Sudan

Summary of Needs

Sudan ranks among the top four countries in the world with the highest prevalence of global acute malnutrition (GAM), with pre-conflict rates of 13.6 percent. Recent¹ SMART surveys show further deterioration in the nutrition situation, with 30 per cent of the 38 validated SMART surveys reporting GAM prevalence of 15 per cent and above the WHO emergency threshold, out of which three surveys recorded GAM of 30 per cent, which is the famine threshold. The nutrition outlook is projected to further deteriorate in 2025 due to expanding conflict, food security decline, compromised health and WASH services, and prolonged and recent displacements. As more SMART surveys continue to reveal worsening nutrition situation in many parts of the country, the 2025 projected PiN of 3.72 million² - of which over 772,000 are cases of children under five years of age with Severe Acute Malnutrition (SAM) – across the country from IDP, host and non-hosting communities is expected to be higher.

Around 77 per cent of acutely malnourished children under five years of age, pregnant and breastfeeding women reside in 137 localities with nutrition cluster severity level 4 and 5. In addition, over 33 per cent (about 1.26 million) of the total PiN live in 61 localities with the highest multi-sectoral vulnerability (severity level 4 and 5) for FSL, Health and WASH, implying high likelihood of increased prevalence of acute malnutrition being widespread to the extent never documented in Sudan before.

Apart from wasting, micronutrient malnutrition is prevalent, with 48 per cent³ of children under five experiencing anemia due to iron deficiency. Minimum dietary diversity among children under five 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 children under five and 3.7 million pregnant and breastfeeding women or girls will need emergency humanitarian nutrition assistance throughout 2025.

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.

Response Strategy

The Nutrition Cluster aims to scale up preventive and treatment nutrition interventions by expanding service sites, prioritizing areas with high malnutrition rates in both host and IDP communities and areas with high intersectoral severity of needs. The Cluster will promote non-food prevention measures and strengthen cluster coordination. To ensure efficiency and intact supply pipeline of the core therapeutic and supplementary food, the procurement will be continued by lead agencies (UNICEF, WFP and WHO) for distribution as well as increasing cross-border and crossline routes 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 as per guidance that will be provided.

The Cluster targets 2.3 million people representing over 62 per cent of the 3.7 million cases of malnourished children under five years and pregnant and breastfeeding women or girls in need of treatment for acute malnutrition. Over 87 per cent of the total PiN with SAM with and without complications (695,000 people) will be targeted, of which more than 101,000 people have medical complications. On the hand, over 64 per cent of the total (2.2 million) children with moderate acute malnourished children and pregnant and breastfeeding women (0.5million) will be targeted. The risk of mortality among children with SAM and moderately acute malnutrition (MAM) is 11 times and four times higher respectively compared to their well-nourished peers. For children with SAM and medical complications, nine out of 10 are likely to die if not treated.

In addition, 2.3 million⁴ children under five years and 1.9 million pregnant and breastfeeding women or girls will be targeted by nutrition services, but these figures are not included in the cluster’s PiN⁵. 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 especially in locations where traditional response programming is a challenge.

Targeting and Prioritization

Targeting is based on strict specific nutrition criteria⁶, including individual nutrition assessments. The nutrition response for 2025 will focus on eight areas:

• Prioritizing the youngest and most vulnerable children with the highest mortality risk.
• Providing life-saving preventive and protective nutrition package.
• Implementing non-food and food-based malnutrition prevention programs.
• Treating SAM cases with medical complications.
• Treating SAM cases without medical complications among children under five years
• Supplementation of MAM children at higher risk with RUTF.
• Provision of supplementary feeding for moderately malnourished children under-fives years, pregnant and breastfeeding women, or girls.
• Generating evidence for planning, advocating for resources and decision-making.

The cluster prioritized localities based on specific criteria mainly – the GAM rate of 15 per cent and above - the WHO emergency threshold as priority one. For priority two and three, IPC AcuteFood Insecurity (IPC-AFI) and IDPs are considered. In the context of 2025 HRP prioritization, the cluster priority one localities include the 54 inter-cluster prioritized localities and 59 localities with GAM 15 per cent and above that are not part of the inter-cluster prioritization. This implies that the nutrition cluster will focus and give equal weight in terms of prioritization of response to the 113 localities targeting about 66.4 per cent of the nutrition cluster annual target (see the priority 1 localities link map). The priority localities will be updated regularly as the latest SMART surveys results are shared with all partners.

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 per cent of this budget allocated to addressing acute malnutrition among children under-five years and pregnant and breastfeeding women or girls. The cluster has revised the targets for the prevention interventions given the consideration of the funding projection for 2025, insecurity, high operational costs and access constraints. Part of the lifesaving preventive interventions will be funded through common UN approaches.