Breaking News:Acute Hepatitis in Sudan’s Displaced Population– What Just Happened

SUDAN is in the midst of an outbreak of acute hepatitis among displaced populations, highlighting the vulnerability of communities in conflict-affected regions. Acute hepatitis, an inflammatory liver condition that can progress to liver failure, has been observed in multiple areas of Gezira State, with nearly 500 cases documented between March and July 2025. Around 15–20% of these cases advanced to acute liver failure, characterised by severe jaundice, coagulopathy, and encephalopathy, underscoring the seriousness of this emerging health concern.

Collapsed Health Services Heighten Risk

The ongoing conflict in Sudan has displaced millions. The situation has led to more than 519 attacks on healthcare facilities and the deaths of 119 healthcare workers. While the number of internally displaced persons has fallen to 9.8 million as some returned to recently recovered regions, over 80% of health facilities in these areas remain non-functional. This disruption increases the risk of malnutrition-related liver conditions, such as Kwashiorkor, alongside infectious outbreaks including cholera, measles, and dengue fever. Communities with poor sanitation and contaminated water appear particularly affected, suggesting environmental factors may contribute to the spread of hepatitis.

Clinical Presentation of the Outbreak

Patients present with jaundice, nausea, vomiting, and right hypochondrial pain. Laboratory tests show markedly elevated liver enzymes exceeding 1,000 IU/L, total bilirubin above 8 mg/dL, and severe coagulopathy with INR over 5. While many cases follow a self-limiting course, a worrying proportion develop acute liver failure, carrying a high mortality risk. Cases span genders, ages, and socioeconomic groups, and community reporting suggests the true incidence may be higher than official figures indicate.

Standard serological testing for hepatotropic viruses (A, B, C, and D) has consistently returned negative results, pointing to a possible undetected pathogen, environmental exposure, or hepatitis E infection. Other potential explanations include ischaemic hepatitis in the context of hypovolemia and severe malnutrition, as well as toxic hepatitis from contaminated industrial sources. Ongoing insecurity, limited laboratory capacity, and disrupted surveillance networks have severely hampered investigation into the causes of the outbreak.

Urgent Public Health Action Needed

Experts emphasise that this outbreak reflects the consequences of collapsed healthcare systems and ineffective early warning mechanisms. Without immediate investigation and coordinated humanitarian response, the hepatitis cases could spread to other regions. Global hepatology societies are urged to support disease surveillance, resource mobilisation, and field investigations to prevent further fatalities.

Providing humanitarian aid, including well-balanced nutritional support, is also critical. Adequate nutrition can mitigate risk factors for liver damage, such as kwashiorkor, and may help reduce the severity of acute hepatitis among vulnerable populations.

This situation in Sudan highlights how emerging liver diseases can escalate rapidly in conflict zones, reinforcing the urgent need for sustained international investment in fragile health systems, early intervention measures, and comprehensive humanitarian assistance.

Reference

Dafallah MA, Mamoun M. Alarming increase of acute liver failure during Sudan’s conflict: a call for urgent global hepatology response. Ann Hepatol. 2026;DOI:10.1016/j.aohep.2025.102167

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