Sudan

Sudan ranks among the top four countries with the highest prevalence of global acute malnutrition (GAM), rates, currently at 13.6 percent. Recent  SMART surveys show further worsening in nutrition situation with 82 percent of the 35 validated SMART surveys reporting GAM prevalence of 15 percent and above the WHO emergency threshold, while three surveys recorded GAM of 30 percent and above- the famine threshold.  The nutrition outlook is projected to further deteriorate in 2025 due to ongoing conflict, food security decline, compromised health and WASH services, prolonged and recent displacements.  As more SMART surveys continue to reveal worsening of nutrition situation in many parts of the country, the 2025 estimated PIN of 3.7 million  of which over 772,000 are cases of under-five children with Severe Acute Malnutrition (SAM) across the country from IDP, host and non-hosting cross and frontline communities are expected to be higher than the projected PIN above.

Around 77 per cent of acutely malnourished under-five children, pregnant and lactating women reside in 137 localities with nutrition cluster severity level four and five. In addition, over 33 percent (about 1.26 million) of the total PIN live in 61  localities with highest multi-sectoral vulnerability (severity level 4 and 5) for FSL, Health and WASH, implying high likelihood of widespread high prevalence of acute malnutrition that have never seen before. 

Apart from wasting, micronutrient malnutrition is prevalent, with 48 per cent of under-five children experiencing anaemia due to iron deficiency. Minimum dietary diversity among under-fives is low at 25 per cent, further exacerbated by massive displacement disrupting feeding and caregiving practices. The cluster has estimated that over 6.6 million under-fives and 1.9 million Pregnant and Breastfeeding Women (PBW) will need humanitarian nutrition assistance.

Primary needs in the nutrition cluster are multi-fold, namely (i) preventive nutrition interventions focusing on maternal and young child nutrition; (ii) early detection and treatment of acute malnutrition; (iii) Management of small and nutritionally At-risk Infants and their Mothers (MAMI); (iv) micronutrient supplementation; (v) food and non-food nutrition interventions; (vi) evidence generation through assessments and analyses; (vii) rehabilitation of nutrition infrastructure; and (viii) capacity strengthening

The Nutrition Cluster aims to scale up preventive and treatment nutrition interventions by expanding service sites, prioritizing areas with high burden and low coverage in both host communities and IDP camps (or camp-like settings) and areas with high intersectoral severity. The cluster will promote non-food prevention measures and strengthen cluster coordination. To ensure efficiency, core supplies will be procured by lead agencies (UNICEF, WFP and WHO) for distribution as well as increasing cross- border routes and crosslines and pre-positioning of supplies. In consultations with partners, the cluster will adapt interventions and approaches recommended by the 2023 WHO guideline on Wasting management as appropriate to the Sudan context. 

The cluster targets 2.33 million representing over 62 percent of the 3.72 million cases of malnourished children under-five years and PBWs in need of treatment for acute malnutrition. About 607,000 (26%) of the 2.33 million targeted, are cases with severe acute malnutrition of which over 101,000 have medical complications whose risk of mortality is 9 out of 10 likely to die if not treated. An additional 6.7 million children under-five years and 1.9 million PLWs will receive nutrition services, but these figures are not included in the cluster’s PiN. Response modalities include static sites, integrated mobile teams, and cross-border response in hard-to-reach areas and integrated nutrition screening and micro-nutrient supplementation campaign. Cash transfers for recommended nutrition cluster curative and preventive interventions will also be implemented for specific groups and areas as needed and where traditional response programming is a challenge. 

TARGETING & PRIORITIZATION 

Targeting is based on strict specific nutrition criteria including individual nutrition assessments. The nutrition response for 2025 will focus on six key areas:

1. Prioritizing the youngest and most vulnerable children with the highest mortality risk.

2. Providing life-saving preventive and protective nutrition package.

3. Implementing non-food and food-based malnutrition prevention programs

4. Treating SAM cases with medical complications.

5. Treating SAM cases without medical complications among children under-five years and provision of supplementary feeding for moderately malnourished under-fives, pregnant and lactating women

6. Generating evidence for planning, advocating for resources and decision-making

The cluster prioritized localities based on specific criteria including high severity needs in Health, WASH and FSL clusters, acute malnutrition rates – global acute malnutrition (GAM) of 15 per cent – and risk of famine areas[3] to ensure effective targeting. Depending on availability of resources, priority will be given to immediate lifesaving interventions especially in famine risk areas and localities with emergency and catastrophic levels of acute malnutrition.

COST OF RESPONSE 

The Cluster requires $471.66 million to implement its planned activities. With about 71 percent of this budget allocated to addressing acute malnutrition among children under-five and pregnant and breastfeeding women. Due to insecurity, high operational costs and constrains related to access and operational capacity, the cluster is unable to target as many malnourished children for preventive and treatment interventions as in previous years. Part of the live saving preventive interventions will be funded through UN common approaches. However, the procurement of core supplies through lead partners reduces individual procurement expenses.

• Access constraints remain one of the major challenges for the provision of both curative and preventive nutrition interventions.

• Delivery of supplies was hampered due to access and resource constraints, resulting in stockouts for some of the interventions in some of the areas.

• Gaps in geographical coverage of nutrition services in some parts of the country due to access and insecurity.

• Sustained interruption of health workers salaries and limited operation costs for nutrition facilities 

• Delayed approval for SMART survey implementation in some localities of the country.

• Limited funding; only 17%% of the 2025 annual cluster HRP funding requirement (US$ 471.7M) was received.