Sudan: Score Justification Summary

1.1.1a National plan for AMR priority pathogens

Score: 100

Sudan has a national antimicrobial resistance plan that covers surveillance, detection, and reporting of priority antimicrobial resistant pathogens. The Federal Ministry of Health and the Federal Ministry of Animal Resources issued the “National Action Plan on Antimicrobial Resistance, 2018 to 2020,” which states that Sudan will establish and strengthen national antimicrobial resistance surveillance systems, detect priority resistant pathogens through laboratory networks, and report antimicrobial resistance data nationally and internationally, including through participation in the World Health Organization Global Antimicrobial Resistance and Use Surveillance System ^{1, pp. 7–10}. The plan includes an operational plan and a monitoring and evaluation framework specifying surveillance activities, indicators, and reporting mechanisms across the human and animal health sectors under a One Health approach ^{2, pp. 28, 39}. Sudanese government communications after 2020 reference approval and implementation of a revised national antimicrobial resistance plan covering a later period, including public statements reported by the Sudan News Agency ³⁴. These communications do not include publication of the revised national plan text, and the World Health Organization listing of national antimicrobial resistance plans for Sudan identifies only the 2018 to 2020 plan as publicly accessible ⁵.

1.1.1b Capacity of national lab/lab system to test for AMR priority pathogens

Score: 50

Sudan has a national laboratory system that tests for some, but not all, of the WHO GLASS priority AMR pathogens. According to the WHO “GLASS Annual Report 2022,” Sudan submitted data on Escherichia coli and Staphylococcus aureus, but not on the full set of 7+1 priority pathogens ⁶. A 2023 Sudan News Agency article confirms that the Federal Ministry of Health, in collaboration with WHO and FAO, conducted a national workshop in March 2023 to analyze antibiotic usage and resistance patterns across human and animal sectors; the event emphasized microbial resistance mapping and national policy coordination ⁷. The 2023 Infectious Disease Detection and Surveillance (IDDS) Annual Report further documents laboratory surveillance capacity-building in Sudan during FY2023, including technical support and training related to AMR detection and reporting under a One Health approach ⁸. In addition, the WHO Joint External Evaluation for Sudan reports that the NPHL and all SPHLs can test microscopically for malaria and tuberculosis, that the NPHL and some SPHLs test for HIV and Salmonella, and that the NPHL tests for influenza, polio, and viral haemorrhagic fevers ^{9, p. 30}; the same JEE notes that three human laboratories in Khartoum State (NPHL, Soba Hospital, Omdurman Hospital) can detect and report all seven WHO priority AMR pathogens: Escherichia coli, Klebsiella pneumoniae, Neisseria gonorrhoeae, Staphylococcus aureus, Streptococcus pneumoniae, Salmonella spp., and Shigella spp. However, detection and reporting for Acinetobacter sepp. is not avaiable. ^{10, p. 14}.

1.1.1c National environmental surveillance for AMR residues/organisms

Score: 0

There is no publicly available evidence that Sudan’s government conducts environmental detection or surveillance for antimicrobial residues or AMR organisms. A 2023 scoping review found no evidence of government-led surveillance programs for AMR residues or organisms in environmental matrices in Sudan ¹¹. Although the review mentioned isolated research efforts, it concluded that no national-level environmental AMR surveillance frameworks were present in Sudan ¹². No documents from the Sudanese Ministry of Health, Ministry of Higher Education and Scientific Research, or the Sudanese Standards and Metrology Organization provide evidence of an official environmental AMR detection program, monitoring network, or national regulatory enforcement for AMR in soil, wastewater, or surface water ¹³. Sudan is not listed in the WHO GLASS 2023 environmental surveillance reporting modules for 2022, confirming the absence of national data contributions or programmatic surveillance efforts during this time ¹⁴. The World Bank AMR Country Progress Tracker likewise contains no records of environmental surveillance systems, pilot programs, or national detection activities for Sudan ¹⁵.

1.1.2a National law(s) requiring prescription for antibiotic use (humans)

Score: 50

Sudan has national legislation requiring prescriptions for antibiotic use for humans, but there is publicly available evidence of significant gaps in enforcement. The operative legal instrument governing medicines regulation is the “Drugs and Poisons Act, 2009,” which repealed the earlier “Pharmacy and Poisons Act, 2001” while preserving its effect until replaced and establishes prescription-based control over the dispensing of medicines. The Act defines dispensing as the supply of a drug upon a prescription issued by a licensed medical practitioner and embeds this requirement within the national framework regulating pharmacy practice and medicines control under the Ministry of Health and the National Medicines and Poisons Board ^{16, pp. 3, 5, 10}. Despite this legal requirement, enforcement challenges are well documented. A 2022 peer reviewed analysis of antimicrobial resistance in Sudan reports that non prescription access to antibiotics remains widespread and is driven by weak regulatory oversight and low awareness among pharmacy staff ^{17, p. 6}. Further evidence of enforcement gaps is provided by a 2023 cross sectional survey conducted in Khartoum State, which found that 68.6% of antibiotic purchases occurred without a prescription, directly contravening national law and confirming that the prescription requirement is not consistently enforced in practice ^{18, p. 7}.

1.1.2b National law(s) requiring prescription for antibiotic use (animals)

Score: 100

Sudan has national legislation requiring prescriptions for the use of antibiotics in animals, with publicly available evidence of enforcement. The Medicines and Poisons Act of 2009 (قانون الأدوية والسموم لسنة 2009), administered by the National Medicines and Poisons Board (NMPB), applies to both human and veterinary medicines and prohibits the dispensing of antibiotics without a prescription from a licensed veterinarian ^{19, p. 6}. Enforcement evidence includes a 2024 Sudan News Agency report on the closure of multiple pharmacies for violating the Pharmacy and Poisons Law, indicating active inspection and sanctioning by authorities to uphold prescription requirements ²⁰. In 2025, peer-reviewed public health research documented continued government enforcement of veterinary antibiotic prescription controls, citing the National Medicines and Poisons Board’s role in regulating antimicrobial use in animals and preventing unauthorized sales ^{21, p. 2}.

1.2.1a Laws/plans on zoonotic disease

Score: 100

Sudan has national strategy documents for zoonotic disease prioritization, detection, and reporting, with publicly available evidence of implementation. In August 2022, the Federal Ministry of Health, together with the Ministry of Animal Resources and the Higher Council for the Environment and Natural Resources, in collaboration with WHO and FAO, conducted a One Health Zoonotic Diseases Prioritization Workshop that produced a prioritized list of eight zoonoses of greatest concern, a multisectoral action plan, and an agreement to establish a One Health Platform with a Joint Coordination Committee to oversee its implementation ^{22, p. 12–13}. In 2025, WHO’s Health Emergency Appeal for Sudan reports that the Ministry of Health, supported by WHO, is expanding the Early Warning, Alert and Response System (EWARS), training health workers, reinforcing community-based surveillance, and strengthening the National Public Health Reference Laboratory and state-level Emergency Operations Centers to enhance detection and reporting capacities for communicable diseases ^{23, p. 3–4}.

1.2.1b Laws/plans on zoonotic disease spillover from animals to humans

Score: 100

Sudan has national strategy documents that include measures for risk identification and reduction for zoonotic disease spillover from animals to humans, with publicly available evidence of implementation. In August 2022, the Federal Ministry of Health, the Ministry of Animal Resources, and the Higher Council for the Environment and Natural Resources, in collaboration with the World Health Organization (WHO) and the Food and Agriculture Organization (FAO), conducted a One Health Zoonotic Diseases Prioritization workshop that produced a prioritized list of eight zoonoses of greatest concern, a multisectoral joint action plan, and the establishment of a Joint Coordination Committee to oversee creation of a national One Health Platform. The plan includes joint outbreak investigation protocols, cross-sectoral information sharing, and surveillance at the human, animal, and environment interface ^{24, pp. 12–13}. Explicit risk identification and reduction measures are documented; the World Bank diagnostic recommends mapping and modeling zoonotic hotspots and land use actions to reduce exposure, including buffer areas separating people and wild animals, and strengthening forecasting and early warning systems ^{25, pp. 39–40}. In 2025, WHO reports that Sudan’s Ministry of Health, with WHO support, is expanding the Early Warning, Alert and Response System (EWARS) and community-based surveillance, strengthening the National Public Health Reference Laboratory and state-level Emergency Operations Centers, and enhancing information management for detection and reporting of zoonotic threats ^{26, pp. 3–4}. WHO’s Public Health Situation Analysis dated 10 March 2025 confirms that national EWARS has been operational since August 2023 and that EWARS Mobile was rolled out in Central and East Darfur and is being expanded to North, West, and South Darfur in 2025, alongside biweekly coordination chaired by the Ministry of Health and WHO ^{27, pp. 7, 10, 12, 13}.

1.2.1c Laws/plans for surveillance & control of multiple zoonotic pathogens

Score: 100

Sudan has national strategy documents that account for the surveillance and control of multiple zoonotic pathogens of public health concern, with publicly available evidence of implementation. In August 2022, the Federal Ministry of Health, the Ministry of Animal Resources, and the Higher Council for the Environment and Natural Resources, in collaboration with the World Health Organization (WHO) and the Food and Agriculture Organization (FAO), conducted a One Health Zoonotic Diseases Prioritization workshop that produced a prioritized list of eight zoonoses of greatest concern, a multisectoral joint action plan, and a Joint Coordination Committee to oversee the establishment of a national One Health Platform. The action plan covers surveillance and control for Rift Valley fever, salmonellosis, dengue fever, rabies, brucellosis, Crimean-Congo hemorrhagic fever, zoonotic avian influenza, and hepatitis E ^{28, pp. 12–13}. In 2025, WHO confirms that the Ministry of Health, with WHO support, is expanding the Early Warning, Alert and Response System (EWARS) and community-based surveillance to cover priority zoonotic diseases, reinforcing the National Public Health Reference Laboratory and state Emergency Operations Centers, and implementing outbreak detection and control activities through coordinated health cluster operations ^{29, pp. 3–4}. WHO’s Public Health Situation Analysis of 10 March 2025 documents EWARS Mobile rollout in Darfur states, bi-weekly coordination chaired by the Ministry of Health and WHO, and integration of zoonotic pathogen reporting, demonstrating active implementation of surveillance and control measures for multiple zoonoses in 2025 ^{30, pp. 7, 10, 12}.

1.2.1d Cross-ministerial department/agency/unit for zoonotic disease

Score: 100

Sudan has a national multi-sectoral coordinating mechanism for zoonotic disease that functions across ministries. In August 2022 the Federal Ministry of Health, the Ministry of Animal Resources, and the Higher Council for the Environment and Natural Resources, with WHO and FAO, created a Joint Coordination Committee and agreed to establish a national One Health Platform to coordinate policy, surveillance, laboratories, and response across the human, animal, and environment sectors ^{31, pp. 12–13}. In 2025 WHO reports bi-weekly coordination chaired with the Federal Ministry of Health and the rollout of EWARS Mobile to hard-to-reach Darfur states, demonstrating an operational cross-ministerial coordination mechanism in practice ^{32, p. 12}. WHO’s 2025 Health Emergency Appeal further confirms coordinated expansion of EWARS and support to the National Public Health Reference Laboratory and state Emergency Operations Centers, reflecting an active national coordinating function ^{33, pp. 3–4}. The Sudan News Agency also records a 2025 One Health Platform activities report, including coordination with national supply authorities to provide rabies vaccine to ten states, evidencing ongoing interministerial coordination this year ³⁴.

1.2.1e Presence of One Health strategic plan

Score: 0

While Sudan does not have standalone One Health startegic plan, it has adopted the One Health concept to address threats to humans, animals, and environment, as a platform for multisectoral actions. This focus intensified after the Joint External Evaluation (JEE) in 2016 recommendation of strengthening joint approaches . The Federal Ministry of Health (FMOH) and the Federal Ministry of Animal Resources (FMOAR), as supreme governance bodies have implemented “One Health approach” and utilized it to manage 2019 RVF outbreak through governance, coordination, field operations, monitoring, and oversight at national and sub-national levels. ³⁵³⁶

1.2.2a Surveillance/reporting mechanism for zoonotic disease for livestock owners

Score: 100

Sudan has a national mechanism requiring livestock owners to report suspected notifiable diseases to a central government agency, with publicly available evidence of its operation. The Epidemic Diseases of Animals Act (2001), administered by the Ministry of Animal Resources, mandates livestock keepers to notify local veterinary offices or state veterinary authorities of suspected outbreaks, with these reports transmitted to the central Veterinary Epidemiology and Animal Health Directorate ^{37, pp. 18–19}. The 2022 One Health Zoonotic Diseases Prioritization workshop confirmed integration of livestock disease reporting into national surveillance channels coordinated between the Ministry of Animal Resources and the Federal Ministry of Health ^{38, pp. 12–13}. In 2025, WHO confirmed that veterinary sector representatives participated in EWARS coordination meetings chaired by the Federal Ministry of Health, where animal health surveillance data was incorporated into national situational analysis and outbreak response planning ^{39, p. 12}.

1.2.2b Laws/regulations on data confidentiality to protect livestock owners

Score: 0

There is no publicly available evidence that Sudan has legislation or regulations safeguarding the confidentiality of information generated through surveillance activities for animals for livestock owners. The World Organisation for Animal Health’s Veterinary Legislation Identification Mission report for Sudan reviews the Epidemic Diseases of Animals Act (2001), the Animal Disease (Free Zone) Act (1973), the Meat Inspection Act (1974), and other principal laws, confirming provisions for mandatory disease reporting and inspection without any clauses protecting owner-identifiable information ^{40, pp. 73–75}. The FAOLEX country legislation profile for Sudan lists all veterinary laws in force, including epidemic disease control and quarantine regulations, with no reference to confidentiality safeguards ⁴¹. The Veterinary Council Act (1995), which governs veterinary professional conduct and oversight, also contains no provisions on protecting the confidentiality of animal surveillance data or livestock owner information ^{42, pp. 1–2}.

1.2.2c Wildlife zoonotic disease surveillance

Score: 0

There is no publicly available evidence that Sudan conducts zoonotic disease surveillance in wildlife and poultry as part of surveillance covering wildlife, poultry, and livestock. The World Reference Laboratory for Foot-and-Mouth Disease quarterly reporting documents laboratory receipt and testing of a Sudan batch of 40 clinical field samples, but the Sudan entry is limited to livestock, specifically cattle, and does not describe surveillance activities in wildlife or poultry, nor any insect or other vector surveillance ^{43, pp. 10, 14}. The subsequent quarterly report specifies that the same Sudan batch comprised samples collected from cattle between January 2019 and March 2022 across Sudan states, with laboratory results and sequencing status reported, and its Annex tables list the Sudan clinical samples as cattle only, with no wildlife or poultry sampling described ^{44, pp. 9–10, 12, 24–25}.

1.2.3a Annual reporting to OIE on zoonotic disease incidence

Score: 100

Sudan has an operational mechanism for reporting notifiable animal diseases to the World Organisation for Animal Health (WOAH), with publicly available evidence from the WOAH World Animal Health Information System (WAHIS). On 8 January 2025, WOAH validated Follow-up report 1 (Event ID 6097) on an outbreak of equine influenza virus (H3N8), following its recurrence on 31 March 2024 after last being reported in May 2019. The report, submitted by Sudan’s Veterinary Services, confirms that the disease was clinically diagnosed and control measures such as selective killing and disposal were applied. The event remains ongoing, and WOAH notes that the source was illegal animal movement and that conflict conditions limited epidemiological investigation ⁴⁵

1.2.4a Number of veterinarians per 100,000 people

Score: 25.3

1.2.4b Number of veterinary para-professionals per 100,000 people

Score: 13.05

1.2.5a Inclusion of private sector in national plan/law on zoonotic disease

Score: 0

There is no publicly available evidence that Sudan’s national plan on zoonotic disease, or other legislation, regulation, or plan, includes mechanisms for working with the private sector in controlling or responding to zoonotic diseases. Sudan’s “National Health Sector Recovery and Reform Strategic Plan 2022–2024” describes intentions to organize public private partnerships and develop a public private partnership framework, and it references engagement with non state actors including the private sector in broader health system risk mitigation, but it does not define any formal, operational mechanism assigning private sector roles in zoonotic disease surveillance, prevention, or outbreak response ^{46, pp. 30, 42}. The same plan mentions application of the One Health Tool for costing and planning purposes without establishing partnership modalities or responsibilities for private veterinary services, laboratories, or other private actors in zoonotic control ^{47, p. 40}. The World Bank report “Toward a One Health Approach in Sudan” identifies the presence of private veterinary and laboratory services and recommends their future inclusion, but it does not document any adopted national law, regulation, or plan that integrates the private sector into zoonotic disease governance or response systems ^{48, pp. 33–34}. A World Organisation for Animal Health follow up report on an equine influenza event in Sudan provides official outbreak notification and public sector response information only and contains no description of private sector engagement mechanisms within national zoonotic disease control arrangements ⁴⁹.

1.3.1a Updated national records of especially dangerous pathogen/toxin inventories

Score: 0

There is no publicly available evidence that Sudan maintains a national, government-held record, updated within the past five years, that lists all facilities storing or processing especially dangerous pathogens and toxins and includes details on each facility’s inventories and inventory management systems. The World Health Organization’s Public Health Situation Analysis for Sudan, dated March 10 2025, describes coordination with the central public health laboratory for specimen handling during Ebola Virus Disease preparedness and recalls the April 2023 seizure of the National Public Health Laboratory, but it does not reference any national registry or inventory tracking record for high-risk pathogen facilities ^{50, p. 22}. WHO’s 2023 note on upgrading the Port Sudan Public Health Laboratory to replace the Khartoum National Public Health Laboratory during the conflict similarly discusses equipment and preparedness, not a national facilities and inventory record ⁵¹. Sudan’s National Biosafety Law No. 15 of 2010 regulates genetically modified organisms and related biosafety matters, but it does not establish a countrywide register of laboratories handling especially dangerous pathogens or mandate inventory management reporting to a central authority ^{52, pp. 1–6}.

1.3.1b Biosecurity laws on facility security for especially dangerous pathogens

Score: 50

Sudan has legislation that addresses biosecurity in facilities handling especially dangerous pathogens and toxins, but there is insufficient publicly available information confirming that it contains explicit requirements for all listed elements such as physical containment, operational practices, failure reporting systems, and cybersecurity. The National Biosafety Law No. 15 of 2010, administered by the Higher Council for Environment and Natural Resources, regulates the safe handling of genetically modified organisms, pathogens, and hazardous biological materials ^{53, pp. 1–6}. The law includes provisions on containment measures, licensing, and inspection of facilities, and it authorizes the competent authority to impose operational controls and enforce biosafety measures ^{54, pp. 4–5}. However, the law does not include detailed, publicly accessible clauses describing mandatory failure reporting systems or cybersecurity requirements for pathogen-handling laboratories. The World Health Organization’s Public Health Situation Analysis for Sudan (March 2025) notes that the National Public Health Laboratory and other facilities follow certain biosafety protocols during specimen management for priority diseases, but it does not cite any national regulations specifying comprehensive requirements for physical containment, operations, failure reporting, and cybersecurity ^{55, p. 22}.

1.3.1c Agency for enforcement of biosecurity laws/regulations

Score: 100

Sudan has designated national authorities responsible for enforcing biosecurity legislation and regulations. The National Biosafety Law No. 15 of 2010 assigns enforcement responsibilities to the Higher Council for Environment and Natural Resources (HCENR), which acts through the Sudan National Biosafety Council (SNBC) as the Competent Authority for oversight of facilities handling genetically modified organisms, pathogens, and hazardous biological materials ^{56, pp. 1–2}. The law authorizes HCENR to conduct inspections, enforce compliance measures, and coordinate with relevant ministries for implementation ^{57, pp. 4–5}. International focal point records confirm that SNBC under HCENR is Sudan’s legally recognized enforcement body for biosafety ⁵⁸. In practice, the Federal Ministry of Health, through the National Public Health Laboratory, supports operational enforcement for pathogen-handling facilities under public health surveillance, including specimen transport and biosafety compliance, as noted by the World Health Organization’s Public Health Situation Analysis for Sudan (March 2025) ^{59, p. 22}.

1.3.1d Consolidation of especially dangerous pathogens into minimum # of facilities

Score: 0

Sudan has taken steps to centralize testing for especially dangerous pathogens into a limited number of facilities, but there is insufficient publicly available evidence of active measures to reduce the total number of facilities permitted to hold such pathogens. In August 2023, the World Health Organization Regional Office for the Eastern Mediterranean announced that the Public Health Laboratory in Port Sudan had been upgraded to function as the national reference facility for outbreak preparedness and response, replacing the Khartoum National Public Health Laboratory, which was no longer accessible due to the conflict. The upgrade included biosafety and diagnostic capacity for priority pathogens and was intended to receive samples from across Sudan ⁶⁰. This was corroborated by the Sudan News Agency in September 2023, which reported that the Port Sudan facility was prepared to process samples from multiple eastern states under Federal Ministry of Health oversight ⁶¹.

1.3.1e Capacity to conduct tests for anthrax/Ebola without culturing live pathogens

Score: 0

There is no publicly available evidence that Sudan has in country capacity to conduct Polymerase Chain Reaction based diagnostic testing for anthrax and or Ebola in a manner that would preclude culturing a live pathogen. World Health Organization reporting on Sudan’s conflict emergency consistently documents severe disruption to national laboratory systems and describes outbreak detection capacity as limited, without identifying any validated in country Polymerase Chain Reaction assays, protocols, or accredited workflows for Bacillus anthracis or Ebola virus diagnostics ^{62, p. 2}. The World Health Organization Public Health Situation Analysis covering April to August 2024 notes that some specimens for other diseases were pending transfer to Port Sudan for Polymerase Chain Reaction testing, indicating constrained and centralized molecular capacity, but it does not document pathogen specific Polymerase Chain Reaction testing for anthrax or Ebola within Sudan ^{63, p. 12}. The World Health Organization Regional Office for the Eastern Mediterranean Sudan Health Emergency Situation Report further references distribution of general diagnostic supplies and laboratory support activities during the emergency response, yet it provides no evidence of in country Polymerase Chain Reaction capability specific to anthrax or Ebola, nor any indication of validated assays, biosafety clearance, or routine use that would meet the indicator threshold ^{64, p. 1}.

1.3.2a Biosecurity training using a standardised, required approach

Score: 0

There is no publicly available evidence that Sudan requires biosecurity training, using a standardized and required national approach, for personnel working in facilities that house or handle especially dangerous pathogens, toxins, or biological materials with pandemic potential. The World Health Organization Joint External Evaluation for Sudan published in 2016 documents that biosafety and biosecurity training was occurring only in some central laboratories and that there was no national training programme for all laboratories and staff, with priority actions recommending development and delivery of a national training programme rather than confirming any standardized required approach or recertification cycle in force ^{65, pp. 30–32}. Publicly available Sudanese legal and environmental governance materials accessible in 2025, including the “National Biosafety Law” text hosted by the Higher Council for Environment and Natural Resources, focus on biosafety for genetically modified organisms and do not establish a standardized required biosecurity training curriculum, train the trainer programme, or recertification requirement for facilities handling especially dangerous pathogens ^{66, pp. 2–4}. The Higher Council for Environment and Natural Resources news item describing a biosafety awareness and capacity workshop likewise does not evidence a standardized required national biosecurity training system for high consequence pathogen facilities ⁶⁷.

1.3.3a Personnel checks for permission to access to especially dangerous pathogens

Score: 0

There is no publicly available evidence from that Sudan’s regulations or licensing conditions require security or other personnel with access to especially dangerous pathogens, toxins, or biological materials with pandemic potential to undergo drug testing, background checks, or psychological fitness checks. World Health Organization (WHO) publications describing Sudan’s laboratory capacity and public health emergency operations do not indicate the existence of such personnel vetting requirements for facilities handling high-risk agents ⁶⁸⁶⁹. Materials published by the Higher Council for Environment and Natural Resources (HCENR) do not contain provisions mandating any of the three checks for laboratory or security staff with access to dangerous biological materials ⁷⁰. The Verification Research, Training and Information Centre’s Biological Weapons Convention National Implementation Measures database also does not list Sudanese legal measures that establish drug testing, background checks, or psychological screening for these personnel ⁷¹.

1.3.4a National transport regulations for Category A and B infectious substances

Score: 100

Sudan has publicly available national regulations governing the safe and secure transport of infectious substances, explicitly including Categories A and B, through binding civil aviation regulations issued by the Sudan Civil Aviation Authority. The Sudan Civil Aviation Authority promulgated the “Sudan Civil Aviation Regulations (SUCAR) Part 18: The Safe Transport of Dangerous Goods,” First Edition, issued in April 2021, which establishes mandatory requirements for the classification, packaging, marking, labeling, documentation, handling, storage, acceptance, loading, segregation, and incident reporting of dangerous goods transported by air ^{72, pp. 18-1, 18-4}. SUCAR Part 18 defines infectious substances as dangerous goods and regulates their transport in accordance with Annex 18 to the Convention on International Civil Aviation and the International Civil Aviation Organization Technical Instructions, including provisions applicable to both Category A and Category B infectious substances ^{73, pp. 18-1, 18-4}. The regulation sets out enforceable obligations for shippers, operators, and handling agents, including packaging instructions, documentation requirements, and procedures for damage, leakage, and incident reporting involving infectious substances during air transport ^{74, pp. 18-3, 18-4}.

1.3.5a Laws/regulations on cross-border transfer and end-user screening

Score: 0

There is no publicly available evidence that Sudan has legislation or regulations requiring permits for cross-border transfers or end-user screening of especially dangerous pathogens, toxins, or pathogens with pandemic potential. Review of key sectoral instruments found no such provisions. The Sudan Civil Aviation Regulations, Part 9 – Facilitation (2021), set requirements for passenger, cargo, and public health procedures at airports, referencing International Health Regulations and International Civil Aviation Organization dangerous goods instructions, but regulate only packaging, documentation, and carriage, not transfer licensing or end-user vetting ^{75, pp. xiii–xvii, 4-1 to 4-6}. The Public Health Quarantine Law (1974) provides inspection and quarantine powers at points of entry but contains no controls on the transfer of high-risk biological agents or screening of recipients ⁷⁶. Import guidance from the National Medicines and Poisons Board regulates medicines and devices via licensure but does not address high-risk biological agents ⁷⁷⁷⁸. The United Nations Security Council 1540 Committee’s approved matrix for Sudan records no end-user control measures for nuclear, chemical, or biological materials ^{79, p. 12}.

1.4.1a Biosafety laws/regulations

Score: 0

There is no publicly available evidence that Sudan has national biosafety legislation or regulations that extend beyond genetically modified organisms to regulate the safe handling, containment, and control of dangerous pathogens and toxins with pandemic potential. Sudan’s “National Biosafety Law No. 15 of 2010” applies to activities involving a genetically modified organism or a product of a genetically modified organism, establishing a biosafety framework for genetically modified organisms rather than laboratory biosafety for high consequence biological agents ^{80, p. 2}. Sudan’s national reporting under the Convention on Biological Diversity likewise describes the 2010 biosafety law as addressing handling and trading in genetically modified organisms and their products, linked to implementation of the Cartagena Protocol on Biosafety ^{81, p. 42}. The World Health Organization Joint External Evaluation for Sudan reports that a multisectoral laboratory group had drafted a national policy on biosafety and biosecurity, and that comprehensive national biosafety and biosecurity legislation was being developed but was not finalized, indicating the absence of an established national legislative framework for dangerous pathogens and toxins ^{82, pp. 9, 31}.

1.4.1b Agency for enforcement of biosafety laws/regulations

Score: 0

There is no publicly available evidence that Sudan has an established agency responsible for the enforcement of biosafety legislation and regulations covering dangerous pathogens and toxins. Sudan’s “National Biosafety Act No. 15 of 2010” establishes the National Biosafety Council as the competent authority for biosafety matters exclusively in relation to modern biotechnology and genetically modified organisms, including their development, handling, transport, import, export, and environmental release ^{83, pp. 1–3}. The Act defines biosafety in connection with risks arising from genetically modified organisms and products of modern biotechnology and does not contain provisions addressing laboratory biosafety, biosecurity, or enforcement responsibilities for especially dangerous human or animal pathogens and toxins ^{84, pp. 1–2}. Publicly documented actions linked to this framework further confirm its limited scope. A 2022 national workshop reported by the Higher Council for Environment and Natural Resources focused on reinstating the National Biosafety Council within the existing biotechnology biosafety framework, without reference to pathogen or toxin biosafety enforcement ⁸⁵. Similarly, a 2023 announcement of a biosafety department established at Port Sudan customs concerned screening and control of genetically modified organism consignments entering the country, rather than enforcement of biosafety regulations for infectious agents or toxins ⁸⁶.

1.4.2a Biosafety training using a standardised, required approach

Score: 0

Sudan has biosafety and biosecurity training that is provided on an ad hoc basis rather than through a standardized, required national approach for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential. The World Health Organization “Joint External Evaluation of IHR Core Capacities of the Republic of the Sudan” states that training in biosafety and biosecurity is carried out at some central laboratories, while also stating that no national training programmes are available for all laboratories and staff across sectors, and identifying development and conduct of a national training programme for all staff in all facilities as a priority action, which indicates the absence of a standardized national requirement ^{87, pp. 24–25}. Sudan’s “National Biosafety Act” is scoped to genetically modified organisms and products of modern biotechnology, and it does not establish a standardized, required biosafety training curriculum, train the trainer mechanism, or recertification requirement applicable to facilities handling dangerous pathogens and toxins ^{88, pp. 3–6, 22–23}. A Higher Council for Environment and Natural Resources report on a 23 November 2022 two day training for Sudan Customs officers on biosafety programmes focuses on sampling and detection of genetically modified organisms and products, which evidences training activity but not a standardized national requirement for high consequence pathogen and toxin facilities ⁸⁹.

1.5.1a Evidence of national assessment of dual-use research

Score: 0

There is no publicly available evidence that Sudan conducted a national assessment to determine whether ongoing research was occurring on especially dangerous pathogens, toxins, pathogens with pandemic potential, or other dual-use research. Government sources from this period, including the Higher Council for Environment and Natural Resources (HCENR), document activities such as evaluating laboratory capacities to detect genetically modified organisms ⁹⁰, site visits by the Biosafety Technical Committee to university microbiology laboratories ⁹¹, and establishment of a biosafety laboratory administration in Port Sudan ⁹²⁹³. While these confirm biosafety infrastructure development and technical inspections, none constitute a formal assessment of whether such research is actively taking place at national level. No publications from the Ministry of Health, Ministry of Higher Education and Scientific Research, or other competent Sudanese authorities provide evidence of a government-led review or survey of ongoing research involving these agents during the reference period. Sudan’s Biological Weapons Convention profile and other international reporting also do not cite such an assessment ⁹⁴.

1.5.1b National law/regulation on oversight of dual-use research

Score: 0

There is no publicly available evidence that Sudan had legislation or regulation requiring oversight of research involving especially dangerous pathogens, toxins, pathogens with pandemic potential, or other dual-use life sciences research. The United States Department of Health and Human Services Office for Human Research Protections 2024 “International Compilation of Human Research Standards” lists Sudan’s ethics instruments for human subjects research and the 2010 National Biosafety Law, but no legal provision mandating oversight of dual-use or high-consequence pathogen research ^{95, p. 51}. The GeneConvene Global Collaborative’s regulatory profile confirms that the 2010 biosafety law applies to living modified organisms and biotechnology, not research with pathogens or toxins ⁹⁶. The World Health Organization Strategic Partnership for Health Security Sudan country profile does not record any such legal instrument ⁹⁷. The Biological Weapons Convention National Implementation Database entry for Sudan also lists no legislation or regulation addressing oversight of dual-use or dangerous pathogen research ⁹⁸. The Higher Council for Environment and Natural Resources website for 2022–2023 shows only biosafety administrative activities, with no indication of DURC oversight laws ⁹⁹.

1.5.1c Existence of agency responsible for oversight of dual-use research

Score: 0

There is no publicly available evidence that Sudan designates an agency responsible for oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential, or other dual-use research of concern (DURC). The Sudan National Biosafety Council, established under the National Biosafety Law No. 15 of 2010, is listed by the Food and Agriculture Organization (FAO) GM Foods Platform as the competent authority for biosafety of genetically modified organisms (GMOs) under the Cartagena Protocol; this mandate does not extend to oversight of DURC or research involving pathogens with pandemic potential (PPP) ¹⁰⁰. The Higher Council for Environment and Natural Resources (HCENR) confirms that its biosafety functions are limited to GMOs and related biotechnology safety ¹⁰¹. The GeneConvene Global Collaborative’s Sudan profile also records biosafety governance limited to GMOs, with no role in DURC or PPP oversight ¹⁰². The United States Department of Health and Human Services (HHS) Office for Human Research Protections (OHRP) 2024 International Compilation of Human Research Standards lists Sudan’s human-subjects research ethics instruments but no agency tasked with DURC or PPP oversight ¹⁰³. The World Health Organization (WHO) Strategic Partnership for Health Security (SPH) portal for Sudan similarly contains no evidence of a designated national authority for such oversight ¹⁰⁴.

1.5.2a Requirement to screen synthesised DNA against list prior to sale

Score: 0

There is no publicly available evidence that Sudan has enacted legislation or regulation requiring providers of synthesized deoxyribonucleic acid to screen orders against lists of known pathogens and toxins before sale. The National Biosafety Law No. 15 of 2010 governs living modified organisms, including contained use and transboundary movement, but it does not address sequence screening by DNA synthesis providers ¹⁰⁵¹⁰⁶. The World Health Organization Strategic Partnership for Health Security portal lists Sudan’s biosafety and biosecurity activities, yet it contains no reference to any mandate for screening synthesized DNA against controlled pathogen or toxin lists ¹⁰⁷. The Verification Research, Training and Information Centre Biological Weapons Convention legislation database, along with the UN Institute for Disarmament Research and VERTIC national implementation site, mention no Sudanese measure imposing a DNA sequence screening requirement on vendors ¹⁰⁸¹⁰⁹.

1.6.1a Immunization rate for humans (measles/MCV2)

Score: 0

1.6.1b Availability of vaccination figures for livestock (FMD) through OIE database

Score: 100

Sudan has official foot-and-mouth disease vaccination figures for livestock publicly available through the World Organisation for Animal Health World Animal Health Information System database. The World Organisation for Animal Health World Animal Health Information System Control Measures Dashboard publicly displays Sudan-specific foot-and-mouth disease control information, including official vaccination data recorded by reporting period for livestock, demonstrating that vaccination figures are made publicly available through the OIE platform ¹¹⁰. The dashboard presents numerical vaccination entries for Sudan under surveillance and control measures for foot-and-mouth disease ¹¹¹.

1.6.1c Equitablenature of national immunization strategy/plan

Score: 100

Sudan has a national immunization strategy that remains in force. The plan commits to equitable distribution through the Reach Every Community strategy, annual microplans tailored to population size and geography, and monitoring of disadvantaged groups ^{112, pp. 66–69, 95–96}. It includes strategies to address socioeconomic, geographic, cultural, linguistic, and gender barriers, such as using female vaccinators and mapping nomads, refugees, internally displaced persons, border populations, and other hard-to-reach groups for inclusion in microplans ^{113, pp. 66–69}. In 2022, routine immunization was accelerated and bundled with coronavirus disease vaccination to target zero-dose children, increasing measles coverage from 70 percent to 80 percent, vaccinating 1.4 million children, and reaching 776,036 under-one children in humanitarian settings ^{114, pp. 13–14}. In 2023, immunization delivery continued despite conflict-related access constraints, with measles vaccination activities implemented for children in affected states and vaccines relocated from Khartoum to safer locations to sustain equitable access ¹¹⁵. In 2025, measles–rubella catch-up campaigns reached 1.3 million children with 93 percent coverage, oral cholera vaccination covered 6.1 million people, and more than 16 million vaccine doses were delivered alongside expanded cold-chain capacity in conflict-affected areas ^{116, pp. 2–3, 11–15}. An oral cholera vaccination campaign launched in June 2025 targeted more than 2.6 million people in Khartoum State, with vaccination conducted through fixed and mobile sites in the most affected localities under WHO-supported microplanning ^{117118, pp. 1, 3}.

1.6.1d Vaccine hesitancy and build public trust coverage in vaccines in national immunization strategy/plans

Score: 100

Sudan’s national immunization plan includes specific measures to address vaccine hesitancy and build public trust in vaccines. The Comprehensive Multi-Year Plan (cMYP) 2021-2025 sets “Advocacy and Communication” as a strategic objective, calling for development of a national communication plan, engagement of stakeholders, and creation of demand for immunization services ^{119, pp. 40–41}. It identifies language and cultural barriers and outlines actions such as training vaccinators in interpersonal communication, using community health workers and midwives to improve uptake, and re-establishing vaccine pharmacovigilance to detect, investigate, assess causality, and communicate adverse events following immunization ^{120, pp. 42, 54}. The plan’s Framework for Action commits to “increase the demand, link with community and social mobilization” as a core strategy to reach coverage targets ^{121, p. 95}, and it acknowledges vaccine rumors and hidden refusal while noting a UNICEF-supported communication strategy under development ^{122, pp. 88–89}. Consistent with these provisions, Sudan’s 2023–2025 Gavi proposal budgets for “advocacy, communication and social mobilization” to support measles-rubella introduction and catch-up campaigns ^{123, p. 24}.

1.6.1e National advisory group for immunization strategy/plan

Score: 100

Publicly available evidence confirms that Sudan maintains a functioning national immunization technical advisory group that provides guidance to government on immunization strategy. The World Health Organization’s Strategic Advisory Group of Experts (SAGE) participant list for April 2022 includes a Sudanese National Immunization Technical Advisory Group (NITAG) representative from Khartoum ^{124, p. 6}. The March 2024 SAGE participant list identifies the Sudan NITAG chairperson by name ^{125, p. 9}. In 2025, the Eastern Mediterranean Public Health Network documented the participation of Sudan NITAG members in a regional training to strengthen evidence-based decision-making for respiratory syncytial virus vaccine introduction ¹²⁶. The group was established under Ministerial Decree No. 11 of 2009, which mandates advising the Federal Ministry of Health and relevant organizations, analyzing immunization policies, developing strategies for vaccine-preventable disease control, and supporting policy and decision-making for immunization activities ^{127, pp. 1–2}.

1.6.1f Presence of an immunization programme for influenza

Score: 0

Sudan does not have publicly available evidence of a national seasonal influenza immunization programme. The World Health Organization (WHO) Eastern Mediterranean influenza bulletin reports that 14 countries in the Region have a national seasonal influenza vaccination policy, without listing Sudan among them; it also notes Sudan’s disruption of influenza surveillance in the 2023–2024 season due to emergency conflicts ^{128, p. 3129, p. 2}. The WHO Strategic Partnership for Health Security country page for Sudan shows activities for pandemic influenza preparedness and surveillance but lists “Influenza Plan: N/A,” and provides no documentation of a seasonal influenza vaccination policy or inclusion in the Expanded Programme on Immunization ¹³⁰. Seasonal influenza vaccine has been coordinated for outbound Hajj pilgrims as a travel health measure; the official 2024 announcement confirms availability of basic vaccines for pilgrims including seasonal influenza, which is targeted travel vaccination rather than a nationwide programme ¹³¹.

1.7.1a Strategy/plan for resilience of health system

Score: 100

Sudan has a national health sector strategy that integrates health system resilience to climate change and extreme weather with preparedness for infectious disease threats. The “Sudan Health Sector Strategic Plan 2022–2024” establishes a multi-hazard framework that incorporates prevention, preparedness, response, and recovery measures for emergencies such as floods, conflicts, and climate-sensitive disease outbreaks; it prioritizes strengthening surveillance, rapid response capacity, and the continuity of essential health services during crises, and includes actions targeting vector-borne and zoonotic diseases such as malaria, Rift Valley fever, dengue, and leishmaniasis ^{132, pp. 8, 33–37}. Measures also address infrastructure improvement, health workforce readiness, and community engagement to mitigate seasonal and environmental health risks ^{133, pp. 33–37}. The “Country Cooperation Strategy for WHO and Sudan 2022–2025” reinforces these objectives by committing to multisectoral, integrated approaches to emergency preparedness and response, enhanced public health surveillance, outbreak detection systems, and strengthened implementation of the International Health Regulations (2005) ^{134, pp. 1–3, 23–30}.

2.1.1a Capacity of national lab system to conduct 5 or more WHO core tests

Score: 100

Publicly available evidence confirms that Sudan’s national laboratory system can conduct diagnostic testing for more than five of the ten World Health Organization (WHO) core tests, with specific tests named. Polymerase chain reaction for influenza viruses is performed at the National Influenza Centre, which was reactivated with multiplex testing kits and advanced molecular training for staff ¹³⁵. The Public Health Laboratory in Port Sudan has real time polymerase chain reaction kits and rapid diagnostic test kits, and confirms measles and rubella cases transported from multiple states ¹³⁶. During the 2023 cholera resurgence, WHO reported that seven affected states used cholera rapid diagnostic tests, and culture confirmation was undertaken both in state laboratories such as Red Sea State and at the National Public Health Laboratory in Port Sudan ^{137, pp. 10–11}. The Federal Ministry of Health’s 2023 malaria protocol requires parasitological confirmation for all suspected cases using quality-assured microscopy or rapid diagnostic tests ^{138, p. 2}.

2.1.1b Plan to conduct testing during a public health emergency

Score: 50

Publicly available documentation indicates that Sudan has a national plan in effect that addresses testing during public health emergencies, but there is insufficient evidence that it fully meets all criteria for novel pathogens, scaling capacity, and explicit testing goals. The Federal Ministry of Health’s National Health Sector Recovery and Reform Strategic Plan 2022-2024 includes Strategic Project 3 on health security, preparedness, response, and resilience against all hazards, which outlines strengthening the national public health laboratory network for timely detection and identification of all types of hazards, integrating laboratory supplies into emergency logistics, and applying the District Health Information Software 2 tracker to report epidemics and pandemics ^{139, pp. 46–47}. The plan also includes performance indicators such as the number of test results generated during epidemics and outbreaks and the number of functioning public health laboratories ^{140, p. 47}. The World Health Organization Country Cooperation Strategy 2022–2025 confirms ongoing work to upgrade laboratory capacity for all hazards and to strengthen preparedness frameworks ^{141, p. 17}, but does not provide a distinct national testing strategy for 2025 that contains detailed provisions for novel pathogens, surge capacity, and defined testing targets ^{142, pp. 22–23}.

2.1.2a Existence of an accredited national lab serving as a reference facility

Score: 0

There is no publicly available evidence that Sudan has a national reference laboratory accredited to ISO 15189, CLIA, or equivalent. The Sudan Health Sector Strategic Plan 2022-2024 states that the national laboratory quality system is weak and accreditation systems are inactive, indicating that no national accreditation system is operational ^{143, p. 44}. Searches of the global ISO 15189-accredited laboratory directory from the College of American Pathologists show no facilities from Sudan ¹⁴⁴. Likewise, the Strengthening Laboratory Management Toward Accreditation (SLMTA) directory includes lab entries from neighboring countries but none from Sudan ¹⁴⁵. A peer-reviewed study and regional reports confirm that no medical laboratory in Sudan has achieved international accreditation ¹⁴⁶.

2.1.2b External quality assurance of a national lab serving as a reference facility

Score: 0

There is no publicly available evidence that Sudan has a national laboratory that serves as a reference facility which is subject to external quality assurance review. Public polio surveillance documentation describes that the Global Polio Laboratory Network is monitored through standardized quality assurance activities, including annual onsite audits and proficiency testing, but it does not publicly document an external quality assurance review of a named Sudan national reference laboratory, nor does it provide publicly accessible accreditation or audit results for Sudan’s laboratory system as a national reference facility ^{147, p. 3}. The Global Polio Eradication Initiative’s 2025 to 2026 action plan likewise describes networkwide laboratory accreditation, audit procedures, and proficiency testing processes, but it does not identify a Sudan laboratory as a national reference facility under external quality assurance review, and it frames performance documentation as being recorded within internal management systems rather than as public country specific audit outputs ^{148, pp. 25–27}. Regional reporting also notes that Sudan’s crisis affected sample testing in the National Polio Laboratory, with consideration of testing in other laboratories, which further does not establish an externally reviewed national reference laboratory function in publicly verifiable form ^{149, p. 1}.

2.2.1a Nationwide specimen transport system

Score: 0

There is no publicly available evidence that Sudan has a fully operational, nationwide specimen transport system that is standardized for routine and emergency transport of all relevant specimen types. The World Health Organization situation report for Sudan’s health emergency notes that confirmation of cases is “challenging” because public health laboratories are not functional in most states, and it describes specimens being transported to the State Public Health Laboratory in Port Sudan for confirmation, including measles samples routed using the acute flaccid paralysis referral pathway, with World Health Organization support for kits, staffing, and logistics ^{150, pp. 2, 5}. This documents disease and outbreak specific transport workarounds during a period of major access constraints, not an established nationwide, standardized specimen transport system serving the entire country for all specimen categories ^{151, pp. 2, 5}. The World Health Organization “Country Cooperation Strategy for WHO and Sudan 2022 to 2025” describes priorities to strengthen laboratory and surveillance functions, but it does not document a nationwide specimen transport system ^{152, p. 20}.

2.2.2a Plan to rapidly authorize/license laboratories to scale-up testing during an outbreak

Score: 0

There is no publicly available evidence that Sudan has a plan in place to rapidly authorize or license laboratories to supplement national public health laboratory capacity during outbreaks. The National Health Sector Recovery and Reform Strategic Plan 2022-2024 sets out laboratory strengthening under Strategic Project 3, including building public health laboratory capacity and laboratory surveillance, but it does not describe any emergency mechanism to rapidly authorize or license additional public or private laboratories during an outbreak ^{153, pp. 17, 19-21}. The World Health Organization Country Cooperation Strategy 2022-2025 commits to supporting development or updating of governing documents, laws, and policies and to upgrading laboratory network services for all hazards, yet it does not set out an emergency licensing protocol for rapid scale-up of testing ^{154, pp. 21-22}. The World Health Organization Public Health Situation Analysis for Sudan, dated 1 September 2024, references the National Multi-Hazard Health Emergencies Preparedness and Response Plan 2022 but provides no published policy text indicating rapid laboratory authorization procedures ^{155, p. 29}. No relevant documentation describing such a plan is available on the World Health Organization Strategic Partnership Portal for Sudan or on the Sudanese National Council for Medical and Health Professions website ¹⁵⁶¹⁵⁷.

2.3.1a Evidence of ongoing event-based and indicator-based surveillance and analysis

Score: 50

Publicly available evidence confirms that Sudan maintains ongoing event-based and indicator-based surveillance for notifiable and novel infectious diseases; however, no evidence indicates that surveillance data are analyzed on a daily basis. In 2022, the World Health Organization (WHO) supported the Federal Ministry of Health to reactivate the national influenza sentinel surveillance system, ensuring standardized case enrollment, regular reporting from sentinel sites, and data sharing with WHO ¹⁵⁸. By December 2023, WHO and national authorities had implemented the electronic Early Warning and Response System (EWARS) in nine states, with weekly electronic reports submitted and analyzed for outbreak detection ^{159, p. 2160, p. 6}. In 2024, WHO reported EWARS reporting completeness at 36 percent, activated laboratory and response modules in Kassala State, and launched a national event-based surveillance module, confirming sustained system functionality and analytical capacity without specifying daily review ^{161, p. 6}.

2.3.1b Evidence of a mechanism (such as IHR focal point) for reporting notifiable diseases to the WHO within the set timeline

Score: 100

Sudan has a publicly documented mechanism for reporting notifiable diseases to the World Health Organization within the set timeline via the International Health Regulations (IHR) National IHR Focal Point ^{162, pp. 7–8; 2}. The IHR require the National IHR Focal Point to notify WHO within 24 hours of the assessment of public health information for events that may constitute a public health emergency of international concern ^{163, pp. 7–8}. During the reference period, WHO Disease Outbreak News records notification from Sudan regarding circulating vaccine-derived poliovirus type 2, and a WHO Sudan situation report documents an IHR National Focal Point notification on 21 January 2024, evidencing use of the mechanism ^{164165, p. 7}.

2.3.2a Electronic national and sub-national reporting surveillance system

Score: 0

There is no publicly available evidence that Sudan operates an electronic reporting surveillance system at both national and subnational levels. The World Health Organization Regional Office for the Eastern Mediterranean reports that an endorsement and training workshop in Port Sudan in August 2023 marked the rollout of the World Health Organization electronic Early Warning Alert and Response System in coordination with Sudanese authorities, indicating an implementation process rather than a fully established nationwide system ¹⁶⁶. As of 15 December 2023, the World Health Organization Sudan Health Emergency Situation Report documents that electronic Early Warning and Response System data were being received from 9 states, which indicates partial geographic coverage rather than national and subnational operation across all states ^{167, pp. 3, 6}. As of 6 September 2024, the World Health Organization further reports completeness of the national Early Warning and Response System at 36%, alongside a pilot training using the World Health Organization Early Warning and Response System Mobile in Central Darfur and East Darfur, and notes a future scale up plan to activate response and laboratory modules, confirming the system remained incomplete and under expansion rather than fully operational across subnational levels ^{168, p. 6}.

2.3.2b Collection of ongoing/real-time lab data by electronic surveillance system

Score: 0

There is no publicly available evidence that Sudan’s electronic reporting surveillance system collects ongoing or real-time laboratory data that can be disaggregated and analyzed by age, ethnicity, or similar demographic variables at the national level. The World Health Organization reports that the Federal Ministry of Health, supported by the World Health Organization, rolled out the electronic Early Warning and Response System in August 2023, and that electronic Early Warning and Response System data were being received from nine states, indicating partial and incomplete operational coverage rather than a nationwide system capable of comprehensive real-time laboratory capture ^{169, p. 2}. The same report notes that confirmation of cases is challenging due to the absence of functional public health laboratories in most states, further underscoring constraints on laboratory data capture at scale ^{170, p. 2}. In September 2024, the World Health Organization reported that the completeness of the existing national Sudan Early Warning and Response System was 36% as of 6 September 2024, and that activation of response and laboratory modules was planned to begin from Kassala State with gradual scaling up, which indicates that laboratory module functionality was not yet fully implemented nationwide ^{171, p. 6}.

2.3.3a National wastewater surveillance programme or initiative

Score: 100

There is evidence that Sudan has a national wastewater surveillance programme within its environmental surveillance system. Environmental surveillance was first implemented in Sudan in 2016 with 5 sites in Khartoum state. Until 2020, environmental surveillance for polioviruses, including wastewater surveillance, in Sudan was only conducted in Khartoum State. In 2021, Sudan’s Federal Ministry of Health, the National Polio Laboratory and WHO worked together to expand the practice from five sites in this one state, to 14 sites in seven states.[1, 2]]

The WHO EMR Polio Bulletin from May 2026 documents positive environmental samples from the country in 2026.[3]

2.4.1a Common usage of electronic health records

Score: 50

Sudan uses electronic health records in limited settings, but they are not commonly in use nationwide. The World Health Organization assessment states that routine health information systems remain paper based up to higher administrative levels and use Excel for compilation, indicating the absence of widespread digitized patient records ^{172, p. 9}. Within the human immunodeficiency virus program, only a few antiretroviral treatment centers adopted an electronic patient management system, and data collection was described as mostly on paper, demonstrating isolated electronic records rather than common national practice ^{173, p. 37}. The National Health Sector Recovery and Reform Strategic Plan 2022 to 2024 introduces hospital-level electronic patient registration and sets an indicator to track the number of hospitals running such systems, and it calls for initiating hospital reporting on District Health Information System 2, which evidences incremental adoption rather than nationwide coverage ^{174, pp. 16–17}. The plan’s monitoring framework records a 2022 baseline of zero hospitals with electronic patient registration, reinforcing that electronic records were not commonly in use during the period ^{175, p. 53}.

2.4.1b Public health system access to individual electronic health records

Score: 0

Sudan’s national public health system has no publicly available evidence of access to individuals’ electronic health records; available evidence shows paper-based routine reporting with Excel used for compilation, and only program-specific pilots rather than nationwide access. The World Health Organization assessment of Sudan’s health information system states that routine reporting remains paper based and relies on Excel for compilation, showing that digitized patient records are not the norm ^{176, p. 9}. Within the human immunodeficiency virus program, only a few antiretroviral treatment centers adopted an electronic patient management system, while most data collection continued on paper, demonstrating that access to electronic records was programmatic and not nationwide ^{177, p. 37}. The National Health Sector Recovery and Reform Strategic Plan 2022 to 2024 introduces an indicator to monitor the number of hospitals with electronic patient registration and calls for initiating hospital-level reporting on District Health Information System 2, which indicates planned expansion but confirms that such access was not common during this period ^{178, pp. 16–17; 53}. The World Health Organization Strategic Partnership Portal contains no evidence of widespread national access to electronic records, further supporting that electronic health records were limited to select facilities and programs ¹⁷⁹.

2.4.1c Existence of data standards for health record data comparability

Score: 0

There is no publicly available evidence that Sudan has formally adopted national data standards, such as International Organization for Standardization standards, that ensure health data are comparable across all facilities in Sudan. The World Health Organization assessment documents that routine health reporting relies on the District Health Information Software version 2 and that the integrated disease surveillance and response system applies standardized case definitions for notifiable diseases, but it explicitly notes the absence of a unified national surveillance system and highlights limited and uneven reporting coverage, demonstrating that these practices do not constitute systemwide data comparability standards ^{180, p. 26}. The same assessment confirms that the International Classification of Diseases, Tenth Revision is used for mortality and morbidity coding, yet it also reports that District Health Information Software version 2 has not been implemented in most hospitals, reinforcing that standardized classification and reporting are not uniformly applied across the health system ^{181, p. 33}. The Federal Ministry of Health strategic plan for 2022 to 2024 references intentions to expand hospital reporting and electronic patient registration through District Health Information Software version 2, but it does not establish or reference any formally adopted national data standards governing comparability across all facilities ^{182, p. 61}.

2.4.2a Data sharing mechanisms

Score: 0

There is no publicly available evidence that Sudan has established mechanisms across the ministries responsible for animal, human, and wildlife surveillance to routinely share surveillance data. A World Bank technical report states that Sudan’s One Health Platform remains under formation and, despite meetings of a Joint Coordination Committee, “hasn’t been formally established” and “has not yet been legally constituted,” indicating the absence of an operationalized multisectoral structure to enable systematic cross sector surveillance data sharing, including wildlife surveillance, at the national level ^{183, p. 14}. The World Health Organization Joint External Evaluation mission report likewise notes that Sudan’s “One Health” concept note was awaiting approval, and it recommends operationalizing a One Health platform with consensus among public health, animal health, wildlife, and other sectors, implying that such an integrated mechanism was not yet in place at the time of assessment ^{184, p. 8}. Sudan’s national health sector plan also identifies weak horizontal information sharing and reporting, reinforcing that routine cross sector information flows remain a documented gap ^{185, p. 14}.

2.4.3a Availability of de-identified health surveillance data on disease outbreaks

Score: 100

Sudan publicly releases de-identified infectious disease surveillance data on a government website, which satisfies this indicator. On May 25, 2025, the Ministry of Culture and Information published an article quoting the Federal Minister of Health that reported weekly cholera case estimates of approximately 600 to 700 cases over the preceding four weeks in Khartoum State, presented as aggregate counts with no personal identifiers ¹⁸⁶. An operational update issued on July 3, 2025 by the United Nations Office for the Coordination of Humanitarian Affairs, based on Federal Ministry of Health reporting, likewise presents national suspected cholera case and death totals in aggregate form, confirming public dissemination of de-identified surveillance figures to the public domain ¹⁸⁷. A UNICEF Sudan flash update dated July 2, 2025 publishes cumulative and weekly cholera totals for Sudan and states, and cites the national surveillance and interactive dashboard of the General Directorate of Health Emergencies and Epidemic Control as the source, demonstrating that official surveillance totals were made publicly available in anonymized form during 2024 to 2025 ^{188, pp. 2–3}.

2.4.4a Confidentiality legislation/regulations for identifiable health information

Score: 100

Sudan has enforceable legislation that safeguards the confidentiality of identifiable health information, and there is public evidence of sector implementation during 2022 to 2025. The National Public Health Act requires every health institution to “regard and preserve secrecy of information,” creating a statutory duty of medical confidentiality applicable to information held by care providers ^{189, p. 17}. The Electronic Transactions Act establishes a “Secrecy of information” rule for data handled by licensed bodies and obliges any service provider operating a data-processing system to protect information “by all means and available technologies,” which covers electronic handling of personal data generated by health services and surveillance activities ^{190, pp. 8–9}. Implementation is visible in 2025 sector policies, including the National Health Insurance Fund’s privacy policy governing beneficiary data ¹⁹¹. The National Information Center also reported government training on cybersecurity and secrecy of information in 2025, indicating operational reinforcement of confidentiality practices ¹⁹².

2.4.4b Inclusion of cyber protections in health data confidentiality law/regulation

Score: 100

Sudan has in-force legislation and recent government measures that safeguard the confidentiality of identifiable health information and require protections relevant to cyber attacks. The National Public Health Act imposes a statutory duty on every health institution to “regard and preserve secrecy of information,” establishing medical confidentiality for patient information held by providers ^{193, p. 17}.
The Electronic Transactions Act establishes a “Secrecy of information” rule and obliges service providers operating data-processing systems to protect information “by all means and available technologies,” and it empowers authorities to set systems and safeguards for coding, security, and periodic reviews; it also criminalizes disrupting electronic systems and destroying data, which encompasses cyberattack conduct such as ransomware ^{194, pp. 8–9; 11; 17}.
Implementation during 2022 to 2025 is evidenced by the National Information Center’s cybersecurity and information-secrecy training for government entities in July 2025 ¹⁹⁵, and sector policies that govern handling of personal data on official health websites, including the Sudanese National Council for Medical and Health Professions and the National Health Insurance Fund ¹⁹⁶¹⁹⁷.

2.4.5a Cooperative commitments or agreements within regions

Score: 50

The Government of Sudan has made a publicly documented commitment to share surveillance information with neighboring countries for poliomyelitis, but no comparable commitments for additional diseases are publicly documented. On 21–22 December 2022 in Khartoum, Sudan’s Federal Ministry of Health hosted officials from Chad and South Sudan for a cross border meeting where the countries agreed to share information and coordinate at local levels, with regular six month follow up to support surveillance and response along borders ¹⁹⁸. In 2023, while Sudan’s polio laboratory was nonfunctional, the program arranged for cross border testing at Egypt’s VACSERA laboratory, with 56 acute flaccid paralysis specimens shipped on 16 June 2023 and results shared within 11 days, demonstrating operational exchange of surveillance materials and information between national programs ¹⁹⁹. WHO EMRO’s Sudan news archive and Sudan crisis pages contain no 2022–2025 documents describing Sudan government commitments to share surveillance data for other diseases ²⁰⁰²⁰¹.

Sudan's adherence to the International Health Regulations (IHR 2005) serves as a primary legal and operational commitment. As a signatory, Sudan is obligated to notify the World Health Organization (WHO) of public health events that may constitute a public health emergency of international concern. However, this does not specify provisions to share with other countries. ²⁰²

2.5.1a National support to conduct contact tracing in the event of a public health emergency

Score: 50

Sudan maintains national support to subnational contact tracing only in response to active public health emergencies. The Country Cooperation Strategy sets measures to operationalize emergency operations centers at federal, state, locality, and community levels, and to develop standard operating procedures and guidelines for public health emergencies ^{203, pp. 21–22}. Polio partners document ongoing outbreak surveillance operations in Sudan during 2024–2025, reflecting the use of national and partner networks that operate at locality level ²⁰⁴. The World Health Organization Health Emergency Appeal 2025 for Sudan lists “Surveillance, case investigation and contact tracing” as a resourced emergency response pillar and describes collaboration with the Federal Ministry of Health [وزارة الصحة الاتحادية]; it adds that subnational support will expand through zonal offices, increased resources, and strengthened health cluster coordination ^{205, p. 6, p. 13, p. 3}. This support is tied to emergency response rather than a standing nationwide preparedness program for contact tracing across all states ^{206, pp. 21–22; 3, p. 3, p. 6, p. 13}.

2.5.1b Provision of wraparound services to enable self-isolation/quarantine as recommended

Score: 0

There is no publicly available evidence that Sudan provided national wraparound services enabling infected people or their contacts to self-isolate or quarantine. The World Health Organization Country Cooperation Strategy reports collaboration with the Federal Ministry of Health to update technical guidelines and to strengthen case management and surveillance, and it sets case management capacity as a health emergency priority ^{207, pp. 15, 25}. The National Health Sector Recovery and Reform Strategic Plan includes interventions to “support case management operations for emergencies and epidemics,” tracks the number of revised case definition and management protocols, and monitors the number and functionality of isolation and management centers, including equipment and trained providers ^{208, pp. 26–27, 62–64}. The International Labour Organization NATLEX entry cites the Sudan Labour Act of 1997 without evidence of implementation of paycheck protection or quarantine income support in 2022 to 2025 ²⁰⁹. A World Bank Labour Management Procedures document references the act and annexes a translation but does not demonstrate a national income-replacement or job-protection scheme for isolation ^{210, p. 14}. Checks of the Federal Ministry of Health website and the World Health Organization Strategic Partnership Portal yielded no national measures providing income replacement, paid isolation leave, or job protection ²¹¹²¹².

2.5.2a Strategy for tracing and quarantining international travelers

Score: 100

Sudan has a joint plan and cooperative arrangements between the Federal Ministry of Health and border control authorities to identify suspected cases in international travelers and coordinate quarantine measures during future public health emergencies. The National Health Sector Recovery and Reform Strategic Plan 2022-2024 includes Strategic Project 3 on health security, preparedness, response, and resilience, which operationalizes national and subnational Emergency Operations Centers and coordination mechanisms to ensure joint planning with multiple authorities, including border entities ^{213, p. 17}. The plan specifies monitoring of active points of entry as part of emergency workforce effectiveness, integrating border surveillance directly into national preparedness ^{214, p. 18}. It also requires the delivery of a minimum package of essential services during emergencies, including for internally displaced persons and refugees, and the expansion of standard operating procedures and emergency guidelines, which together ensure continuity of detection, tracing, and case management in traveler-related events ^{215, p. 20}. Complementing this framework, the Federal Ministry of Health and the Sudan Civil Aviation Authority signed a memorandum of understanding in April 2023 to formalize coordination for case detection and traveler health measures ²¹⁶. In addition, directives issued in August 2022 by the Civil Aviation Authority retained health surveillance at airports in line with the International Health Regulations, instructing screening and quarantine of suspected cases ²¹⁷.

2.6.1a Access to field epidemiology training program in country and/or abroad

Score: 100

Sudan has an in-country applied epidemiology training program through its Field Epidemiology Training Program (FETP), which is documented as part of the public health workforce development initiatives ^{218, p. 9}. The Sudan FETP is established within the Federal Ministry of Health’s Health Emergency and Epidemic Response Department, with two advanced cohorts and one intermediate cohort completed and two intermediate cohorts running during 2023-2024, demonstrating ongoing national training capacity in applied epidemiology ²¹⁹. The Eastern Mediterranean Public Health Network reports that the Federal Ministry of Health partnered with Global Health Development to establish the program and that it is recognized by the Sudan Medical Specialization Board as a Master of Science program, confirming government affiliation and formal academic recognition ²²⁰²²¹. The program is also listed by the Training Programs in Epidemiology and Public Health Interventions Network, indicating its status as a national field-based applied epidemiology training program ²²².

2.6.1b Existence of field epidemiology training for animal health professionals

Score: 0

There is no publicly available evidence that Sudan’s field epidemiology training programs explicitly include animal health professionals or that a veterinary field epidemiology training program is offered. A 2024 peer-reviewed assessment of the Sudan Field Epidemiology Training Program describes the program under the Federal Ministry of Health, notes two advanced cohorts and one intermediate cohort completed with additional intermediate cohorts in progress, and does not reference veterinary participants or an animal health track ^{223, p. 2}. The Eastern Mediterranean Public Health Network country page for Sudan outlines the Field Epidemiology Training Program and its recognition by the Sudan Medical Specialization Board without indicating inclusion of veterinarians or a dedicated veterinary curriculum ²²⁴. The Training Programs in Epidemiology and Public Health Interventions Network page for Sudan provides a general overview and likewise contains no mention of veterinary inclusion or a Field Epidemiology Training Program for Veterinarians ²²⁵. The World Health Organization Strategic Partnership Portal country page for Sudan contains no listings of veterinary field epidemiology initiatives such as the In-Service Applied Veterinary Epidemiology Training or a veterinary FETP ²²⁶.

2.6.2a Evidence of at least 1 trained field epidemiologist per 200,000 people

Score: 0

There is no publicly available evidence that Sudan has at least 1 trained field epidemiologist per 200,000 people. The World Health Organization reports Sudan’s 2023 population as 50,042,791, implying an approximate benchmark need of 250 trained field epidemiologists at the 1 per 200,000 standard ^{227, p. 2}. A peer reviewed assessment of the Sudan Field Epidemiology Training Program reports that the program was established in 2017 and that 2 advanced cohorts and 1 intermediate cohort completed training, and its cohort table shows 23 total advanced graduates, from 14 in the first advanced cohort and 9 in the second advanced cohort, plus 11 intermediate graduates in the first intermediate cohort ^{228, pp. 2, 6}. A review of the World Health Organization Strategic Partnership for Health Security and Emergency Preparedness country profile for Sudan and the Federal Ministry of Health portal did not identify any official workforce inventory or consolidated public reporting that would document a trained field epidemiology workforce at or above the benchmark level ²²⁹²³⁰.

3.1.1a National emergency response plan for diseases with pandemic potential

Score: 0

There is no publicly available evidence that Sudan has an overarching national public health emergency response plan in place that addresses planning for multiple communicable diseases with epidemic or pandemic potential. The Federal Ministry of Health’s “National Health Sector Recovery and Reform Strategic Plan 2022–2024” refers to the development and updating of a “National Multi hazard Health Emergency Preparedness and Response Plan for Sudan, March 2022,” but does not publish the plan text, decree, or any confirmation that such a plan is adopted and in force ^{231, pp. 3, 17–18}. The World Health Organization “Country Cooperation Strategy for WHO and Sudan 2022–2025” similarly frames a multi hazard national public health emergency preparedness and response plan as a planned result, not as an issued or operative instrument ^{232, p. 27}. A 2023 report by the Eastern Mediterranean Public Health Network describes discussion and approval of a time bound health emergency response plan for August to December 2023, but the plan itself is not released publicly and does not constitute evidence of an overarching national framework ²³³. Publicly available documentation instead reflects disease specific response planning, such as cholera outbreak response activities, which do not meet the rubric threshold for an overarching national public health emergency response plan ^{234, pp. 2, 5}.

3.1.1b National public health emergency response plan published in past 3 years

Score: 100

Sudan’s national multi-hazard public health emergency preparedness and response plan was last updated in March 2022. The Federal Ministry of Health’s National Health Sector Recovery and Reform Strategic Plan 2022–2024 explicitly references the “National COVID-19 Preparedness and Response Plan, December 2021, and the National Multi-hazard Health Emergency Preparedness and Response Plan for Sudan, March 2022” as the most recent national plans for health emergencies ^{235, p. 2}. Strategic Project 3 of the same document includes an indicator for the “presence of jointly developed, updated and implemented multi-hazard preparedness and response plan,” embedding updates into the 2022–2024 implementation framework ^{236, pp. 17–19, 53–54}. The World Health Organization (WHO) Country Cooperation Strategy for Sudan 2022–2025 also highlights the need to build resilience through a multi-hazard approach and specifies that WHO support will include developing and updating the national public health emergency preparedness and response plan during this period ^{237, pp. 21–22, 25–26}.

3.1.1c One health principles by covering multiple threat types

Score: 0

There is no publicly available evidence that Sudan has an overarching national public health emergency response plan that applies One Health principles and covers antimicrobial resistance, zoonotic spillover, laboratory accidents, and deliberate biological events. The World Health Organization Country Cooperation Strategy for Sudan 2022–2025 describes support for development of a multi hazard public health emergency preparedness and response plan and strengthening of One Health coordination, including a national crisis management center with the Public Health Emergency Operations Center; these are objectives rather than a published operational plan with multi threat scope (pp. 26–27, 30–31) ²³⁸. The Federal Ministry of Health’s National Health Sector Recovery and Reform Strategic Plan 2022–2024 references a National Multi hazard Health Emergency Preparedness and Response Plan dated March 2022 but does not reproduce or link the plan text or show One Health content (p. 3) ²³⁹. The World Bank’s 2023 One Health diagnostic review notes agreement to establish a Sudan One Health Platform but highlights the absence of formal structures, operationalization, and direct funding (pp. 12–13, 54–55) ²⁴⁰. Media reports confirm that a National Health Security Plan for 2023–2027 was approved in January 2023, yet the plan text is not publicly available for verification of One Health, multi threat scope ²⁴¹²⁴². No such plan is posted on the World Health Organization Strategic Partnership Portal country page for Sudan ²⁴³.

3.1.1d Vulnerable populations in national public health emergency response plan

Score: 0

There is no publicly available evidence that Sudan has an overarching national public health emergency response plan in place that includes consideration of health equity or mechanisms for identifying and addressing the needs of vulnerable populations. The Federal Ministry of Health’s “National Health Sector Recovery and Reform Strategic Plan 2022–2024” sets out equity, community engagement, empowerment, and gender sensitivity as guiding principles and references mechanisms such as community participation and expanded National Health Insurance Fund coverage for vulnerable populations, but it is a sectoral reform strategy rather than an emergency preparedness or response plan applicable to multiple communicable disease threats ^{244, pp. 7, 23–24}. The World Health Organization “Country Cooperation Strategy for WHO and Sudan 2022–2025” reinforces objectives related to equitable access to services, protection of poor and vulnerable groups, and improved disaggregated data for monitoring health inequalities, but it likewise functions as a cooperation framework and does not publish or operationalize an overarching national public health emergency response plan ^{245, pp. 1–2, 25, 28}.

3.1.2a Mechanism to engage private sector in outbreak preparedness/response

Score: 100

Sudan maintains a formal coordination mechanism that engages the private sector in outbreak emergency preparedness and response through the Sudan Health Sector Partners’ Forum (SHSPF) and its Emergency Humanitarian Cluster Committee. The SHSPF’s membership includes the Federal Ministry of Health, United Nations agencies, academia, civil society organizations, donors, and private sector representatives, with the Emergency Humanitarian Cluster Committee co-chaired by the World Health Organization to harmonize humanitarian and emergency health response activities ^{246, p.14}. The World Health Organization’s Country Cooperation Strategy for Sudan further documents the functioning of this humanitarian coordination architecture, confirming WHO’s co-lead role across the Health Cluster platforms for preparedness and response ^{247, p.13}. It also emphasizes strengthening partnerships with non-state actors and highlights the role of the private sector as an active partner in Sudan’s health agenda for 2022–2025 ^{248, p.4}. Additional evidence from the National Health Sector Recovery and Reform Strategic Plan 2022–2024 indicates that the SHSPF and its emergency cluster continued to operate during periods of political instability, underscoring their institutional role in emergency preparedness and response ^{249, pp.50–51}.

3.1.3a Policy/plan/guidelines in place to implement non-pharmaceutical interventions (NPIs)

Score: 50

Publicly available evidence shows Sudan has national policy and guidance to implement non-pharmaceutical interventions for at least one disease. The National Health Sector Recovery and Reform Strategic Plan 2022–2024 records updated national plans for health emergencies and cites the National COVID-19 Preparedness and Response Plan, December 2021, and the National Multi Hazard Health Emergencies Preparedness and Response Plan, March 2022; however, public copies of these plans could not be located to verify explicit NPI provisions ^{250, p. 11251, pp. 85–86}. For cholera, UNICEF documents that response activities are structured around the Sudan Health and Water, Sanitation and Hygiene Cluster Cholera Prevention and Response Plan, which operationalizes risk communication and community engagement, hygiene promotion, water chlorination, and related measures in affected states ^{252, pp. 2–3, 6}.

3.2.1a Completion of biological-focused IHR exercise with the WHO in past year

Score: 0

There is no publicly available evidence that Sudan activated a national emergency response plan for an infectious disease outbreak or completed a national level biological threat-focused exercise. The World Health Organization (WHO) situation report of 30 September 2023 confirms that Sudan declared a cholera outbreak in Gedaref State and describes WHO’s support to the response ^{253, pp.1, 3}. The WHO situation report of 31 October 2024 states that the cholera outbreak was officially declared on 12 August 2024 and details coordination with federal and state health authorities ^{254, pp.1, 6}. Neither report indicates activation of a national emergency response plan or evidence of a national biological exercise. The WHO Strategic Partnership for Health Security Sudan country page lists a National Action Plan for Health Security event in 2022 and an After Action Review in 2023, but no national simulation exercises are recorded for 2024 or 2025 ²⁵⁵. UNICEF’s Flash Update of 5 June 2025 further summarizes the cholera outbreak response without showing national plan activation or a biological threat exercise ²⁵⁶.

3.2.1b Evidence of bio-focused exercise to identify gaps/best practices

Score: 50

Sudan has formally identified gaps in its infectious disease response and developed a plan to improve capacity, but no evidence of a publicly accessible government plan has been located. On 31 August 2024 the Sudan News Agency reported that the Federal Ministry of Health, in collaboration with Amfant, convened a workshop to review and update cholera surveillance and response activities, demonstrating an official process to examine weaknesses and practices in outbreak management ²⁵⁷. The United Nations Children’s Fund Flash Update of 5 June 2025 confirms that ongoing response operations were carried out in alignment with the Sudan Health and WASH Cluster Cholera Prevention and Response Plan, and further specifies that activities in Khartoum were structured according to the National Cholera Prevention and Response Plan ^{258, p. 2259, p. 3260, p. 5}.

3.2.2a Evidence of national-level biological threat-focused exercise that includes private sector

Score: 0

In the past year, Sudan did not conduct a publicly documented national level biological threat focused exercise that included private sector representatives; the World Health Organization Strategic Partnership Portal Simulation Exercise Activities list and the Sudan country page, Federal Ministry of Health pages, and WHO regional news identified no such event ^261262263264. The Simulation Exercise Activities list, updated on July 22, 2025, returns no Sudan entries when filtered for “Sudan,” confirming no national biological simulation with private sector participation in 2024 or 2025 ²⁶⁵. A 2022 National Action Plan for Health Security activity describes only a planned state level rapid response team simulation ²⁶⁶. WHO Eastern Mediterranean Regional news for October 2024 describes a hospital training with a small simulation on rehabilitation; it is not national or biological threat focused and provides no evidence of private sector participation ²⁶⁷. The WHO Public Health Situation Analysis for April to August 2024 documents severe service disruptions, including about 80 percent of hospitals in the most conflict affected areas not working and interruptions to disease surveillance and public health laboratory functions ^{268, p. 1269, pp. 22–23}.

3.3.1a Existence of Emergency Operations Center (EOC)

Score: 100

Sudan has a National Emergency Operation Center under the Federal Ministry of Health. The Sudan Health Sector Recovery and Reform Strategic Plan 2022–2024 defines the acronym “NEOC – National Emergency Operation Center” and includes a strategic intervention to operationalize and ensure the effectiveness of national and subnational Emergency Operation Centers (EOCs). The monitoring framework lists indicator 3.A.1.1 as “Number of active EOCs” with baseline and annual targets provided ^{270, pp. VI–VII, 53}. The World Health Organization Regional Office for the Eastern Mediterranean reported that by the end of 2023 Public Health Emergency Operations Centers had been established in all 22 countries and territories of the Region, which includes Sudan ^{271, p. 3}. In April 2024 the Federal Emergency Operations Center held its 41st weekly meeting in Kassala to review national emergency situations ²⁷², and in July 2025 the Health Emergency Operations Center held its 100th regular meeting, directing support to Darfur and Kordofan States ²⁷³.

3.3.1b Requirement for EOC to conduct/evidence EOC conducts at least annual drills

Score: 0

There is no publicly available evidence that Sudan’s Public Health Emergency Operations Center (EOC) is required to conduct an annual drill or that it has conducted at least one EOC drill per year. The World Health Organization Strategic Partnership Portal lists a 2022 activity described as “refreshment training EOC” with status “Just Started,” which is training and not a documented drill or annual requirement ²⁷⁴. Another portal entry notes a simulation exercise to test rapid response teams, but this relates to field teams and not the EOC ²⁷⁵. News reports from the Sudan News Agency describe an EOC workshop in November 2022 focused on building and accelerating the center and routine coordination meetings in May 2024, yet neither confirms the conduct of an operational drill ²⁷⁶²⁷⁷. The World Health Organization Health Cluster’s Sudan resource library and the Sudan country page on the Strategic Partnership Portal contain no references to EOC drills or annual drill requirements during 2022–2025 ²⁷⁸²⁷⁹.

3.3.1c EOC activation within 120 minutes of identification of emergency/scenario

Score: 0

There is no publicly available evidence that Sudan’s Public Health Emergency Operations Center (EOC) conducted within the last year a coordinated emergency response or an emergency response exercise activated within 120 minutes. The World Health Organization (WHO) Strategic Partnership Portal country profile for Sudan and the Health Cluster Sudan key resources page do not contain reports of EOC rapid activation drills or responses meeting a two hour activation threshold in this period ²⁸⁰²⁸¹. Strategic Partnership Portal activity pages describe a 2022 “refreshment training EOC” and a rapid response team simulation exercise, but these activities are trainings for personnel and field teams, not documentation of an EOC drill activated within 120 minutes ²⁸²²⁸³. The WHO Sudan emergencies overview confirms responses to multiple crises but does not specify that the EOC was activated within two hours ²⁸⁴. Sudan News Agency reports describe EOC workshops in 2022 and weekly coordination meetings in 2024 and 2025, but none of these sources provide evidence of a time bound EOC activation ²⁸⁵²⁸⁶.

3.4.1a Joint exercise/procedures for potential deliberate biological events

Score: 0

There is no publicly available evidence that Sudan conducted a multisector exercise specifically to respond to a potential deliberate biological event involving public health, animal health, the private sector, and national security authorities, and there are no publicly available standard operating procedures, guidelines, memorandums of understanding, or other agreements between those sectors for such events. The World Health Organization Strategic Partnership for Health Security portal lists a Sudan National Action Plan for Health Security activity to develop joint investigation and response SOPs between public health and security authorities, but the entry shows status not started with zero percent implementation and no published SOPs ²⁸⁷. The Federal Ministry of Health website posts news, program pages, and files, but no intersectoral SOPs or exercise reports addressing deliberate biological incidents are available ²⁸⁸. The Ministry of Interior portal similarly carries news, laws, and services without any published intersectoral SOPs or exercise documentation for deliberate biological threats ²⁸⁹. No relevant materials are published on the Ministry of Agriculture and Forests website ²⁹⁰.

3.5.1a Risk communication plan for specific use during a public health emergency

Score: 100

Sudan has a national plan that contains a dedicated risk communication section intended for use during public health emergencies. The Federal Ministry of Health’s National Health Sector Recovery and Reform Strategic Plan 2022–2024 includes Strategic Project 3, “Health Security,” which identifies as Objective 3.F to “enhance risk communication and community engagement, including the development of the risk communication center’s core documents.” The plan defines measurable outputs, including the number of RCCE core documents produced and the number of community dialogues conducted, and places these within the national emergency preparedness framework alongside surveillance, laboratory capacity, and emergency standard operating procedures (pp. 19–21) ²⁹¹. The World Health Organization Country Cooperation Strategy for Sudan 2022–2025 reinforces this commitment by setting Outcome 2.1 to protect the population against health emergencies, explicitly listing as a deliverable the development of “guidelines and systems for community partnership, starting with risk analyses” to support risk communication and coordination during emergencies (p. 21) ²⁹².

3.5.1b Inclusion of different population & sector needs in risk communication plan

Score: 0

Sudan does not have a publicly available national risk communication plan that specifies how messages will reach populations and sectors with different communication needs such as different languages, geographic areas, media access, vulnerable groups, or hard to reach groups. The National Health Sector Recovery and Reform Strategic Plan 2022 to 2024 acknowledges the need to enhance risk communication and community engagement and calls for the development of the risk communication center’s core documents, but at the time of publication the baseline for these documents was listed as none ^{293, pp. 45–46, 56}. The plan describes activities such as community health dialogues and emphasizes participatory approaches, but it does not outline a structured national plan for differentiated communication targeting linguistic minorities, internally displaced persons, or other marginalized populations ^{294, p. 45}. The World Health Organization Strategic Partnership Portal for Sudan and the 2024 State Party Self-Assessment reporting entry for risk communication do not provide evidence of an adopted national plan addressing these requirements ²⁹⁵²⁹⁶. The official website of the Federal Ministry of Health similarly provides general information and updates but no national risk communication plan ²⁹⁷.

3.5.1c Designation of a specific government spokesperson during a public health emergency

Score: 0

Sudan does not have a publicly available risk communication plan that designates a specific government position to serve as the primary spokesperson during a public health emergency. The National Health Sector Recovery and Reform Strategic Plan 2022 to 2024 lists activities to enhance risk communication and community engagement and to develop the risk communication center’s core documents; it does not assign a spokesperson role to any office or official ^{298, pp. 17–21}. A bilingual search of the World Health Organization (WHO) Strategic Partnership Portal country page for Sudan and the 2024 State Party Self-Assessment reporting on Risk Communication found no uploaded plan, regulation, or strategy that designates a primary spokesperson ²⁹⁹³⁰⁰. The Federal Ministry of Health website likewise provides sector updates but no national instrument identifying a spokesperson for emergency risk communication ³⁰¹.

3.5.2a Government use of media platforms to share info on public health emergencies

Score: 100

Sudan’s public health system regularly shares information on ongoing health concerns through official online channels in the past year, including the Federal Ministry of Health website and social media. The Ministry’s website is active and updated, with dedicated health-education and service pages covering immunization services and health awareness content, and it displays 2025 updates and sections for disease prevention and campaigns ³⁰². Within the last year it has posted cholera response updates, including a notice that the Ministry received 2.2 million oral cholera vaccine doses as part of the national response, indicating routine use of the website to inform the public about an active outbreak ³⁰³. The Ministry also disseminates prevention messaging through its online health awareness section, which provides structured public guidance on disease risks and prevention ³⁰⁴. In August 2024 the Federal Ministry of Health formally declared a cholera outbreak, after which coordinated online updates and vaccination campaign notices continued into 2025, demonstrating sustained public communication on an ongoing health threat ³⁰⁵.

3.5.2b Evidence that senior leaders have shared mis/disinformation on infectious diseases

Score: 100

There is no publicly available evidence that Sudan’s president or federal ministers have shared misinformation or disinformation on infectious diseases during the past two years. The Federal Ministry of Health website provides official updates on services, campaigns and health awareness without any posted corrections or retractions of false infectious-disease statements by senior leaders ³⁰⁶. World Health Organization country news confirms that the Federal Ministry of Health declared a cholera outbreak on 12 August 2024 and reports case counts and response actions through 2025; these WHO updates present figures and actions attributed to the Ministry and do not document misinformation by senior leaders ³⁰⁷³⁰⁸. UNICEF Sudan likewise reports the 12 August 2024 official declaration and subsequent vaccination activities, with data aligned to WHO and Federal Ministry of Health reporting ³⁰⁹.

3.6.1a Percentage of households with Internet

Score: 29.27

3.6.2a Mobile-cellular telephone subscriptions per 100 inhabitants

Score: 0

3.6.3a Gender gap in access to a mobile phone (percentage points)

Score: 66.67

3.6.4a Gender gap in access to the Internet (percentage points)

Score: 58.33

3.7.1a Restrictions on export/import of medical goods due to an infectious disease outbreak

Score: 100

There is no publicly available evidence that Sudan has implemented restrictions on the export or import of medical goods due to an infectious disease outbreak in the past year. The National Medicines and Poisons Board extended temporary registrations and permitted imports through 31 December 2024 ³¹⁰. In 2025 the Board reported increased medicine imports rather than restrictions ³¹¹. The National Medical Supplies Fund issued tenders in 2024 for imported medical consumables ³¹², and the National Medicines and Poisons Board provides an import services guide that outlines active procedures without reference to outbreak-related prohibitions ³¹³. The World Health Organization Multi-country External Situation Report No. 4 for August 2024 documents deliveries of cholera kits and other medical commodities, including 28 tons and 68 metric tons of cholera supplies shipped to Port Sudan ^{314, pp. 7-9}. The Federal Ministry of Health website contains no notice of restrictions ³¹⁵, the World Health Organization Strategic Partnership Portal country page for Sudan contains no such documentation ³¹⁶, and the ReliefWeb humanitarian database contains no postings describing restrictions on medical goods due to outbreaks ³¹⁷.

3.7.1b Restrictions on movement and/or exports/imports due to disease outbreak

Score: 100

There is no publicly available evidence that Sudan implemented restrictions on the export or import of non-medical goods due to an infectious disease outbreak in the past year. The World Health Organization (WHO) Regional Office for the Eastern Mediterranean reported on an oral cholera vaccination campaign in Khartoum State in June 2025 but did not describe any trade measures related to non-medical goods ³¹⁸. WHO multi-country external situation reports for May, June, and July 2025 document Sudan’s cholera epidemiology, commodities delivered, and operational response; none reference restrictions on food, textiles, or other non-medical imports or exports ^{319, p. 9320, p. 9321, p. 9}. The Central Bank of Sudan’s standing import procedures and regulations outline financial requirements for imports rather than outbreak-triggered measures ³²². Its 2025 policy circular on import procedures sets documentary and banking rules and does not establish restrictions linked to infectious disease outbreaks ^{323, p. 1}. The Federal Ministry of Health website contains no notices on such restrictions ³²⁴, and the WHO Strategic Partnership Portal country page for Sudan similarly contains no documentation of non-medical trade restrictions during this period ³²⁵.

3.7.2a Evidence of travel ban due to an infectious disease outbreak

Score: 100

There is no publicly available evidence that Sudan has implemented inbound or outbound travel restrictions in response to infectious disease outbreaks. World Health Organization (WHO) multi-country cholera situation reports from June and July 2025 describe cases, deaths, states affected, vaccination campaigns, and water, sanitation, and hygiene interventions in Sudan but make no reference to any travel measures at borders or airports ^{326, p. 9327, p. 9}. WHO Eastern Mediterranean Regional Office press releases covering Sudan’s cholera response in 2025 highlight vaccination and community-based prevention without mention of movement restrictions ³²⁸³²⁹. Similarly, the WHO Strategic Partnership Portal for Sudan and the official Ministry of Health website contain no documentation of outbreak-related entry or exit restrictions ³³⁰³³¹.

3.7.2b Risk-based approach to international travel-related measures

Score: 100

Sudan has a risk based approach to an international travel related health measure by conditioning entry on yellow fever vaccination documentation. United Kingdom Foreign, Commonwealth and Development Office travel advice states that, to enter Sudan, travelers must have a certificate proving yellow fever vaccination, which is a border health requirement linked to a specific disease risk rather than a universal rule applied to all health threats ³³². Passport Health likewise states that proof of yellow fever vaccination is required for entry to Sudan, and describes consequences for travelers without proof, reinforcing that entry is conditioned on vaccination documentation tied to yellow fever risk ³³³. Government of Canada travel health advice identifies Sudan as a country with yellow fever risk and addresses vaccination as part of traveler risk management, providing additional public health context for why yellow fever is treated as a risk determinant in travel to Sudan ³³⁴.

4.1.1a Doctors per 100,000 people

Score: 3.23

4.1.1b Nurses and midwives per 100,000 people

Score: 14.39

4.1.1c Updated health workforce strategy to address human resource shortfalls

Score: 0

Sudan does not have a publicly available health workforce strategy that has been updated within the past five years; the most recent national, HRH-specific strategy is the Federal Ministry of Health’s National Human Resources for Health Strategic Plan for Sudan 2012–2016, dated January 2011 ^{335, p. 1}. The current sectoral framework, the Sudan Health Sector Strategic Plan 2022–2024, describes persistent HRH system weaknesses, including absences of staffing and deployment policies, lack of a comprehensive health workforce information system, maldistribution and retention challenges, and insufficient training capacities, but it does not present an updated, adopted HRH strategy ^{336, p. 4}. The World Health Organization Universal Health Coverage Partnership country profile for Sudan documents technical assistance toward an HRH 2030 framework and related HRH work, yet it does not provide a link to a published national HRH strategy updated since 2020 ³³⁷. Taken together, publicly verifiable sources show the existence of an older HRH strategy and acknowledge ongoing HRH gaps and support, but they do not evidence an updated, in-force national health workforce strategy during 2022–2025, which supports a score of 0 ^{338, p. 1339, p. 4340}.

4.1.1d Health system capacity for essential health services

Score: 100

There is no publicly available evidence that Sudan has sufficient capacity within the health system to deliver essential health services.

According to the Joint external evaluation of IHR core capacities, the country receives a score of 5 meaning sustainable capacity. The JEE says that the Sudan Medical Council Law and the Sudanese Medical Profession Council Law form the legislative backing for sending or receiving medical personnel. Sudan has regional agreements in place with countries like Saudi Arabia for sending medical personnel on the annual Hajj pilgrimage. The JEE flags that a mechanism should be enhanced to provide and receive medical licensing for personnel from/to different countries, and Sudan’s involvement should be expanded in different entities like the Global Outbreak Alert and Response network to respond to global emergencies.³⁴¹

World Health Organization reporting shows that only 16% of primary care facilities and 14% of hospitals are operational nationwide, demonstrating failure to meet R3.2 facility functionality requirements for essential service delivery ^{342, pp. 27–28}. The same assessment reports that 85% of general clinical and trauma services are not normally provided, and that more than 60% of child health and nutrition services and communicable disease services are not normally provided, indicating that essential service availability across core R3.2 domains is largely absent ^{343, pp. 27–28}. Health Resources and Services Availability Monitoring System data cited in the World Health Organization “Sudan conflict and refugee crisis, Multi country External Situation Report 10” indicate that as of December 2024, 38% of assessed facilities in seven states and the Abyei area were nonfunctional, and that in Khartoum State only 31% of hospitals and 17% of primary health centers were functional, further confirming system wide incapacity under R3.2 operational criteria ^{344, p. 3}. Continuity of routine preventive services under R3.2 is also not met, as World Health Organization and United Nations Children’s Fund estimates place coverage for the third dose of diphtheria, tetanus, and pertussis vaccine at 51% in 2023, down from 84% in 2021, reflecting sustained degradation of essential service delivery ^{345, p. 5}.

4.1.1e Essential health services continuity plan for public health emergencies

Score: 0

There is no publicly available evidence that Sudan has a national plan to ensure continuity of essential health services during a public health emergency. The Federal Ministry of Health’s Sudan Health Sector Strategic Plan 2022 to 2024 explicitly lists as a system weakness the “lack of clear guidelines and protocols to ensure continuity of essential health services during emergencies” ^{346, p. 15}. The World Health Organization’s Public Health Situation Analysis for Sudan dated 1 September 2024 documents wide service disruptions, noting that about 80 percent of hospitals in the most conflict-affected areas and 45 percent of facilities in five states were not working as of June 2024, and that critical services including maternal and child health care and treatment of chronic conditions were discontinued in many areas ^{347, pp. 22, 11} . No national continuity plan is posted on the World Health Organization Strategic Partnership Portal country page for Sudan ³⁴⁸.

4.1.2a Hospital beds per 100,000 people

Score: 13.16

4.1.2b In-country capacity to isolate patients with highly communicable diseases

Score: 100

Sudan has the capacity to isolate patients with highly communicable diseases in dedicated patient isolation units. During the Omicron wave in 2022, Khartoum State operated multiple COVID-19 isolation centers, including Ibrahim Malik Teaching Hospital, Al-Shaab Teaching Hospital, Bahri Teaching Hospital, Omdurman Hospital, Alnaw Hospital, and Jabra Hospital for Emergency and Injuries, confirming in-country isolation capacity ^{349, p. 4}. Jabra Isolation Center is described as Sudan’s first and largest COVID-19 isolation facility, accredited by the Federal Ministry of Health and the World Health Organization, indicating a designated unit capable of managing highly communicable diseases ^{350, p. 2}. Outside Khartoum, the United Nations Office for the Coordination of Humanitarian Affairs reported in September 2023 that the isolation center at Gedaref Teaching Hospital was renovated and equipped with patient beds by partners, demonstrating continued availability of isolation facilities during the conflict period ^{351, p. 2}.

4.1.2c Demonstrated capacity / evidence of plan to expand isolation capacity

Score: 100

Sudan has expanded isolation capacity and updated plans for patient isolation during infectious disease outbreaks. In September 2023, the United Nations Office for the Coordination of Humanitarian Affairs reported that the United Nations High Commissioner for Refugees renovated the isolation center at Gedaref Teaching Hospital and the World Health Organization delivered patient beds with plans for full operational support, which constitutes a documented expansion of isolation capacity during an outbreak ^{352, p. 2}. The World Health Organization further reported the establishment of 12 cholera treatment units across six states for severe cases between September 2024 and January 2025, treating more than 5,700 patients and demonstrating operational surge capacity ³⁵³. In March 2025, the World Health Organization’s Public Health Situation Analysis recorded that Sudan designated isolation centers, set up a national referral policy and patient pathway, and updated case management and infection prevention and control protocols for Ebola virus disease, showing evidence of recent planning for expanded isolation ^{354, p. 22}.

4.2.1a National procurement protocol for the acquisition of routine laboratory/medical supplies

Score: 100

Publicly available evidence shows that Sudan maintains national procurement frameworks that enable routine acquisition of both medical and laboratory supplies by government ministries during 2022–2025, warranting a score of 2 ^{355, p. 1356, pp. 25–26}. The Public Procurement, Contracting and Disposal of Assets Act applies to purchases by all state bodies at every administrative level and expressly covers procurements financed through international and bilateral agreements, while providing detailed procedures for international and local purchasing methods ^{357, p. 1358, pp. 25–26}. Within the health sector, the National Medical Supplies Fund operates standardized tendering that covers routine medical consumables, with Tender No. 7/2020 explicitly spanning 2020–2022 and requiring National Medicines and Poisons Board registration and post-award quality testing at the National Quality Control Laboratory ^{359, p. 7360, p. 12}. For 2022–2024, the Federal Ministry of Health’s National Health Sector Recovery and Reform Strategic Plan confirms the existence of a national supply management system and sets an objective to strengthen a unified, non-interrupted national supply system for medicines, health products, technologies and laboratory supplies to the last mile ^{361, p. 11362, p. 29}.

4.2.2a Stockpile of medical supplies for national use during a public health emergency

Score: 0

There is no publicly available evidence that Sudan maintains a government-run national stockpile of medical countermeasures or a plan for equitable nationwide distribution. The Federal Ministry of Health’s National Health Sector Recovery and Reform Strategic Plan 2022–2024 lists “inadequate emergency stock and supply management capacities,” and reports frequent stock-outs that hamper laboratory services, indicating the absence of a maintained reserve for emergencies ^{363, p. 5}. The World Health Organization’s Public Health Situation Analysis dated March 10, 2025 describes many health facilities operating with severe shortages of medicines, vaccines, equipment and supplies, as well as limited access to medical supplies across the country, reflecting reliance on ad hoc humanitarian deliveries rather than a national stockpile ^{364, pp. 1, 3}. The United Nations Office for the Coordination of Humanitarian Affairs records partner provision of cholera kits and explicitly states that supply chain management needed improvement in Gedaref State, and documents large-scale humanitarian deliveries and prepositioning, which are not evidence of a government stockpile or distribution plan ^{365, pp. 2, 4}. No document on the World Health Organization Strategic Partnership Portal for Sudan describes a national stockpile or an equitable distribution mechanism ³⁶⁶.

4.2.2b Stockpile of laboratory supplies for national use during a public health emergency

Score: 0

Publicly available evidence does not show that Sudan maintains a government-run national stockpile of laboratory supplies for emergencies. The World Health Organization (WHO) Public Health Situation Analysis for Sudan dated 10 March 2025 reports that medicines and medical supplies coverage was limited to eight of eighteen states through Health Cluster partners, indicating reliance on humanitarian pipelines rather than a government stockpile ^{367, p. 28}. The Federal Ministry of Health’s Health Sector Strategic Plan 2022–2024 acknowledges that public health laboratories and blood banks experience frequent supplies stock-outs and that emergency stock and supply management capacities are inadequate ^{368, p. 6}. The WHO situation report of 15 December 2023 confirms that shortages of medicines and medical supplies, including laboratory reagents, continue to persist, with supplies being provided by WHO and partners, and also notes the absence of functional public health laboratories in most states, with samples being sent to the Port Sudan State Public Health Laboratory after WHO support ^{369, pp. 2–3}. No document on the WHO Strategic Partnership Portal for Sudan describes a government laboratory supplies stockpile or an equitable national mechanism for its distribution ³⁷⁰.

4.2.2c Annual review of national stockpile to ensure sufficient supply

Score: 0

There is no publicly available evidence that Sudan conducts or requires an annual review of a government run national stockpile of medical or laboratory supplies. The World Health Organization Public Health Situation Analysis dated 10 March 2025 states that medicines and medical supplies coverage reached only eight of eighteen states through Health Cluster partners ^{371, p. 28}. A World Health Organization situation report on 15 December 2023 documents persistent shortages of medicines, medical supplies, and laboratory reagents, and explains that partner provision of supplies was ongoing but did not meet demand ^{372, p. 3}. The Federal Ministry of Health’s Sudan Health Sector Strategic Plan 2022–2024 lists frequent supplies stock outs in public health laboratories and inadequate emergency stock and supply management capacities as sector weaknesses, without any policy language on annual review of a national reserve ^{373, p. 6}. No document on the World Health Organization Strategic Partnership Portal for Sudan describes a government stockpile or a mandatory annual review ³⁷⁴³⁷⁵.

4.2.3a Plan/agreement to produce/procure medical supplies during a public health emergency

Score: 0

There is no publicly available evidence that Sudan has a plan or mechanism to leverage domestic manufacturing capacity, procure medical supplies for national use during a public health emergency, or expedite medical supplies through points of entry during a public health emergency. The National Medical Supplies Fund issued an open tender for intravenous fluids and emergency medicines for 2022 to 2024, which describes standard procurement and delivery terms, including Incoterms 2020, customs and official fees paid by the Fund, and payment after delivery and acceptance at the Fund’s Khartoum warehouses, but it does not establish an emergency specific plan, mechanism, or points of entry expediting procedure tied to a public health emergency ^{376, pp. 1, 7, 11, 19}. World Health Organization reporting instead describes constraints and delays affecting the movement and delivery of medicines and essential supplies, including bureaucratic barriers linked to travel permits and cross border access, and continued delays from insecurity and bureaucratic hurdles, which is not evidence of an expediting mechanism ^{377, p. 27378, p. 4}.

4.2.3b Plan/agreement to produce/procure lab supplies during a public health emergency

Score: 0

There is no publicly available evidence that Sudan has a plan, agreement, or emergency mechanism to procure or expedite laboratory supplies for national use during a public health emergency. The National Medical Supplies Fund’s “Open Tender for Supply of Medical Laboratory Consumables, Tender No. 02/2022” sets out a routine, competitive procurement process for laboratory consumables, including eligibility criteria, bid submission requirements, quality assurance documentation, delivery to National Medical Supplies Fund warehouses, and standard payment terms, but it contains no reference to a public health emergency trigger, emergency procurement procedures, expedited timelines, surge conditions, or emergency use authorization ^{379, pp. 4-5, 7-10}. Similarly, the National Medical Supplies Fund’s “RFQ/00028/2022” documents supplier quotations for laboratory reagents and diagnostics, listing products, quantities, prices, and manufacturers, but it functions as a standard request-for-quotation instrument and does not establish or reference any mechanism specific to procurement during a public health emergency, nor any procedures for emergency activation, fast-tracking through points of entry, or crisis response use ^{380, pp. 1-2, 11-12, 16-17}.

4.2.3c Mechanism emergency logistics and supply chain management

Score: 100

Sudan has a national and subnational mechanism for emergency logistics and supply chain management, which is regularly reviewed, includes provisions for vaccine cold chain, and involves both public and private stakeholders. The Federal Ministry of Health and the National Medical Supplies Fund operate a structured mechanism defined in the 2024-2028 strategy, with roles for federal, state, locality, and facility levels, and a monitoring and evaluation framework that includes quarterly reviews and key performance indicators ^{381, pp. 58–61}. State-level instruments establish Medical Supply Funds through model agreements and laws, assigning supervisory and reporting responsibilities ^{382, pp. 21, 29, 37}. The World Bank’s Social Assessment documents the vaccine cold chain at one national store, 18 state stores, 183 locality stores, and 2,421 service points, with 283,000 liters of national storage capacity at +2 to +8°C and −20°C ^{383, pp. iv, 28, 35}. UNICEF reporting confirms the continued use of vaccine cold chain facilities during the 2023 crisis ³⁸⁴.

4.3.1a Plan/program/guidelines for dispensing MCMs during a public health emergency

Score: 0

There is no publicly available evidence that Sudan has a nationally issued plan, program, or guideline that operationally governs dispensing medical countermeasures for national use during a public health emergency. The National Medical Supplies Fund supply chain strategy for pharmaceuticals and health products is framed as a national supply chain recovery and reform strategy, and while it references improving emergency supply chain management through protocols and guidelines to keep supply chain processes functioning during emergencies, it does not set out an emergency medical countermeasure dispensing concept of operations, including points of dispensing and workforce models for dispensing to the public ^{385, pp. 1, 58}. The World Bank social impact assessment for the Sudan COVID-19 Emergency Response Project describes a COVID-19 vaccination deployment approach and a vaccination process for fixed and outreach sites, and notes that detailed operational modality would be contained in a project implementation manual, but this is a project document and does not constitute a Sudan government issued, all hazards dispensing guideline for medical countermeasures, including antibiotics, therapeutics, and diagnostics ^{386, pp. 31-33}. The National Medical Supplies Fund state model document focuses on routine medicines distribution and cash collection procedures and historic emergency department free medicines arrangements, not a national public health emergency dispensing guideline ^{387, pp. 3, 7}.

4.3.2a Plan to receive foreign health personnel during a public health emergency

Score: 100

Sudan has a publicly available government plan to facilitate surge of the health workforce during public health emergencies. The National Health Sector Recovery and Reform Strategic Plan 2022–2024 directs the Federal Ministry of Health to “build the capacity of the health emergency workforce” and to “secure health emergency workforce reserves for effective community based and event based surveillance and response,” with explicit indicators and annual targets for Complete Rapid Response Teams at state and locality levels and for responses within seventy two hours of detection ^{388, pp. 17–18}. The World Health Organization Country Cooperation Strategy for Sudan 2022–2025 further sets out a public program to strengthen rapid response teams at federal, state, and locality levels and to develop a multi hazard national public health emergency preparedness and response plan, reinforcing planned surge capacity across the system ^{389, p. 27}.

4.3.2b Plan to facilitate workforce surge in an emergency

Score: 0

There is no publicly available national plan identified for Sudan that sets out procedures to receive international health personnel. The World Health Organization (WHO) October 2024 Sudan Health Emergency Situation Report states that an Emergency Medical Teams Coordination Cell arrived in September 2024 and, at the request of the Federal Ministry of Health, is coordinating the deployment of international Emergency Medical Teams to support trauma care and outbreak response; it also records fourteen partner organizations responding and terms of reference for a national Emergency Medical Teams initiative being prepared with the ministry ^{390, p. 5}. The WHO multi-country external situation report confirms that, following an official request from the Federal Ministry of Health, an Emergency Medical Teams coordinator and deputy arrived in Port Sudan to establish a formal coordination cell, with initial meetings held with the ministry and a tasking plan under finalization ^{391, p. 6}. A Swiss government project brief further documents support to the Emergency Medical Teams Coordination Cell operating in Port Sudan ³⁹².

4.3.2c Plan to redeploy existing health personnel within the country

Score: 100

Sudan has a public plan to redeploy existing health personnel during public health emergencies. The Sudan Health Sector Strategic Plan 2022 to 2024 reports the presence of Rapid Response Teams at locality level, and under Strategic project 3 establishes emergency workforce reserves for surveillance and response, with an indicator that emergencies and epidemics are responded to within 72 hours from detection ^{393, p. 3394, p. 18}. The World Health Organization Country Cooperation Strategy for Sudan 2022 to 2025 includes strengthening rapid response teams at federal, state and locality levels, and developing a multi hazard national public health emergency preparedness and response plan, confirming a publicly available framework for mobilizing existing staff during emergencies ^{395, p. 27396, p. 26}.

4.4.1a Constitutional guarantee of citizens’ right to medical care

Score: 100

Sudan’s constitutional framework guarantees free medical care for all citizens. Article 46 of the 2019 Constitutional Declaration states that “the State shall guarantee to every citizen free primary health care and emergency services” ^{397, p. 13}. This is reinforced by Article 46 of the 2005 Interim National Constitution of the Republic of Sudan, which provides that “the State shall promote public health, establish, rehabilitate and develop basic medical and public health institutions, and provide free primary health care and emergency services for all citizens” ^{398, p. 28}.

4.4.1b Access to skilled birth attendants (% of population)

Score: 67.65

4.4.1c Out-of-pocket health expenditures per capita, PPP (current international $)

Score: 91.86

4.4.1d Coverage of essential health services through universal health coverage

Score: 35.42

4.4.1e Total population pushed below a relative poverty line by household health expenditure (60% of media daily per capita consumption or income)

Score: 47.55

4.4.1f Rate of mortality amenable to health care

Score: 48.19

4.4.2a Guaranteed paid sick leave

Score: 66.67

Paid sick leave is guaranteed in Sudan’s labor law, but there is no public evidence that the statutory entitlement explicitly extends to mental health conditions. Article 47 of the Labour Act 1997 entitles a worker, after three months of continuous service and with a certified illness not due to misconduct or negligence, to three months with full pay, three months with half pay, and three months with quarter pay; reduced-pay sick leave applies only after exhausting normal leave, and prolonged illness may continue without pay pending medical commission review ^{399, pp. 11–12}. The Arabic text confirms the same paid-sick-leave structure and conditions ^{400, p. 13}. The legal provisions use the generic term “illness” and do not specify psychological or mental disorders, and no clause in the cited law text explicitly addresses mental health ^{401, pp. 11–12; 2, p. 13}.

4.4.3a Government prioritisation of care for healthcare workers during response

Score: 0

There is no publicly available evidence that Sudan has issued legislation, a policy, or a public statement committing to provide prioritized healthcare services to healthcare workers who become sick as a result of responding to a public health emergency. The National Public Health Act 2008 establishes free treatment for emergency cases, children under five, pregnant women, and primary care services, but it does not contain provisions guaranteeing priority care for healthcare workers who fall ill due to public health response duties ^{402, p.10}. The National Health Sector Recovery and Reform Strategic Plan 2022–2024, endorsed by the Federal Ministry of Health, outlines health workforce strengthening and emergency response preparedness but does not include commitments to prioritized treatment for healthcare workers ^{403, pp.2–4, 17–18}. The Federal Ministry of Health website shows no announcements, policy texts, or legislative documents establishing such a guarantee ⁴⁰⁴. The World Health Organization Strategic Partnership Portal country page for Sudan similarly contains no evidence of a national law, regulation, or official policy on this matter ⁴⁰⁵.

4.5.1a Existence of system for communication during a public health emergency

Score: 100

Sudan has formal and operational mechanisms that enable communication between public health authorities and healthcare workers during emergencies, including an active National Emergency Operations Centre and the Health Cluster functioning at national and state levels ^{406, p. 3}. The World Health Organization (WHO) health emergency situation report for 15 December 2023 states that WHO is coordinating the health response and continues to lead the Health Cluster for national and sub-national response, and that electronic Early Warning and Response System data are being received from nine states; it also records training of 1,266 health workers in surveillance and case management, demonstrating routine two-way information flow with frontline staff ^{407, pp. 4, 2, 6}. WHO’s Country Cooperation Strategy for 2022–2025 further commits support to improve and operationalize emergency operations centers at all levels and to strengthen communications and coordination among health sectors and partners during public health emergencies, confirming an institutionalized communication system that links officials and providers ^{408, p. 21}.

4.5.1b Inclusion of public and private sector in healthcare communication system

Score: 0

There is no publicly available evidence that Sudan has an emergency communication system for public health officials and healthcare workers that explicitly encompasses healthcare workers in both the public and private sectors. The World Health Organization Regional Office for the Eastern Mediterranean’s “Country Cooperation Strategy for WHO and Sudan 2022–2025” outlines strategic commitments related to strengthening national health information systems and improving data collection and flow across the health sector, but it does not describe an emergency communication system nor document mechanisms for direct emergency communications with private healthcare workers ^{409, p. 3}. The Federal Ministry of Health’s “National Health Sector Recovery and Reform Strategic Plan 2022–2024” references coordination structures such as the National Emergency Operations Center and Health Cluster arrangements, as well as public and private laboratory networks and unified care pathways, but it does not specify emergency communication systems, protocols, or platforms through which private healthcare workers receive or transmit emergency directives or alerts ^{410, pp. 3–4, 16}. The World Health Organization’s “Sudan Health Emergency: Situation Report No. 4” documents surveillance reporting and training activities during the 2023 emergency response but does not demonstrate the existence of a national emergency communication system that includes private-sector healthcare workers ^{411, p. 6}.

4.6.1a Evidence of national public health system monitoring and tracking of HCAIs

Score: 0

There is no publicly available evidence that Sudan’s national public health system monitored and tracked the number of healthcare-associated infections in healthcare facilities. The National Health Sector Recovery and Reform Strategic Plan 2022-2024 lists “Healthcare-associated infection rate” as an indicator, but the baseline is “to be determined,” and the data source is described only as “healthcare-associated infection surveillance,” indicating a planned measure rather than an operational national tracking system for this period ^{412, pp. 51–52}. The 2022 Situational Analysis of Water, Sanitation, and Hygiene in Health Care Facilities reports “no monitoring or limited accountability mechanisms” for WASH in health facilities nationally, and further notes that routine monitoring systems are needed, the District Health Information System covers at most 63 percent of facilities, and the WASH information management system is not functional, all of which are incompatible with nationwide counting and reporting of healthcare-associated infections ^{413, p. 4414, p. 11}.

4.6.1b Infection prevention and control programme

Score: 100

Sudan maintains a national infection prevention and control program, led by the Federal Ministry of Health’s Directorate of Infection Prevention and Control, which has formal mandates to develop and enforce IPC guidelines and to conduct capacity building across the system ^{415, p. 7–8416, p. 4}. The National Health Sector Recovery and Reform Strategic Plan 2022–2024 operationalizes this program by requiring updated patient safety and IPC methods and standards at the primary care level, and by specifying implementation of infection prevention and control in hospital sector reforms ^{417, pp. 13–14}. The World Health Organization Country Cooperation Strategy for Sudan 2022–2025 further confirms active IPC program implementation during this period by prioritizing training on infection prevention and control at health care facilities under Strategic Priority 2 ^{418, pp. 2–3}.

4.6.1c National plan to ensure a safe environment in health facilities

Score: 100

Publicly available evidence shows that Sudan has a national plan to ensure a safe environment in health facilities. The Federal Ministry of Health’s Health Sector Strategic Plan 2022–2024 sets hospital sector reform goals that include the implementation of infection prevention and control, and the rehabilitation of infrastructure to ensure quality and safety in hospitals ^{419, p. 14}. The plan’s quality agenda calls to update, review, and ensure adherence to patient safety and Infection Prevention and Control methods and standards at the primary health care level, with related indicators for implementation ^{420, p. 13}. In parallel, the national Situational Analysis of Water, Sanitation, and Hygiene in Health Care Facilities describes federal responsibilities for the Directorate of Infection Prevention and Control and the Directorate of Health Promotion and Environmental Health to develop and enforce IPC manuals, oversee hygiene and environmental cleaning, and manage hazardous health-care waste in facilities nationwide ^{421, pp. 7–8}.

4.7.1a Requirement for ethical review before beginning a clinical trial

Score: 100

Sudan has a national requirement for ethical review before beginning a clinical trial. The National Public Health Act establishes the Public Health Co-ordination National Council with the function to supervise medical research conducted on human beings and verify compliance with professional ethics, creating a legal basis that requires ethics oversight for human research ^{422, p. 507}. The Act also establishes the Health Research National Council and assigns it national authority over health research policies and plans across public, private, and voluntary institutions, confirming systemwide jurisdiction for ethics governance ^{423, pp. 518–519}. In addition, the United States Department of Health and Human Services (HHS) Office for Human Research Protections (OHRP) 2024 International Compilation lists Sudan’s National Guidelines for Ethical Conduct of Research Involving Human Subjects and the Accreditation Guidelines for Research Ethics Committees, and identifies the National Medicines and Poisons Board under Drugs, Biologics, and Devices, which together document the requirement for prior approval by a research ethics committee or an Institutional Review Board (IRB) before clinical trials proceed ^{424, p. 9}.

4.7.1b Expedited approval for clinical trials of unregistered MCMs during epidemics

Score: 0

Sudan does not have a publicly documented expedited process for approving clinical trials of unregistered medical countermeasures nor a formal mechanism to recognize clinical trial results conducted elsewhere during epidemics. The Medicines and Poisons Act 2009 mandates that the National Medicines and Poisons Board (NMPB) must approve human drug experiments and requires documented evidence from other countries demonstrating safety, but the Act does not provide for an emergency fast-track procedure or mutual recognition framework ^{425, pp. 16–17}. The NMPB website lists the Regulation for Conducting Medical Experiments on Humans and Animals (2017), but the text does not specify any reliance-based or expedited trial approval process ⁴²⁶. No relevant trial-related emergency approval measures are published on public notices, nor are such processes described on the World Health Organization Strategic Partnership for Health Security portal, the Joint External Evaluation repository, or the VERTIC Biological Weapons Convention legislation database ^427428429.

4.7.2a Existence of agency responsible for approving new human MCMs

Score: 100

Sudan has a designated national medicines regulatory authority responsible for approving human medical countermeasures; the National Medicines and Poisons Board serves as the country’s regulator. The African Vaccine Regulatory Forum regulator directory lists the National Medicines and Poisons Board for Sudan ⁴³⁰. The World Health Organization certification scheme contact list explicitly identifies the Board as the national regulatory authority, with the entry revised on 28 February 2024 based on the authority’s website ⁴³¹. Peer-reviewed research further notes that as of 2023 the Board had licensed 153 companies to manufacture, import, or supply pharmaceuticals in Sudan ⁴³². The Federal Ministry of Health’s National Health Sector Recovery and Reform Strategic Plan 2022–2024 includes “Strengthen the national regulatory authority” under Strategic Project 6 and cites NMPB annual reports for indicators on medicine quality and regulatory compliance; the acronym list also defines NMPB as the National Medicines and Poisons Board ^{433, pp. VII, 28–29, 68–69}. The Board’s published Requirements for the registration of Human medicines sets out dossier, stability, and bioequivalence elements for human drug registration ^{434, pp. 2–3}.

4.7.2b Expedited approval for human MCMs during public health emergencies

Score: 100

Sudan maintains an expedited process for approving medical countermeasures for human use during public health emergencies. A legal mechanism allows the National Medicines and Poisons Board to place “emergency drugs” on the market without prior registration during public health emergencies, establishing an expedited pathway for medical countermeasures ^{435, pp. 18–19}. During the 2023 cholera outbreak this pathway was operationalized through reliance on the International Coordinating Group on Vaccine Provision for rapid access to World Health Organization (WHO) prequalified oral cholera vaccine, with WHO reporting that plans were initiated to request oral cholera vaccines from the ICG on 30 September 2023 ^{436, p. 1}. WHO subsequently documented large-scale oral cholera vaccination in 2024, noting that 5.3 million doses were deployed in Sudan ^{437, p. 6}. In parallel, the Federal Ministry of Health, with UNICEF, WHO and Gavi, introduced WHO-recommended malaria vaccines nationally on 4 November 2024, further evidencing recognition and use of externally authorized countermeasures during the emergency period ⁴³⁸.

5.1.1a Submission of IHR reports to the WHO in past year

Score: 100

Sudan has submitted an IHR Self-Assessment Annual Report (SPAR) to the WHO for the last calendar year, with the latest submission in 2024.⁴³⁹

5.1.2a Existence of specific risk reduction strategies for epidemics and pandemics

Score: 0

Sudan does not have an adopted national disaster risk reduction strategy that integrates epidemics and pandemics, and there is no standalone national disaster risk reduction strategy dedicated to epidemics or pandemics. The Diagnostic Report on Emergency Preparedness and Response Capacities highlights overlapping mandates, weak coordination, and confirms that a National Strategy for Disaster Risk Reduction developed with the United Nations Office for Disaster Risk Reduction was not adopted or disseminated ^{440, pp. viii, 8–9}. The Rapid Post Disaster Needs and Recovery Assessment states that the Sudan National Disaster Risk Reduction Strategy 2016 to 2030 was passed by the Council of Ministers but not formally adopted by the government, and it further notes that legal and governance arrangements remain incomplete, with government efforts focused primarily on response rather than preparedness ^{441, pp. 98–101, 104}. In 2023, the United Nations Office for Disaster Risk Reduction reported on Sudan’s national platform and multi-hazard early warning initiatives but provided no evidence that a national strategy integrating epidemics and pandemics had been adopted ⁴⁴².

5.2.1a Existence of public health emergency agreements with regional neighbors

Score: 100

Sudan has cross-border agreements for public health emergencies, and operational evidence confirms they have been implemented. In March 2022, the Intergovernmental Authority on Development (IGAD) adopted the Mombasa Declaration, which commits member states to cross-border data sharing, epidemic surveillance, and coordinated pandemic preparedness; Sudan’s Minister of Health, Dr. Haitham M. AwadAllah, signed the declaration ^{443, pp. 5, 9}. IGAD’s 2023 Annual Report records concrete operational follow-through, including provision of information technology equipment for Sudan’s cross-border health sites and ten cross-border coordination meetings to strengthen surveillance, pandemic preparedness, and digital health systems ^{444, pp. 54–55}. In October 2024, the World Health Organization confirmed actual cross-border implementation by reporting that medical supplies, including cholera kits, were delivered into Sudan through the Adré border crossing from Chad into Darfur ^{445, pp. 1, 8}.

5.2.1b Existence of animal health emergency agreements with regional neighbors

Score: 100

Sudan has formal bilateral cross border memoranda of understanding (MoUs) with neighboring countries on animal health emergencies, and evidence shows they are maintained and operationalized. The Intergovernmental Authority on Development (IGAD) Centre for Pastoral Areas and Livestock Development listed in May 2025 six bilateral MoUs on animal health and sanitary measures, explicitly naming Ethiopia-Sudan and South Sudan-Sudan, and confirmed that implementation frameworks were developed for these agreements ^{446, slide 7}. Sudan’s MoU with Ethiopia on cross border animal health and sanitary measures was signed in September 2020 and remains publicly documented by IGAD ⁴⁴⁷. Similarly, Sudan and South Sudan signed a cross border memorandum in February 2020 on coordination of animal health in frontier areas, as reported by the European Union Delegation ⁴⁴⁸. IGAD’s 2023 Annual Report describes the ongoing operationalization of these MoUs, including harmonized surveillance calendars for transboundary animal diseases, policy enforcement, and coordinated vaccination activities involving Sudan, as detailed on page 23 ^{449, pp. 22–23}.

5.3.1a Biological and Toxin Weapons Convention status

Score: 100

Sudan is a State Party to the Biological Weapons Convention ⁴⁵⁰. The United Nations Office for Disarmament Affairs’ official membership list explicitly includes Sudan among States Parties, confirming its status ⁴⁵¹. UNODA also documents Sudan’s participation as a BWC State Party through a National Preparedness Programme activity ⁴⁵². In addition, the BWC Confidence-Building Measures portal maintains a country page for Sudan, reflecting its eligibility to submit CBM reports as a State Party ⁴⁵³.

5.3.1b Submission of CBMs to the Biological and Toxin Weapons Convention

Score: 0

There is no publicly available evidence that Sudan submitted Biological Weapons Convention confidence building measures during the last three submission years. The United Nations Office for Disarmament Affairs’ electronic CBM portal lists reports by country and the Sudan country page explicitly states “There are no reports for this country” ⁴⁵⁴. The CBM “Reports” repository, which provides all publicly available submissions, likewise contains no entries for Sudan ⁴⁵⁵. The BWC Implementation website also records no CBM submissions by Sudan ⁴⁵⁶.

5.3.1c Submission of UNSCR 1540 reports

Score: 100

Sudan has provided the required national report to the United Nations Security Council Committee established pursuant to resolution 1540. The 1540 Committee’s official “National Reports” list shows Sudan’s submission under document symbol S/AC.44/2004/(02)/153 ⁴⁵⁷. The corresponding United Nations documents record confirms the item titled “Report of the Republic of the Sudan on implementation of United Nations Security Council resolution 1540 (2004)” dated 1 April 2009, which evidences Sudan’s provision of its national report to the Committee ⁴⁵⁸.

5.3.1d Extent of UNSCR 1540 implementation on public health emergencies

Score: 0

5.3.2a Membership in global health security and/or biological weapons agreements

Score: 0

Sudan does not meet the requirement of membership in at least two of the specified international mechanisms. Sudan is not listed as a partner of the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction ⁴⁵⁹. Sudan is not included among the participants of the Australia Group ⁴⁶⁰. Sudan is also absent from the endorsing states of the Proliferation Security Initiative as of 19 November 2024 ⁴⁶¹.

5.4.1a Completion and publication of JEE (or GHSA pilot external assessment) report

Score: 0

Sudan has not completed or published a Joint External Evaluation report within the last five years ⁴⁶²⁴⁶³. The World Health Organization (WHO) Strategic Partnership for Health Security Joint External Evaluation activities page lists only one entry for Sudan, conducted 9–13 October 2016, and shows no subsequent JEE activity or report ⁴⁶⁴. The official JEE report confirms the mission dates of 9-13 October 2016 ⁴⁶⁵.

5.4.2a Completion and publication of PVS report (past five years)

Score: 0

Sudan has not completed or published a State Party Performance of Veterinary Services (PVS) assessment within the last five years. The World Organisation for Animal Health (WOAH) Africa regional status page lists several PVS Pathway missions for Sudan, including a PVS Evaluation in 2009, a PVS Evaluation follow up in 2013, a PVS Gap Analysis in 2014, a PVS Laboratories mission in 2015, and a PVS Legislation mission in 2016 ⁴⁶⁶.

5.4.2b Completion and publication of PVS gap analysis (past five years)

Score: 0

Sudan has not completed or published a World Organisation for Animal Health Performance of Veterinary Services gap analysis in the last five years. The World Organisation for Animal Health Africa PVS Pathway missions status page lists Sudan’s most recent gap analysis as 2014 and shows no subsequent Sudan gap analysis ⁴⁶⁷. The World Health Organization Strategic Partnership for Health Security document library search results for Sudan list “OIE Report – Sudan 2014 Gap Analysis” and do not include any later Sudan gap analysis report ⁴⁶⁸.

5.5.1a Evidence of allocated national funds to improve capacity to address epidemic threats

Score: 0

Sudan has not published any evidence of national funds allocated to improve capacity for pandemic or epidemic threats. The Federal Ministry of Health website does not provide documentation of epidemic preparedness funding in national budgets ⁴⁶⁹. The Ministry of Finance and Economic Planning does not present allocation tables, health sector budget lines, or funding acts that demonstrate domestic financing for pandemic or epidemic response ⁴⁷⁰. The World Health Organization Strategic Partnership for Health Security document library contains no Sudan-specific documents evidencing national budget allocations ⁴⁷¹. The World Health Organization Regional Office for the Eastern Mediterranean’s Sudan crisis portal outlines humanitarian financing needs and partner contributions but does not cite national government budget commitments ⁴⁷². Gavi country pages for Sudan detail partner assistance, co-financing requirements, and external support but do not document domestic allocations in this timeframe ⁴⁷³.

5.5.2a National budget to address gaps identified in JEE, NAPHS or GHSA roadmap

Score: 0

There is no publicly available evidence from the last five years that Sudan’s Joint External Evaluation report, any National Action Plan for Health Security, or a national Global Health Security Agenda roadmap allocate or describe specific funding from the national budget to address identified gaps. The only publicly posted Joint External Evaluation for Sudan remains the 2016 mission report, which does not present domestic budget line allocations ^{474, p. 1}. On the World Health Organization Strategic Partnership Portal, Sudan’s country profile shows a National Action Plan for Health Security event conducted on 18 to 19 October 2022 and the latest JEE completion in 2016, but provides no documentation of national budget appropriations tied to NAPHS activities or a GHSA roadmap for the last five years ⁴⁷⁵.

5.5.2b National budget to address gaps identified in PVS assessment or gap analysis

Score: 0

There is no publicly available evidence that Sudan’s World Organisation for Animal Health Performance of Veterinary Services assessments or any PVS Gap Analysis allocate or describe specific funding from the national budget to address identified gaps; neither the WOAH Africa PVS missions status page nor the World Health Organization Strategic Partnership Portal document library lists a Sudan PVS report from this period that contains domestic budget appropriations ^{476, p. 6477}. The most recent publicly posted PVS document for Sudan is the follow up PVS Evaluation issued in 2014 from a 2013 mission, which characterizes operational funding levels, notes the absence of a consolidated line item operational budget for the veterinary services, and records continued dependence on external funding rather than identifying national budget allocations to close PVS identified gaps ^{478, p. 13479, pp. 55 to 56}.

5.5.3a Emergency public financing during a public health emergency

Score: 100

Sudan has publicly identified special emergency financing mechanisms it can access during public health emergencies. The Pandemic Fund announced on September 19, 2024 a fast tracked allocation of US$128.89 million to support mpox response in 10 countries, explicitly listing Sudan among the beneficiaries ⁴⁸⁰. The Pandemic Fund’s inaugural progress report corroborates this decision, stating that USD 129 million was allocated on a fast track basis in September 2024 for 10 mpox affected countries and again naming Sudan in that group ^{481, p. 1}. The World Bank’s International Development Association (IDA) lists Sudan as currently eligible to receive IDA resources, evidencing an additional publicly identified multilateral financing pathway Sudan can access, including during crisis contexts ⁴⁸². In addition, the United Nations Central Emergency Response Fund publicly allocated US$100 million for underfunded crises on February 19 to 20, 2024, with Sudan identified among the top 3 crises receiving USD 20 million, demonstrating another multilateral emergency funding pathway available to Sudan during acute emergencies ⁴⁸³.

5.5.4a Commitments to improve domestic or foreign capacity for epidemic threats

Score: 0

There is no publicly available evidence that Sudan’s senior leaders, within the past 3 years, have made a public commitment to support other countries to address pandemic or epidemic threats through financing or assistance, or to improve Sudan’s domestic capacity by expanding financing or formally requesting external support to build capacity. World Health Organization reporting documents outbreak response measures led by the Federal Ministry of Health, including initiating a request and later submitting an application to the International Coordinating Group on Vaccine Provision for oral cholera vaccine doses to support reactive campaigns, which reflects operational disease control activity rather than a senior leader public commitment that meets the rubric criteria for financing expansion or capacity building support requests. ^{484, p. 3485, p. 3}. Separately, the Federal Minister of Health is quoted in a World Health Organization operational update describing the malaria vaccine rollout as a “strong and unwavering commitment to malaria control,” which is disease specific and does not constitute a public commitment to expand financing or to request external support to improve national epidemic or pandemic capacity. ^{486, p. 6}.

5.5.4b Investments to improve domestic or foreign capacity for epidemic threats

Score: 100

There is publicly available evidence that Sudan requested international financing and technical support to strengthen its domestic epidemic response capacity. The World Health Organization reported in September 2023 that Sudanese health authorities were planning to request oral cholera vaccine from the International Coordinating Group on Vaccine Provision as part of outbreak response activities ^{487, pp. 1, 4}. In December 2023 the World Health Organization documented that the Federal Ministry of Health formally applied to the International Coordinating Group for oral cholera vaccine doses to sustain reactive vaccination campaigns ^{488, p. 4}. UNICEF later confirmed the arrival of 1.4 million oral cholera vaccine doses in Port Sudan on 5 October 2024, supplied for government-led campaigns in high-risk states ⁴⁸⁹. In addition, the World Health Organization reported in September 2023 that it handed over equipment and supplies to the Federal Ministry of Health to upgrade the Public Health Laboratory in Port Sudan to National Public Health Laboratory status, explicitly framing this as technical support for outbreak preparedness and response ⁴⁹⁰.

5.5.4c Evidence that the country has fulfilled its full WHO contribution within the past two years

Score: 0

There is no publicly available evidence that Sudan has fulfilled its full assessed contribution to the World Health Organization within the past 2 years. In April 2024, the World Health Organization Secretariat reported to the Seventy-seventh World Health Assembly that Sudan had not met its assessed contribution obligations under agreed special repayment arrangements and was subject to potential loss of voting privileges, with Annex 4 detailing unpaid balances and outstanding amounts for the current and prior biennia ^{491, pp. 3–4, 16}. This noncompliance was reaffirmed in May 2025 through Sudan’s official World Health Organization Statement of Account for 2025, which documents continuing arrears and confirms that assessed contributions for the most recent biennium had not been fully paid ^{492, pp. 1–2}. The situation persisted into the subsequent year, as the World Health Organization Secretariat confirmed to the Seventy-eighth World Health Assembly that Sudan’s voting privileges remained suspended under Article 7 of the World Health Organization Constitution due to unpaid assessed contributions and that Sudan had not met its 2024 obligations under the special repayment arrangements ^{493, pp. 2–3}.

5.6.1a Sharing of genetic/biological data and materials beyond influenza

Score: 0

There is no publicly available evidence that Sudan has a national plan or policy for sharing genetic sequence data, clinical specimens, or other biological materials with international partners beyond influenza. The World Health Organization Country Cooperation Strategy for Sudan 2022-2025 highlights surveillance, information flow, and development of a unified digital repository, but it does not establish a policy for international sharing of clinical samples or pathogen genetic data ^{494, pp. 3, 23}. The Sudan National Health Policy 2017-2030 addresses governance, health security, surveillance, and health information systems, yet it contains no provisions for sharing biological specimens or associated epidemiological data with other countries or international organizations ^{495, pp. 38–39, 49–50}. The WHO Strategic Partnership Portal country page for Sudan contains no plan or policy beyond influenza sample sharing ⁴⁹⁶. A handout on Access and Benefit Sharing presents case studies from other countries but includes no Sudan policy or documentation relevant to genetic resource sharing ^{497, pp. 1–2}.

5.6.1b Evidence of non-compliance with sample sharing element of PIP framework

Score: 100

There is no publicly available evidence that Sudan failed to share influenza samples in accordance with the World Health Organization Pandemic Influenza Preparedness Framework. The World Health Organization Pandemic Influenza Preparedness Framework Advisory Group’s Annual Report to the Director-General for 2023 documents virus and clinical specimen sharing through the Global Influenza Surveillance and Response System, including increased shipments by Member States, and does not cite Sudan or any other country for noncompliance with influenza virus sharing obligations ^{498, pp. 5–6}. In September 2022, the World Health Organization Regional Office for the Eastern Mediterranean reported that an expert mission to Sudan supported the reactivation of influenza sentinel surveillance through the Pandemic Influenza Preparedness Framework mechanism, including steps toward shipment of samples to World Health Organization Collaborating Centres, indicating functional engagement with the framework’s sample sharing processes ⁴⁹⁹. Sudan’s National Public Health Laboratory in Khartoum is listed by the World Health Organization as a designated National Influenza Centre, evidencing Sudan’s formal integration into the Global Influenza Surveillance and Response System that underpins implementation of the Pandemic Influenza Preparedness Framework ^{500, p. 26}.

5.6.1c Evidence of non-sharing of pandemic pathogen samples during an outbreak

Score: 100

There is no publicly available evidence that Sudan failed to share pandemic pathogen samples during an outbreak in the past two years. The World Health Organization Pandemic Influenza Preparedness Framework Advisory Group’s Annual Report to the Director-General for 2023 reports on overall implementation of pathogen and specimen sharing mechanisms and does not identify Sudan as having withheld pandemic pathogen samples during outbreaks ^{501, pp. 3, 5}. The World Health Organization describes the role of National Influenza Centres within the Global Influenza Surveillance and Response System as part of broader World Health Organization-coordinated laboratory networks for outbreak detection and response, without reporting any Member State refusals to share samples during outbreaks ⁵⁰². Sudan’s National Public Health Laboratory in Khartoum appears on the World Health Organization list of National Influenza Centres, evidencing participation in internationally coordinated laboratory systems rather than noncompliance with outbreak-related sample sharing ^{503, p. 26}. In addition, the World Health Organization Regional Office for the Eastern Mediterranean reported in 2023 that the Port Sudan Public Health Laboratory was upgraded for outbreak preparedness and response, with no indication of refusal or failure to share samples during outbreaks ⁵⁰⁴.

6.1.1a Policy formation

Score: 0

6.1.1b Quality of bureaucracy

Score: 0

6.1.1c Excessive bureaucracy/red tape

Score: 0

6.1.1d Vested interests/cronyism

Score: 0

6.1.1e Corruption

Score: 15

6.1.1f Accountability of public officials

Score: 0

6.1.1g Human rights risk

Score: 0

6.1.2a Orderly transfers of power

Score: 0

6.1.3a Risk of social unrest

Score: 0

6.1.4a Risk of terrorism

Score: 0

6.1.4b Level of illicit arms flows within the country

Score: 50

6.1.4c Risk of organized criminal activity

Score: 0

6.1.5a Presence or risk of armed conflict

Score: 0

6.1.6a Government territorial control

Score: 0

6.1.7a International tensions

Score: 0

6.2.1a Adult literacy rate (15+ years old, both sexes)

Score: 56.53

6.2.2a UNDP Gender Inequality Index score

Score: 20.27

6.2.3a Poverty gap at $1.90 a day (2011 PPP) (%)

Score: 80.88

6.2.3b Share of employment in the informal sector

Score: 0

6.2.3c Coverage of social insurance programs (% of population)

Score: 0

6.2.4a Public confidence in government

Score: 0

6.2.5a Robust, open, diverse local media and reporting

Score: 100

6.2.6a Gini coefficient

Score: 65.8

6.3.1a Adequacy of road network

Score: 0

6.3.2a Adequacy of airports

Score: 0

6.3.3a Adequacy of power network

Score: 0

6.4.1a Urban population (% of total population)

Score: 71.64

6.4.2a Change in forest area (percentage points)

Score: 65.47

6.4.3a Natural disaster risk

Score: 25

6.5.1a Total life expectancy (years)

Score: 53.84

6.5.1b NCD mortality rate

Score: 63.05

6.5.1c Population aged 65+

Score: 88.3

6.5.1d Tobacco use (% of adults)

Score: 0

6.5.1e Level of adult obesity (%)

Score: 70.37

6.5.1f Age-standardised prevalence of mental health disorders (per 100 000 people)

Score: 25.39

6.5.2a Access to potable water

Score: 64.95

6.5.2b Access to at least basic sanitation facilities

Score: 65.95

6.5.2c Percentage of health-care facilities with no access to any electricity supply

Score: 0

6.5.3a Domestic general government health expenditure per capita (PPP)

Score: 2.48

6.5.4a Trust medical and health advice from the government

Score: 50

6.5.4b Trust medical and health advice from medical workers

Score: 50