Amid war, and on camelback: how Sudan’s vaccinators are delivering a dose of hope
Vaccines reach a remote community located in a mountainous part of Aqiq, in Red Sea State, 2024. Credit: Asrar Fadulelsied.
A year of conflict has left Sudan’s immunisation safety net frayed. Gavi and Save the Children are helping vaccinators patch it back up.
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Muhammad Saleh, the child of nomadic Beja pastoralists in eastern Sudan, was six months old and hadn't received a single vaccine. Born into a country at civil war, and into a family on the move in pursuit of pasture and water, Saleh had slipped through the fingers of the health system.
In that, he wasn't alone. 1.6 million children are born each year in Sudan – that's approximately 1.6 million children born, so far, into the year-old civil crisis that has seen an estimated 8 million people displaced from their homes.
The effect of the conflict on the reach of the country's immunisation services has been colossal. In November 2023, national figures for coverage with the third dose of the basic diphtheria, tetanus and pertussis-containing vaccine (DTP3) stood at 59%, an alarming drop from 93% in 2022.
"In Sudan, the country with the largest displacement crisis globally, immunisation remains the most cost-effective public health intervention preventing disease and reducing child mortality." – Bashir Kamal Eldin Hamid, Health and Nutrition Director at Save the Children International in Sudan
But vaccinators like Abdul Qader, a member of the State Ministry of Health vaccination team in Red Sea state, are working hard to win back lost ground. Operating out of the Aqiq Locality Primary Health Center – home to the last fridge on this particular branch of the Sudanese cold chain – Qader and his vaccine cooler box represent the forward frontier of Sudan's vaccine delivery effort.
Vaccine odyssey
Qader's outreach journeys are often long and difficult. One mid-February day, for instance, he leaves the Aqiq PHC on a motorcycle, heading for the mountains. When the terrain becomes too rough to manage on two wheels, he swaps the bike for a camel, which carries him and his colleague Muhammad Hamed as far as Warhat village.
Infant Muhammad Saleh, whose family is nomadic, receives his first vaccination in a hard-to-reach part of Aqiq locality, Red Sea state, 2024. Credit: Asrar Fadulelsied.
Here, crouched on a thatched mat at the threshold of a Beja family's tent, Qader administers a first vaccine to the baby Muhammad Saleh.
It's a hard-won dose of safety amid pervasive danger.
"In Sudan, the country with the largest displacement crisis globally, immunisation remains the most cost-effective public health intervention preventing disease and reducing child mortality," says Bashir Kamal Eldin Hamid, Health and Nutrition Director at Save the Children International in Sudan. "On top of a fragile health system, the violent conflict [has] disturbed health service and the vaccination programme. Sudanese children are facing risks from conflict, malnutrition and outbreak of vaccine-preventable diseases."
Since December 2022, Save the Children and Gavi, the Vaccine Alliance have been working together to enable the efforts of health workers like Qader, and help bridge the gap between the populace and the health care system. Supporting monthly operations to reach children where they are has reduced the risk to public health that threatens at the change of seasons, when nomadic groups move higher into the hills, and further out of reach of fixed health centres.
In addition to supporting the deployment of mobile vaccination teams, Gavi and Save the Children support routine immunisation, health system strengthening and community resilience in the country – that is, amid some of the toughest conditions in the world today. Gavi's support budget for Sudan in 2023–2024 totals US$ 77.4 million, of which US$ 36 million is earmarked for the purchase of vaccines.
These efforts are making inroads.
"Supported by Gavi, Save the Children, in collaboration with the Ministry of Health, has reached more than 120,000 children in two states, including displaced children in more than 400 gathering points. [The partners are] committed to ensuring service continuity, improve vaccination coverage, and to overcome the current barriers in Sudan," reports Save the Children's Bashir Kamal Eldin Hamid.
Truckful of hope: first shipment of vaccines arrives in Darfur since war's outbreak
Sixty tons of vaccines arrived by truck in Darfur on 8 April, the country's Federal Ministry of Health announced. It's a landmark moment for the immunisation system, as the doses mark the first new vaccine delivery to the region since war broke out over a year ago.
"Gavi congratulates the Federal Ministry of Health in the success of delivering vaccines to Darfur," said Anne Cronin, Gavi's Senior Country Manager for Sudan. "Gavi believes that reviving the immunisation programme throughout the 18 states of Sudan will not only mitigate against the outbreak of communicable disease, but is also an opportunity to contribute to building a bridge for peace in Sudan."
The consignment contains Gavi-funded vaccines against diphtheria, tetanus and pertussis (DTP), meningitis, polio, yellow fever, rotavirus and COVID-19, as well as UNICEF-supported tetanus toxoid, BCG, measles and oral polio vaccines. The new stocks will meet routine immunisation requirements regionally for the three months.
Moving to meet a mobile population
The Gavi-Save the Children collaboration has its origins in a different crisis. Formed to support the rollout of vaccines against the pandemic coronavirus – that is, by supporting the COVAX national deployment plan for Sudan – the partnership helped vaccinate some 500,000 adults against COVID-19 in Khartoum, Red Sea state and El Gezira, before retooling to help connect children with routine immunisations.
A year ago, however, war disrupted implementation in Khartoum, the conflict's epicentre. To protect as many children as possible amid fluid and fractious circumstances, in August 2023, Gavi and Save the Children pivoted again. El Gezira in particular, as one of the two states receiving the densest flows of internally displaced people (IDPs), is a vital fulcrum for focussed vaccination efforts in a mobile population.
Abdul Qader and Muhammad Hamed, vaccination team, during an outreach in Aqiq locality, RS state, 2024. Credit: Asrar Fadulelsied.
Just one month into the intervention in El Gezira, Save the Children-supported mobile teams had helped identify new, unregistered IDP camps. Some 486 IDP camps or gathering points were reached by vaccinators in that short span of time, and, security concerns notwithstanding, 24,320 IDP children received immunisations.
Each child reached and protected is an investment in hope in a country unsettled by uncertainty, and a declaration that the most vulnerable among us are not forgotten.
