health system

Remark

EL OBEID, Sudan – The two Sudanese women thought they had malaria and were on their medication, but things took a serious turn. Both complained of a splitting headache and fever that did not respond to the antimalarial treatment.

By the time she was diagnosed with dengue fever, Raqiya Abdsalam was unconscious.

“Shortly after they examined me, I fell into a coma,” she says of her ordeal some three months ago. Both women have since recovered and are at home in the town of El Obeid in the central province of North Kordofan.

For decades, Sudan’s underfunded public health sector has struggled to effectively diagnose or treat patients as significant government spending has gone to the massive security services. A recent spike in mosquito-borne diseases, such as dengue and malaria, has highlighted the fragility of the African country’s health system, boding ill for future challenges from climate change.

Sudan’s best-equipped hospitals are concentrated in the capital Khartoum, leaving those from distant provinces dependent on aid projects. But many of them are gone.

In October 2021, Sudan’s leading military figure, General Abdel-Fattah Burhan, led a coup that derailed the country’s short-lived democratic transition. The move led to a sharp reduction in aid, with the UN Office for the Coordination of Humanitarian Affairs reporting that funding levels fell to less than 50% of required needs for both 2021 and 2022.

In December, Burhan pledged to install a new civilian government with his ruling generals and several other political forces. But political bickering is standing in the way of a final deal, and it remains unclear when – and if – donor funding will return to previous levels.

In late autumn, a young doctor at a hospital in North Kordofan thought she saw a new malaria outbreak. Patients who arrived at her hospital had malaria-like symptoms: high fever, body fatigue and migraine-like headaches.

But after blood samples were sent to a laboratory in Khartoum for testing, a worrying picture emerged. Some patients had malaria, which is caused by a parasite, but others had dengue fever – similar symptoms but caused by a virus. If severe and left untreated, dengue can lead to organ failure and death.

The young doctor said the hospital did not have the facilities to deal with the outbreak. “Patients had to lie on the floor or bring their own beds to the hospital,” she said.

Although malaria is common in Central and South Sudan, major dengue outbreaks are rare. But last fall and winter, dengue fever spread to 12 of the country’s 18 provinces, killing at least 36 people and infecting more than 5,200, according to the Sudanese health ministry. However, the actual numbers are likely higher given the limitations on testing.

“Most hospitals outside Khartoum are not connected to the Ministry of Health database,” said Alaaeldin Awad Mohamed Nogoud, a liver and transplant surgeon who is also a prominent pro-democracy activist.

The World Health Organization says several factors enabled the dengue outbreak, including the lack of disease-monitoring infrastructure and heavy flooding in the fall. The stagnant water allowed mosquitoes to reproduce and disease to spread.

Health experts also fear that increasing mosquito migration caused by climate change could trigger new spikes in dengue fever, alongside other tropical diseases typically found outside Sudan’s southern borders. The Aedes aegypti, a long-legged mosquito that can transmit the dengue virus, which is growing in numbers in Sudan, is of particular concern.

According to Anne Wilson, an epidemiologist at the Liverpool School of Tropical Medicine, it is difficult to control diseases spread by the Aedes aegypti because they usually bite during the day, making insecticide-treated nets, similar to mosquito nets for beds, less effective. .

Sudan’s public hospitals are state-run, but patients often still pay for medicines and tests. Rural hospitals are the most depleted, filled with little more than metal-framed beds and doctors.

In North Kordofan – the site of the recent dengue outbreak – some believe the virus went unchecked for months due to a widespread lack of blood testing equipment. Abdsalam and Amany Adris, the two women from El Obeid, said several doctors told them they had malaria before they were properly diagnosed.

After the Health Department officially recognized the outbreak in November, officials said free testing and treatment were available for dengue patients. And in January, North Kordofan was declared dengue-free.

But even after that announcement, the young doctor from the province said she was treating suspicious cases. However, few patients can afford to pay for the blood tests themselves, she added.

Both Nogoud and the young doctor said widespread shortages are forcing doctors to turn to the black market for basic drugs, such as acetaminophen IV drops to treat fevers.

Sudan has been in an economic crisis for years with annual inflation exceeding 100% in most months. Since 2018, the Sudanese pound has lost more than 95% of its value against the dollar, making it difficult to buy medicines or medical equipment from abroad.

At the end of last year, Sudan’s National Medical Supplies Fund – the agency in charge of drug procurement – said the availability of cancer drugs was 48% of needed levels, and other emergency medications at 68%. Doctors, who work for little pay and in difficult conditions, have regularly gone on strike.

Critics accuse the country’s leaders of not putting more money into the health sector. The 2021 federal budget, listed on the government’s website, said the country’s health ministry would receive less than half of what would be allocated to the Sudanese Armed Forces and Rapid Support Forces, the country’s largest paramilitary group. country. The military spokesman did not respond to AP’s request for comment.

With few resources, the Health Ministry has turned to short videos on social media, encouraging people with a catchy song to cover stagnant water sources and install nets over windows.

Few see this as a long-term solution.

“The whole country is in a state of chaos,” said Nada Fadul, an infectious disease doctor and contributor to the Sudanese non-governmental organization NexGen.

“Health care may not become the priority for survival,” Fadul added.

Jeffery reported from Cairo.

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