Escalating conflict in Sudan is quickly contributing to a worsening humanitarian crisis. Since violence erupted in the country on April 15th, several international aid organizations were forced to suspend operations and evacuate the region.
The World Food Programme, one of the largest food distribution operations in the world, suspended its operations following the death of two employees. Relief International withdrew international staff from the region after the death of their finance officer during clashes in El Fasher. And the International Rescue Committee recently announced that it has suspended most of its operations in Sudan following the fighting.
Much of the fighting is occurring in Khartoum, as the Rapid Support Forces continue to resist incorporation into the Sudanese army. The power struggle turned violent earlier this month, postponing all hopes for elections and political transition to civilian rule.
Read More: Everything to Know About the Deadly Power Struggle in Sudan
The withdrawals of humanitarian aid organizations will lead to casualties extending far beyond warfare. U.N. agencies say a third of Sudan’s 46 million people relied on international aid before the conflict erupted, and the evacuation of aid organizations is set to have dire consequences when it comes to access to basic necessities.
“Casualties are likely to compound,” says Chidi Odinkalu, a professor at Tufts focusing on International Human Rights Law. Official death toll tops 400, but Odinkalu says the number is likely far higher.
“No one can ever do a good job of counting the human toll in these situations,” says Odinkalu. “All indications are that it’s a lot more than international numbers.”
‘A dire situation’
Sudan was facing multiple crises even before the onslaught of violence, as flooding and drought due to climate change led to rising inflation and widespread food insecurity.
Most recent data from the World Bank placed the country’s inflation rate for 2021 at 382.8%. 15 million people in Sudan were facing food insecurity, the United Nations World Food Programme (WFP) estimated; a quarter of those in need of life-saving nutrition services were children under 5 and pregnant and lactating women. And a dengue fever outbreak erupted earlier this year, after a lack of disease surveillance infrastructure and heavy flooding last fall resulted in pools of mosquito-breeding stagnant water.
Now, the clashes have severely impacted civilian life in the country, as public services and infrastructure in the region have all but collapsed.
“There’s no water, no electricity, no gasoline,” says Odinkalu. “The most expensive thing in Khartoum right now is petrol. People are trying to ration and find petrol by any means so they can escape.”
Airports have shut down, closing off supply chains for humanitarian aid. “Within Khartoum, and within Sudan itself is quite a dire situation.” says Madiha Raza, Global Communications Officer for the International Rescue Committee, one of the organizations that was forced to shut down. “There was already an acute shortage of food, water, and access to health care. Now as a result of the conflict and shortages, the prices of very basic necessities are going up.”
The IRC provided access to basic human necessities like health services and clean water across the country, but Raza says the organization has suspended almost all operations in the country, save for two states: Gadaref and Blue Nile.
“This will almost definitely lead to a further loss of life than we’re seeing,” says Raza.
For those that remain in the region, public health crises will continue to compound until aid workers are allowed back in the region. “Health facilities have been damaged, as well as things like water pipes, which means that people are drinking out of the Nile, which is very unsanitary and could lead to a massive public health crisis.” says Raza.
Spillover in Chad and South Sudan
The IRC is focusing its efforts on neighboring countries, which have seen a surge of refugees as residents of Sudan flee. Raza says that over 20,000 people have crossed into Adre, Chad in recent days, overextending the country’s resources.
“Chad, before this crisis, was already a low-income country stretched quite a lot when it comes to humanitarian need,” says Raza. “It’s important to provide economic support to help deal with the refugee influx.”
Read More: Special Forces Swiftly Evacuate U.S. Embassy Staff From Sudan
Officials in South Sudan—where the U.N. estimates about 75% of the population is already in need of humanitarian aid—say upwards of 10,000 refugees have arrived from Sudan in the past few days.
Attempts at ceasefires have not held, making safe passage for aid workers and supplies difficult. Long-term, Raza says that the safe operations of humanitarian work is essential to keep the country from slipping into further turmoil.
“We need to look at how we can prevent the slide from a fragile state to a failed state,” she says. “It’s critical to ensure that wherever possible public services remain up and running in the country. With the government’s instability, that means allowing aid organizations safe access to communities that need help.”
The request is a far cry from the current reality, in which relentless fighting has left everyone from aid workers to diplomats to average citizens looking to evacuate, and few resources for those left behind.
“The issue that we’re facing is that right now, no one is safe,” says Raza.
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Write to Simmone Shah at simmone.shah@time.com