What the Cholera Epidemic in Sudan Tells Us About the Absurdity of Lifting U.S. Sanctions on Khartoum

By Eric Reeves

January 25, 2017 (SSNA) — Former Obama administration UN Ambassador Samantha Power’s claim that there has been a “sea change” of improvement in humanitarian access in Sudan was not only false, but destructively so. As a justification for Obama’s Executive Order lifting U.S sanctions on the National Islamic Front/National Congress Party regime, her failure to tell the truth was a moral disgrace and gives the regime reason to believe that even token moves to improve humanitarian access will be credited as sufficient, especially under the new Trump administration. Such an attitude on the part of the regime could easily translate into the loss of tens of thousands of Sudanese lives.

One example looms large at present.

There can be little doubt now that the steady stream reports concerning cases of acute watery diarrhea signal a widespread outbreak of cholera—an extremely dangerous but easily treated disease that is the product of contaminated water sources. Today’s report from Sudan Tribune confirms not only that there have been two waves of cholera in various northern states, including Blue Nile, extending back to at least September 2016), but that regime officials have tried to deny that the disease causing so many deaths and hospitalizations is cholera. The Sudan Tribune dispatch is based on a report by the independent Central Committee of Sudanese Doctors (CCSD), which found that “twelve people have died and 500 infected with watery diarrhea in the states of Khartoum, Red Sea and Gedaref during last week”; the CCSD “accuses health authorities in the states of concealing and covering-up the lab results of samples taken from the patients, describing this behavior as ‘irresponsible and reckless.’”

[The entire Sudan Tribune dispatch, along with numerous other recent reports of acute watery diarrhea/cholera extending back to September 2016, as well as reports of acute water shortages, are included in Appendix A. The number who have fallen ill and/or died is significantly higher than can be accurately reported; but epidemiological research on the spread of cholera suggests the number is much higher, especially in a country such as Sudan, ruled by a regime eager to suppress data and even the reality of a cholera epidemic.]

Why is this important? What does it have to do with the lifting of U.S. sanctions? The answers should give pause to those who have rushed to celebrate the lifting of sanctions, particularly on the grounds that these sanctions have hurt only the people of Sudan and not the brutal regime who tyranny oppresses them.

Cholera is a water-borne disease that spreads with terrifying speed and kills rapidly if untreated. Even so, treatment—primarily hydration—is simple and can be done quickly and easily if diagnosed. It is just as easily prevented by ensuring that water supplies are uncontaminated with the cholera bacterium. In its description of cholera, the UN’s World Health Organization notes (http://www.who.int/mediacentre/factsheets/fs107/en/):

• Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae.
• Cholera is an acute diarrhoeal disease that can kill within hours if left untreated.
• Severe cases will need rapid treatment with intravenous fluids and antibiotics.

The worst possible response to a cholera outbreak is denial, which is why the CCSD “accuses health authorities in the states of concealing and covering-up the lab results of samples taken from the patients, describing this behavior as ‘irresponsible and reckless.’” But for the NIF/NCP regime to admit that there have been multiple cholera outbreaks in multiple locations over an extended period of time would be to admit that it has simply not invested in the infrastructure necessary to provide clean water to the people of Sudan, particularly those of the peripheral regions.

This refusal to invest in clean water, even during the flush years of oil revenues, is emblematic of the priorities of the regime: military and security expenditures, and self-enrichment, will always take priority over spending on clean water, which is an ongoing and critical health issue in Sudan, given its climate and geography. Moreover, the regime’s hostility to international humanitarian organizations—even those with expertise in sanitation and provision of clean water—is notorious. Not only has Khartoum denied access to many locations in Darfur where water and sanitation issues are critical, but also in eastern Sudan there has been a striking lack of an international humanitarian presence. Here we should recall that in 2012 this regime decided for no credible reason to expel seven experienced humanitarian organizations from this part of the country. Sudan Tribune again reported authoritatively at the time:

(Sudan Tribune | May 31, 2012 (KHARTOUM) — Sudan’s Humanitarian Aid Commission (HAC) has ordered seven foreign aid groups to suspend their humanitarian activities in eastern Sudan following the findings of an assessment study reporting infractions they allegedly committed.

Eastern Sudan, which suffers from underdevelopment of the region and the marginalisation, is one of the poorest regions in the country where drought contributed largely to abandon nomadic lifestyle. Also, illegal immigration and refugees from Ethiopia and Eritrea have attracted humanitarian groups to the region.

Sudan’s Humanitarian commissioner Suleiman Abdel Rahman on Thursday issued a decision ending the humanitarian activities of the seven aid groups in the three states of Eastern Sudan region: Kassala; Red Sea and Gadaref states. The ban was based on a report prepared by a federal committee that conducted a field assessment of the projects implemented by these groups.

In short, he various health crises in Sudan are self-inflicted by the regime, and have been consistently so for more than 27 years of rule by “kleptocracy” (see | http://sudanreeves.org/2015/12/09/7041/).

Especially notable is the fact that the shortage of medicines in the country is not a product of U.S. sanctions but the crippling lack of foreign exchange currency (Forex). There are many countries around the world more than willing to sell Khartoum the medicines the people of Sudan need, but the regime simply doesn’t have the Forex to pay them. Instead, it either steals what Forex is available—directly or indirectly—or spends that money to weapons acquisitions (see the extraordinary budgetary analysis provided by Sudan Tribune at the end of Appendix A).

The lack of Forex has produced a precipitous drop in the value of the Sudanese Pound (which is now utterly worthless as a currency with which to make purchases abroad); and directly correlating with the drop in the value of the Sudanese Pound is skyrocketing inflation—well over 50 percent for the average Sudanese, year over year.

The increased costs of goods is reflected in bread prices (wheat for flour is imported at a cost of well over $1 billion per year), cooking fuel (refined petroleum products must be imported because of the regime’s failure to invest in domestic refining capacity), and medicines, which are now too costly for a great many Sudanese, with many more facing an acute lack of availability. Some medicines, even critical ones, can be afforded only by the rich can afford. This is what lies behind the grim dispatch from Radio Dabanga earlier this year:

El Sayha newspaper reported on Sunday that three brothers committed suicide in Omdurman. The well-known psychiatrist Ali Baldo was treating them. He said that the three, ‘suffering from a serious depression,” killed themselves as their family could not afford to purchase their medicines. “They were recovering well with medicines. Their mental state, however, rapidly deteriorated after they were deprived of their cure,” he told the newspaper.

Baldo explained that the three patients came from western Sudan. “Their family fled the insecure situation in their home area, and was bit by bit constructing a house in the western part of Omdurman.” The psychiatrist called on the Sudanese government to take into account the economic situation of the people, and keep to its commitment to provide gratis psychotropic medicines. (November 21, 2016 | https://www.dabangasudan.org/en/all-news/article/protest-in-sudan-capital-against-price-rises-brothers-commit-suicide)

Let’s be very clear as various celebrations of the lifting of sanctions continue to appear—some by Khartoum’s Washington lobbyists. Cholera is not and has never been the consequence of U.S. sanctions; the lack of clean water and the infrastructure for providing it is wholly the product of corrupt, self-enriching rule by the NIF/NCP regime; sanitation resources by international humanitarian organizations have been denied access throughout the country at various times, including eastern Sudan, Blue Nile, and—most consequentially—Darfur, where most camps are badly overcrowded and suffer from often critical water and sanitation deficits. From the rest of Sudan, such reports as the following have become commonplace:

‘Children in Sudan dying from lack of clean drinking water’ | Radio Dabanga | November 13, 2016 | KHARTOUM

Sudanese MPs: People dying of thirst in Red Sea and Blue Nile | Radio Dabanga | November 9, 2016 | RED SEA / BLUE NILE

The brutal campaign against the people of Jebel Marra (Central Darfur) in 2016 only exacerbated the problems of water shortages and sanitation shortcomings, as do the continuing predations of the Rapid Support Forces (RSF) in Jebel Marra and East Jebel Marra.

The regime this now formally incorporated the RSF into the regular army, the Sudan Armed Forces, which should mean that their war crimes should figure in any assessment of regime behavior over the past six months, as well as the next six months (the time-frame specified in the Obama Executive Order lifting sanctions). This is highly unlikely to occur, even as continuing violence against Darfuri civilians did not figure in Obama’s disingenuous claim that there have been “positive” developments in Sudan since July 2016 (see, for example, Radio Dabanga | “Central Darfur displaced demo against chemical weapons, bombs,” October 30, 2016 | Hashisi | https://www.dabangasudan.org/en/all-news/article/central-darfur-displaced-demo-against-chemical-weapons-bombs/ ).

Honesty—whether about the real impact and nature of now effectively lifted U.S. sanctions or the real causes of cholera—has long been in short supply. There is no reason to believe that this will change in a Trump administration already populated by those grossly ignorant about Sudan, habitually expedient, or mindlessly consumed with the securing of counter-terrorism intelligence from Khartoum.

APPENDIX A: Reports of cholera, water shortages, and economic collapse accelerating these trends

• “Acute watery diarrhea kills 12 in Sudan last week: report,” Sudan Tribune | January 24, 2017 (KHARTOUM) | http://www.sudantribune.com/spip.php?article61481

Twelve people have died and 500 infected with watery diarrhea in the states of Khartoum, Red Sea and Gedaref during last week, said a report by the independent Central Committee of Sudanese Doctors (CCSD). The field report, which was seen by Sudan Tribune on Tuesday, accuses health authorities in the states of concealing and covering-up the lab results of samples taken from the patients, describing this behavior as “irresponsible and reckless”.

It is noteworthy that the CCSD issued a report on 16 January disclosing that 8 people have died and 342 infected at several Sudanese states in a second wave of a suspected cholera outbreak within five months. The new report said that the field monitoring revealed 12 new deaths and more than 500 infections within last week, saying the infections took place mainly in the states of Khartoum, Red Sea and Gedaref.

According to the report, 5 people have died and 100 were infected in the locality of Galabat in the Gedaref state, stressing the health authorities have shut down the markets and the schools due to lack of medical services. It pointed out the average child infections have reached 20 cases daily in Port Sudan Children’s Hospital, saying there are currently more than 100 inpatients in the hospital. The report added that the average daily admissions at Port Sudan Teaching Hospitals reached 15 cases, saying that 3 people have died during the past few days.

According to the report, health authorities in Khartoum state have shut down restaurants and cafeterias at the Central Market for ten days following the increasing numbers of acute watery diarrhea infections among the residents.

The report pointed that the average admissions at Ibrahim Malik Hospital in Khartoum reached 20 cases, saying they are mostly from the Central Market area south of Khartoum. It added that the average admissions at Khartoum North Teaching Hospital reached 10 cases, saying that 2 people have died during the past few days and 21 inpatients are currently at the hospital.

The report further added that the average admissions at Al-ban Gadid Hospital in East Nile locality have reached 70 cases during the last week, pointing to the significant shortage of medicines and intravenous fluids besides the lack of safety and prevention measures.

The CCSD stressed that the health authorities didn’t take any real measures to curb the spread of the disease, saying the closure of market, shops and schools is not enough to counter the epidemic.

Last September, Sudan’s Federal Ministry of Health acknowledged that 55 people have died and 2619 were infected in Blue Nile State by watery diarrhea caused by (E. coli) bacteria stressing that the epidemic was not cholera.

The following headlines come from Radio Dabanga unless otherwise indicated:

• Medics: ‘Cholera spreading in Sudan’| January 22, 2017 | KHARTOUM | According to laboratory results, the diarrhoea cases spreading over various parts of Sudan since September last year are caused by cholera.
• Six ‘diarrhoea’ patients die, 97 treated in eastern Sudanese hospitals| January 23, 2017 | EL GEDAREF / PORT SUDAN
• Medics: ‘Cholera spreading in Sudan’| January 22, 2017 | KHARTOUM
• El Gedaref: 52 patients killed, infected by diarrhoea| January 20, 2017 | EL GEDAREF
• Diarrhoea death toll rising in eastern Sudan| January 19, 2017 | RED SEA STATE
• Sudan: Diarrhoea leaves six dead in three days| January 18, 2017 | PORT SUDAN
• Doctors: Diarrhoea cases in Sudan number in the hundreds| January 17, 2017 | KHARTOUM
• Eight dead in suspected Sudan cholera outbreak: report| Sudan Tribune | January 16, 2017 (KHARTOUM) – Eight people have died and 342 infected at several Sudanese states in a second wave of a suspected cholera outbreakwithin five months, said a report by the independent Central Committee of Sudanese Doctors.
• Watery diarrhoea kills eight in eastern Sudan| January 16, 2017 | JEBEIT
• Doctor: ‘Diarrhoea cases mounting in central Sudan’| January 15, 2017 | WAD MADANI
• More die of diarrhoea in eastern Sudan| December 30, 2016 | PORT SUDAN / WAD MADANI
• Death toll from diarrhoea in Sudan’s El Gezira ‘16 and rising’| December 29, 2016 | WAD MADANI
• Ten people die of acute diarrhoea in Sudan’s El Gezira| December 27, 2016 | WAD MADANI
• Medical source: 16 diarrhoea deaths this week in El Gedaref| December 16, 2016 | EL GEDAREF
• More students stricken with diarrhoea in Sudan| December 25, 2016 | WAD MADANI
• Diarrhoea kills two Sudanese students| December 15, 2016 | WAD MEDANI
• Watery diarrhoea claims two lives in Sudan’s El Gedaref| December 12, 2016 | EL GEDAREF
• Baby dies of diarrhoea infection in Port Sudan| November 30, 2016 | PORT SUDAN
• Port Sudan: Spread of ‘deadly diarrhoea’, journalist summoned| November 21, 2016 | PORT SUDAN
• One dead, infections by diarrhoea in Sudan’s White Nile| November 15, 2016 | ED DUEIM
• 32 diarrhoea deaths in Sudan’s El Gezira| November 4, 2016 | WAD MADANI
• Watery diarrhoea claims more lives in Sudan’s El Gezira state| November 3, 2016 | EL GEZIRA
• Sudan: Four dead, 25 infected with acute watery diarrhoea| October 27, 2016 | EL HAJ YOUSIF

Examples of water Shortages

• Thirst in North Darfur’s Shaddad camp| January 9, 2017 | SHADDAD CAMP
• Drinking water crisis as militiamen bar access to North Darfur wells| November 23, 2016 | KABKABIYA
• Water depletion in Sudan’s agricultural scheme| December 13, 2016 | EL GEZIRA / EL GEDAREF
• Winter crops threatened in Sudan’s El Gezira| December 4, 2016 | EL GEZIRA

Further indications of regime priorities and the consequence of kleptocratic rule in Khartoum:

• No water, bread, fuel, electricity in South Kordofan capital| January 23, 2017 | KADUGLI
• Acute shortage of bread in Sudan| January 9, 2017 | KHARTOUM / EL OBEID / EL GEZIRA
• Flour shortage affects bakeries in Sudan capital| December 9, 2016 | KHARTOUM
• Sudan: Pharmacies swept up in high drug prices| November 22, 2016 | KHARTOUM
• Medicine prices expected to double in Sudan| November 8, 2016 | KHARTOUM / EL FASHER / ED DAEIN / BABANUSA
• Protest in Sudan capital against price rises, brothers commit suicide| November 21, 2016 | KHARTOUM
• Sudan Govt.: 15% deficit in flour production| December 8, 2016 | KHARTOUM
• ‘Sudan’s 2017 budget will lead to continued crisis’: Economist| December 25, 2016 | KHARTOUM
• Sudan’s deficit grows to SDG19.5 billion: Finance Minister| December 9, 2016 | KHARTOUM
• Sudan’s inflation continues to rise for eighth straight month| Sudan Tribune | January 18, 2017 (KHARTOUM) – Sudan’s Central Bureau of Statistics (CBoS) on Wednesday reported that inflation jumped to 30.47% in December 2016 from 29.49 in November pointing to continued rise in food and energy price.

[The Central Bureau of Statistics is notorious for misrepresenting unfavorable economic news; but even a 30% inflation rate—especially one that continues to rise—is simply unsustainable. The economy is in fact imploding—ER]

 Where the money goes:

• Sudan allocates $1.8 billion for defense in 2017| Sudan Tribune | December 23, 2016 (KHARTOUM) – Sudan has appropriated more than 29 billion pounds (SDG) (about $1.8 billion) to defense and security which represents the largest single spending item in the 2017 budget. According to Sudan’s 2017 budgetary estimates seen by Sudan Tribune, 5 billion pounds have been allocated to the sovereign sector while 2.3 billion was appropriated for agriculture and forests spending.

Other budget spending items include 1.9 billion (SDG) for the economic sector, 5.5 million for culture and information, 5.3 million for health, 828 million for education, 1.7 billion for minerals and 1.7 billions for transport, roads and bridges.

In other words:

Infrastructure spending (including for improved delivery of clean water) = approximately 6% of the military/security budget;

Education spending = about 3% of the military/security budget;

What the Gulf States and Saudi Arabia are funding:

• Sudan to receive $500 million deposit from UAE: Bashir| Sudan Tribune | December 6, 2016 (KHARTOUM) – Sudanese President Omer al-Bashir on Tuesday has said that his country will receive a $500 million central bank deposit from the United Arab Emirates (UAE).
• Sudanese army conducts largest-ever military drills

Sudan Tribune December 6, 2016 (KHARTOUM) – Sudan Armed Forces (SAF) on Tuesday said it has conducted the largest military exercises in its history in the presence of President Omer al-Bashir and senior army commanders.

Eric Reeves is a Senior Fellow at Harvard University’s François-Xavier Bagnoud Center for Health and Human Rights.