Sudan's Other War

No hacía falta entender la biología.

You didn't need to understand the biology.

Bastaba con el agua.

The water was enough.

Which makes it all the more maddening that in 2026 we're still filing reports about confirmed cholera cases in active conflict zones.

Because the variable that's changed isn't the science.

It's the political will, or the lack of it.

Exactamente.

Exactly.

El cólera es, en el fondo, una enfermedad política.

Cholera is, at its core, a political disease.

Cuando ves un brote, estás viendo un fracaso de gobernanza.

When you see an outbreak, you are seeing a governance failure.

En Yemen, en Haití, en Siria, en Sudán, los brotes modernos de cólera no ocurren en países prósperos con gobiernos funcionales.

In Yemen, in Haiti, in Syria, in Sudan, modern cholera outbreaks don't happen in prosperous countries with functioning governments.

Ocurren donde el Estado se ha venido abajo.

They happen where the state has collapsed.

Haiti is an interesting comparison.

Because the 2010 cholera outbreak there actually came from outside, UN peacekeepers unknowingly introduced the bacteria after the earthquake.

And it took the UN a decade to formally acknowledge responsibility.

Un escándalo tremendo.

A tremendous scandal.

Y lo que demuestra ese caso es que el cólera puede resurgir en cualquier contexto donde el saneamiento falle, aunque el país lo hubiera erradicado décadas antes.

And what that case shows is that cholera can resurface in any context where sanitation fails, even if the country had eradicated it decades earlier.

Haití llevaba cien años sin cólera.

Haiti had gone a hundred years without cholera.

Cien años.

One hundred years.

Y en tres meses después del terremoto ya tenía un brote que acabó matando a casi diez mil personas.

And within three months of the earthquake it had an outbreak that ended up killing nearly ten thousand people.

Ten thousand people.

From a disease we know how to stop.

I find that genuinely hard to sit with.

A mí también.

Me too.

Y volviendo a Sudán, el contexto es si cabe más complejo porque ahí no hay un desastre natural que sirva de detonante.

And returning to Sudan, the context is if anything more complex because there is no natural disaster there to serve as a trigger.

El desastre es la propia guerra.

The disaster is the war itself.

Las Fuerzas de Apoyo Rápido han atacado hospitales, han destruido estaciones de tratamiento de agua, han impedido el acceso humanitario en zonas donde controlan el territorio.

The Rapid Support Forces have attacked hospitals, destroyed water treatment stations, and blocked humanitarian access in areas under their control.

Attacking hospitals is a war crime under international humanitarian law.

Full stop.

And yet it happens with almost metronomic regularity in modern conflicts, in Sudan, in Syria, in Yemen, in Gaza, because there are essentially no enforcement consequences.

Es que la norma existe sobre el papel desde los Convenios de Ginebra de 1949.

The rule has existed on paper since the Geneva Conventions of 1949.

El artículo diecinueve del Cuarto Convenio es explícito: los hospitales civiles no pueden ser objeto de ataque bajo ninguna circunstancia.

Article nineteen of the Fourth Convention is explicit: civilian hospitals cannot under any circumstances be the object of attack.

Pero la distancia entre la norma escrita y la realidad sobre el terreno en Sudán en este momento es abismal.

But the distance between the written rule and the reality on the ground in Sudan right now is abysmal.

I want to push on the healthcare infrastructure piece because I think it gets underreported.

Sudan before the war had 0.3 physicians per thousand people.

The global average is about 1.5.

So even before any hospital was bombed, the baseline was already critically thin.

Y esos médicos que había, muchos han huido.

And many of the doctors that did exist have fled.

Cuando empezó la guerra, Jartum, que era el centro neurálgico de la sanidad sudanesa, se convirtió en un campo de batalla urbano.

When the war started, Khartoum, which was the nerve center of Sudanese healthcare, became an urban battlefield.

Los médicos que no habían emigrado ya antes, emigraron entonces.

The doctors who hadn't already emigrated before, emigrated then.

Lo que queda es un sistema esquelético intentando atender a una población diezmada.

What remains is a skeletal system trying to care for a decimated population.

And notice the cholera cases reported this week are in Khartoum and White Nile.

Those are not remote regions.

Khartoum is the capital.

The disease is not hiding in the periphery.

Lo cual dice muchísimo sobre el estado de la ciudad.

Which says a great deal about the state of the city.

Khartoum fue durante décadas una capital relativamente moderna para los estándares regionales, con una universidad de medicina de cierta reputación, con hospitales universitarios.

Khartoum was for decades a relatively modern capital by regional standards, with a medical university of some reputation, with teaching hospitals.

Ver cólera en Khartoum en 2026 es como ver cólera en Madrid.

Seeing cholera in Khartoum in 2026 is like seeing cholera in Madrid.

Es una señal de colapso total.

It is a signal of total collapse.

Now the measles piece is also worth flagging because measles on its own would be concerning anywhere.

But measles and cholera circulating simultaneously tells you something specific about what's happened to vaccination coverage.

Claro, porque el sarampión es una de las enfermedades más contagiosas que existen, pero disponemos de una vacuna excelente desde los años sesenta.

Of course, because measles is one of the most contagious diseases in existence, but we have had an excellent vaccine since the 1960s.

Si está reapareciendo, es porque las campañas de vacunación se han interrumpido.

If it's reappearing, it's because vaccination campaigns have been interrupted.

Los niños desplazados no están recibiendo sus dosis.

Displaced children are not receiving their doses.

El sistema de cadena de frío para conservar las vacunas se ha roto.

The cold chain system for storing vaccines has broken down.

Cold chain.

That's a term people don't think about enough.

A measles vaccine that gets too warm on its way to a camp is a useless vaccine.

And maintaining a cold chain in an active conflict zone is basically a logistics miracle that nobody's performing.

Y lo que me preocupa más, mirando más allá de los números de hoy, es el fenómeno que los epidemiólogos llaman inmunidad de rebaño erosionada.

And what worries me most, looking beyond today's numbers, is the phenomenon epidemiologists call eroded herd immunity.

Cada año que no se vacuna a una generación de niños, el porcentaje de la población sin inmunidad crece.

Each year that a generation of children goes unvaccinated, the percentage of the population without immunity grows.

Y cuando el porcentaje supera un umbral, generalmente en torno al quince por ciento para el sarampión, el virus encuentra suficientes huéspedes para expandirse de forma exponencial.

And when the percentage exceeds a threshold, generally around fifteen percent for measles, the virus finds enough hosts to expand exponentially.

So the damage compounds.

Even if the war ended tomorrow, and it shows no signs of ending, you'd have a cohort of unvaccinated children who become a reservoir for outbreaks years down the line.

Exacto.

Exactly.

Las guerras tienen consecuencias sanitarias que duran generaciones.

Wars have health consequences that last generations.

En la guerra civil siria, la poliomielitis, que ya casi habíamos erradicado globalmente, reapareció en 2013, tres años después del inicio del conflicto.

In the Syrian civil war, polio, which we had almost globally eradicated, reappeared in 2013, three years after the conflict began.

Veinte años de esfuerzo internacional borrados en menos de tres años de guerra.

Twenty years of international effort erased in less than three years of war.

That Syria polio story is one I covered peripherally.

There's something specifically demoralizing about polio coming back because the global eradication campaign has been going since 1988.

People have dedicated their careers to it.

And a single conflict can undo years of that work in months.

Y sin embargo nadie habla de Sudán con la misma urgencia mediática que otros conflictos.

And yet nobody talks about Sudan with the same media urgency as other conflicts.

El número de desplazados sudaneses supera al de Ucrania en el momento álgido de la crisis de 2022.

The number of Sudanese displaced people surpasses that of Ukraine at the height of the 2022 crisis.

Es la mayor crisis de desplazamiento interno del mundo en este momento.

It is the world's largest internal displacement crisis right now.

Y pasa casi desapercibida.

And it passes almost unnoticed.

There's a real conversation to be had about which crises get attention and why.

I don't want to be cynical about it, but proximity matters, shared cultural reference points matter, geopolitical stakes for Western governments matter.

Sudan ticks very few of those boxes for European or American news editors.

Es una jerarquía de vidas que existe aunque nadie la reconozca abiertamente.

It is a hierarchy of lives that exists even though nobody openly acknowledges it.

Y lo que se pierde en esa jerarquía no son solo las muertes individuales, que ya es brutal, sino también el conocimiento.

And what gets lost in that hierarchy is not just the individual deaths, which is already brutal, but also the knowledge.

Si no cubrimos esta crisis, no entendemos cómo funcionan las enfermedades infecciosas en contextos de guerra, y eso nos deja peor preparados para la próxima.

If we don't cover this crisis, we don't understand how infectious diseases work in war contexts, and that leaves us worse prepared for the next one.

What's the realistic picture for any kind of humanitarian response right now?

The WHO and MSF are operating there, but operating under what constraints?

Las restricciones son enormes.

The constraints are enormous.

Médicos Sin Fronteras ha documentado docenas de incidentes de acceso denegado, convoyes detenidos, personal amenazado.

Médicos Sin Fronteras has documented dozens of incidents of denied access, stopped convoys, threatened staff.

Las dos partes del conflicto han usado el acceso humanitario como palanca de negociación.

Both sides of the conflict have used humanitarian access as a negotiating lever.

En ese contexto, llevar sales de rehidratación oral a un campo de desplazados puede convertirse en una operación que requiere semanas de negociación.

In that context, getting oral rehydration salts to a displacement camp can become an operation requiring weeks of negotiation.

Oral rehydration therapy deserves a moment.

It is genuinely one of the most important medical innovations of the twentieth century and almost nobody outside global health circles knows its name.

It's basically salt, sugar, and water in the right proportions.

It costs cents.

And it cut child mortality from diarrheal diseases by an extraordinary amount when it was rolled out in the 1970s and 80s.

The Lancet la llamó en los ochenta el avance médico más importante del siglo veinte.

The Lancet called it in the eighties the most important medical advance of the twentieth century.

Por encima de la penicilina, por encima de los trasplantes de corazón.

Above penicillin, above heart transplants.

Porque su impacto en términos de vidas salvadas en países pobres fue mayor que el de cualquier otra intervención.

Because its impact in terms of lives saved in poor countries was greater than any other intervention.

Y sin embargo nadie ha hecho una película sobre los científicos que la desarrollaron.

And yet nobody has made a film about the scientists who developed it.

That's the thing that sticks with me after going through all of this.

The solutions aren't mysterious.

Rehydration therapy, clean water, vaccines that have existed for sixty years.

What's broken in Sudan is not the medicine.

It's everything around the medicine.

Lo cual nos lleva al único camino real hacia la solución: el cese de las hostilidades.

Which brings us to the only real path to a solution: a cessation of hostilities.

No hay respuesta humanitaria que pueda igualar lo que conseguiría un alto el fuego.

There is no humanitarian response that can match what a ceasefire would achieve.

Cada día que la guerra continúa es un día en que el cólera, el sarampión y la siguiente enfermedad tienen más espacio para moverse.

Every day the war continues is a day cholera, measles, and the next disease have more room to move.

You used a phrase earlier, "se ha venido abajo," about the state collapsing.

I've been hearing that construction all episode and I want to ask you about it because it seems to work differently than just decir "colapsó."

Buena observación.

Good observation.

"Venirse abajo" es un verbo pronominal que indica un proceso de desmoronamiento gradual, no un evento puntual.

"Venirse abajo" is a pronominal verb that indicates a gradual process of crumbling, not a single event.

"El sistema colapsó" describe un momento.

"El sistema colapsó" describes a moment.

"El sistema se ha venido abajo" describe algo que ha ido cayendo en pedazos con el tiempo.

"El sistema se ha venido abajo" describes something that has been falling apart over time.

Fíjate: también se usa para personas.

Notice: it also applies to people.

Puedes decir "me vine abajo" cuando algo te supera emocionalmente.

You can say "me vine abajo" when something overwhelms you emotionally.

So it carries process inside it.

The falling is baked into the verb form, not just the meaning.

In English we'd reach for something like "has been crumbling" to get that sense of duration.

"Collapsed" just marks the endpoint.

Exacto.

Exactly.

Y en el contexto de Sudán, esa distinción importa.

And in the context of Sudan, that distinction matters.

El sistema sanitario sudanés no colapsó en un día.

The Sudanese health system did not collapse in a day.

Se fue viniendo abajo durante años: el golpe de 2019, la pandemia, la inestabilidad política, y luego la guerra que aceleró todo.

It has been crumbling for years: the 2019 coup, the pandemic, political instability, and then the war that accelerated everything.

El verbo captura esa historia.

The verb captures that history.

Right, "venirse abajo" as a verb that tells the whole story in three syllables.

There's something I genuinely appreciate about a language that packages that much history into a reflexive construction.

Though I will say, if I tried to use it in a sentence I'd almost certainly put the "se" in the wrong place.

Fletcher, llevas cuatro años estudiando español y todavía pones el "se" en el lugar equivocado.

Fletcher, you've been studying Spanish for four years and you still put the "se" in the wrong place.

Aunque por lo menos ya no le dices a la gente que estás embarazado.

Although at least you no longer tell people you're pregnant.

Eso es progreso.

That's progress.