Atovaquone-Proguanil (Malarone) — Preferred

One tablet daily from 1–2 days before entry, throughout stay, and 7 days after leaving. First-line choice. Requires a prescription — obtain before travel as no reliable supply exists in Sudan.

Doxycycline

100mg daily from 1–2 days before entry and 28 days after. Alternative for those who cannot take Malarone. Do not rely on obtaining this medication locally — bring a full supply.

Treatment Self-Carry

Given the complete collapse of healthcare in Sudan, humanitarian workers and essential travelers should carry artemether-lumefantrine (Coartem) as emergency standby malaria treatment, per their physician. Healthcare access in conflict zones cannot be assumed. Any fever is a medical emergency — treat promptly.

Port Sudan (Current Safer Area)

Port Sudan on the Red Sea coast has been a relatively safer area and has some functioning medical facilities. It has become the de facto functioning capital during the conflict. Even here, healthcare is severely strained. International NGO medical facilities (MSF, IRC) operate in some areas but are stretched to the limit.

Khartoum & Conflict Zones

Khartoum has suffered catastrophic destruction. Major hospitals including Khartoum Teaching Hospital have been occupied, looted, and damaged. No functioning medical care exists for civilians in the active conflict areas of Khartoum, Darfur, and South Kordofan. Any injury or serious illness in these areas is likely fatal without immediate evacuation.

Evacuation Options

Medical evacuation from Sudan is severely complicated by the conflict. The nearest viable medical destinations are Cairo, Egypt (if northern Sudan is accessible) or Addis Ababa, Ethiopia or Nairobi, Kenya (for southern access). Commercial flights operate irregularly from Port Sudan. The US government conducted an emergency evacuation of Embassy staff in May 2023. Standard medical evacuation services have extremely limited capacity in Sudan.

Active Combat Operations

Intense fighting occurs in Khartoum, Khartoum North, and Omdurman (the capital area), as well as El Fasher, El Geneina, Nyala, and Zalingei in Darfur. Artillery, airstrikes, and ground combat create extreme danger. Frontlines shift unpredictably. There are no safe areas in active conflict zones.

Kidnapping & Atrocities

Kidnapping for ransom and political motives occurs. RSF forces have committed widespread atrocities against civilians including summary executions, sexual violence, and ethnic targeting. Foreign nationals face extreme risk of detention, abuse, and death in areas controlled by irregular forces.

UXO & Landmines

Unexploded ordnance and improvised explosive devices are present throughout conflict-affected areas. Do not approach any unfamiliar objects. Stick to known safe routes only — and recognize that "known safe routes" may change daily in an active conflict environment.

Exit Options

If currently in Sudan, consider all available exit routes: commercial flights from Port Sudan (if available), land border crossings to Egypt (Wadi Halfa — if northern routes are passable), Chad (dangerous given Darfur situation), Ethiopia, or Eritrea. Contact the State Department immediately for current guidance on available exits. Do not rely on a single exit route.

Cholera

Cholera is endemic in Sudan and has surged dramatically since the conflict began — with water supply infrastructure destroyed in many areas. Purify all water without exception. Oral rehydration salts are essential. Any severe diarrheal illness in Sudan should be treated as potentially cholera. The oral cholera vaccine is recommended for humanitarian workers.

Meningococcal Disease

Sudan is in the Meningitis Belt. Outbreaks occur during dry season (November–June). Displacement camps are high-risk environments. MenACWY vaccination is strongly recommended. Seek immediate medical attention for sudden severe headache, high fever, stiff neck, or sensitivity to light — meningitis can kill within 24 hours.

Trauma & Conflict Injuries

Blast injuries, gunshot wounds, and trauma from the conflict are the primary causes of death and injury for those in combat areas. If you must operate in Sudan in a professional capacity (journalism, humanitarianism), carry a trauma kit including tourniquet, hemostatic dressings, and chest seals, and have trained personnel available.

Extreme Heat

Sudan experiences extreme heat — temperatures in Khartoum regularly exceed 45°C (113°F) in summer. Conflict and displacement have eliminated reliable shelter and clean water for millions. Heat-related illness and death are occurring among displaced populations. Maintain hydration, seek shade, and avoid all physical exertion during peak heat hours.