With fighting showing no sign of abating and humanitarian access extremely limited, the crisis in Sudan has become one of the world’s largest emergencies, the UN Office of the High Commissioner for Refugees (UNHCR) warned on Monday.

“This is a very, very sad milestone,” Mamadou Dian Balde, UNHCR Regional Director for East Africa said, marking two years since the outbreak of war.

“We are seeing massive violations, massive displacements and a devastating impact on millions of people.”

A humanitarian catastrophe

The war, which erupted in April 2023 between the Sudanese Armed Forces (SAF) and the paramilitary Rapid Support Forces (RSF), has triggered a full-blown humanitarian catastrophe.

More than half the population – around 25 million people – require humanitarian assistance and protection, but funding shortfalls and insecurity have left vast swaths of the country beyond reach.

The UNHCR-led $1.8 billion Regional Refugee Response Plan for 2025 – which aimed to support 4.8 million refugees and host community members – remains only 10 per cent funded, Mr. Balde said, jeopardizing essential services such as food, shelter, education and healthcare.

“Communities that have very little are sharing what they have with the refugees. It is an extraordinary show of solidarity,” he added, urging the international community to step up support for the most vulnerable across the region.

Thousands of lives at risk

Hunger has reached catastrophic levels in Sudan, with famine confirmed in 10 areas and 17 more at risk, according to the UN World Food Programme (WFP).

In some areas, emergency food assistance is the only barrier preventing starvation. However, vital operations are constrained by insecurity and lack of funds.

“Without immediate assistance, especially in famine or famine-risk areas, thousands of lives are at risk,” said Makena Walker, WFP Acting Country Director in Sudan.

“We can scale up – but we need all parties to guarantee safe, unhindered access for humanitarian convoys,” she added.

Children hit hardest

Children remain among the hardest hit.

According to the UN Children’s Fund (UNICEF), child casualties this year have surged by 83 per cent compared to early 2024. Children are also at severe risk of sexual and gender-based violence or being forced into armed groups, on top of already losing out on education.

In addition, an estimated 146,000 children are projected to suffer from severe acute malnutrition this year, leaving them up to 11 times more likely to die than a well-nourished child.

A public health emergency

The crisis has also spiralled into a public health emergency, with over 20.3 million people now in urgent need of medical care. Cholera, measles, malaria and dengue are spreading rapidly across two-thirds of Sudan’s states, with cholera alone claiming over 1,500 lives.

This situation is unravelling against a health infrastructure on the brink of collapse: 38 per cent of hospitals in the worst affected regions are non-functional and the remaining only partially operational, according to the UN World Health Organization (WHO).

Attacks on healthcare have surged, with 156 attacks verified over the past two years, resulting in hundreds of deaths and injuries.

“In addition to being a famine crisis, the humanitarian situation in Sudan is also a protection and health crisis,” said Shible Sahbani, WHO Representative in the country.

The UN health agency is determined to continue working to improve health access for Sudan’s people. However, recent funding cuts have forced WHO to scale back operations, potentially affecting health services.

If funding does not flow, 4.7 million people targeted for health interventions this year will be affected. Services at 335 health facilities will also have to be reduced, including trauma and emergency care.

Working against the odds

Despite the challenges, UN humanitarians and partners continue their efforts to reach the most vulnerable communities with lifesaving assistance.

Since the war began, WFP has provided over 13 million people with food and nutrition support. For its part WHO, has supported over one million people with health services, treated 75,000 severely malnourished children and helped vaccinate 11.5 million children against polio and measles.

But aid workers warn the situation is deteriorating fast, particularly in the states of Darfur and parts of Khartoum and Al-Jazirah (also spelled Gezira), where active fighting and sieges are cutting civilians off from assistance.

Mr. Balde reiterated the urgent need for the international community to help silence the guns, “we call for peace, protection and sustained support – [only then] normalcy can return, and refugees can return home.”