Resurgence of multistate cholera in Sudan amidst ongoing conflict.

Objectives: This study describes the changing trends of multistate cholera outbreaks in Sudan during the ongoing conflict. Methods: This was a retrospective cross-sectional study based on cholera surveillance data available at the national level (from August 2023 to June 2025). Case fatality rates (CFRs) annually and per state were obtained, and the data were analyzed using R program 4.2.2 (Version 2025.05.1+513). The study used the anonymous secondary data provided by the Surveillance Directorate dashboard. Results: In 2023, a total of 9581 cases and 254 fatalities (overall CFR of 2.7%) were reported in 10 states. The Red Sea state recorded the highest number of cases (n = 3379, with 101 deaths and a CFR of 3%). Then 2024 recorded the highest number of cases and fatalities (n = 50,832, with 1380 deaths and a CFR of 2.7%), compared to 2023 and the first half of 2025 (n = 23,488 cases, with 517 deaths and a CFR of 1.7%). Regarding the overall trend per state, Khartoum, White Nile, and the North Kordofan states showed an increasing trend between August 2023 and June 2025, while the Red Sea, Al Jazirah, Al Qadarif, and Kassala states showed a decreasing trend. Conclusions: The findings underscore the complex dynamics of cholera transmission influenced by conflict-related water and sanitation disruptions, displacement, and vaccination efforts. The dramatic (>5-fold) increase in cases from 2023 to 2024, followed by a declining CFR in 2025, suggests that although the outbreak surged quickly, interventions may have ultimately improved case outcomes. Continued surveillance, targeted interventions, and health infrastructure strengthening are paramount to controlling current outbreaks and preventing future resurgence in conflict-affected regions.