A scattering of fresh and older graves lined the roads of one hunger-hit part of Sudan’s Nuba Mountains. Shallow mounds – some marked with rocks, sticks, or a shoe – served as markers of loss, often no larger than a child’s body.
Residents said the graves belonged to those who died of hunger last year during the worst food crisis in living memory. And now the situation – driven by Sudan’s civil war – may worsen, as the rainy season sets in amid aid funding cuts and an escalation in fighting.
“We expect many to die this year,” said Namarag Ali, a pharmacist at a hospital receiving patients from around the mountainous area, which is in South Kordofan state near the border with South Sudan.
Ali estimated that about 400 patients – many of them pregnant women and children – cross the doors of his hospital in the town of Tujuk every day in desperate need of food and care.
Sudan’s war began in April 2023 and pits the national military – the Sudanese Armed Forces (SAF) – and allied groups against the paramilitary-turned-rebel Rapid Support Forces (RSF), which is armed extensively by the United Arab Emirates.
The impact of the conflict, which has fuelled the world’s largest displacement and hunger crises, has been especially severe in the Nuba Mountains, which is controlled by a third armed group, the Sudan People’s Liberation Movement-North (SPLM-N).
Nearly a million people have taken refuge in the area, yet aid groups have struggled to deliver supplies, as the SPLM-N has clashed with the SAF and the RSF at different times, and as both groups have blocked humanitarian access as a result.
Famine was declared last year in the western part of the Nuba Mountains by the Famine Review Committee of the IPC, the globally recognised authority on food insecurity, while the central Nuba Mountains – where The New Humanitarian visited on an April reporting trip – was declared at-risk.
Several residents described last year as the worst of their lives, while medics, aid workers, and SPLM-N officials warned this year could be even worse as US funding cuts impact the few aid groups operating in the remote region.
Others said the situation will deteriorate because the SPLM-N has recently aligned itself with the RSF – despite the paramilitary force abusing many civilians in South Kordofan – drawing the region even more directly into the conflict.
“The alliance is definitely going to worsen the humanitarian situation,” said Hafiz Mohamed, who was born in the Nuba Mountains and is the director of Justice Africa, a social justice and human rights organisation.
“We’ve had two deaths just this month”
The SPLM-N has long governed the Nuba Mountains, rejecting control by Sudanese political and military elites, who have historically been from central parts of the country and have overseen the marginalisation of peripheral populations.
The rebellion has left Nuba civilians – who form the core of the SPLM-N support base – exposed to repeated waves of violence, enduring attacks and displacement at the hands of former governments and allied militias.
At the outset of the current conflict, the rebels launched operations against the SAF, and engaged in hostilities with the RSF. Roads into the region were blocked – with the SAF, RSF, and even the SPLM-N blamed at different times – or closed due to fighting.
At the same time, the arrival of displaced people without food or supplies placed immense pressure on local communities, who were struggling even before the war due to a poor harvest and a locust infestation.
Monika Leyendecker, a physician with the German NGO Cap Anamur working at a hospital in the town of Lowere, said patients would leave their beds at night during last year’s peak hunger period in search of food, while she had to ration supplies for hospital staff.
Leyendecker said this year has been shaping up to be just as bad, with hunger-related admissions rising even earlier than usual – ahead of the rainy season, when roads are cut off, food stocks dwindle, and malaria and waterborne diseases spread faster.
“We’ve had two deaths just this month and this is the dry season. It’s too early for this,” said Leyendecker from the hospital, where mothers queued for high-calorie milk to feed their infants, and underweight children were being brought into a malnutrition ward.
In a hospital in the town of Tujuk, doctors said they had also seen a sharp rise in malnutrition over the past few months, especially among pregnant women and children.
Abass Hamdan, the doctor overseeing malnutrition cases at the hospital, said the number of patients would increase even more between June and September during the rainy season.
Hamdan said he was also concerned about the lack of mental health support for the hundreds of displaced people arriving each week into the Nuba Mountains, describing it as an unseen medical crisis that is not receiving enough attention.
“Many displaced people come with mental health issues and have to be counselled, but there are no services,” Hamdan said. He added that medics have been treating RSF troops with bullet wounds – requiring blood transfusions and amputations – despite a lack of supplies.
No water, no food
The situation was similarly bleak in displacement camps scattered across the mountains, though residents described how they support each other and strive to carry on with life as best they can.
At a camp hosting some 2,500 people in the village of Loembre, residents have been “plagued by hunger and insecurity”, according to Ataib Ismael, a clinic team leader at a local health centre.
Ismael said 500 newly displaced people had arrived at the camp the week before, many of them suffering from eye infections, skin diseases, and respiratory illness like pneumonia caused by sleeping on the dusty ground.
Cheikh Nur Abdallah Kodi, a community leader who is the head of Loembre village, said local residents have also been suffering so they can help the new arrivals in the displacement camp.
“We had challenges in terms of food shortages because they came with nothing,” Kodi said. “We had to share everything, most of our space and goods. People survived just on tree leaves.”
Kodi said a famine in the mid-1980s — during a period of government attacks in the region — was similarly severe, but still not as devastating as during parts of last year.
“There was no food, no money, nothing,” he said. “It was the worst I can remember.”
Kodi said he was optimistic about the coming period, believing last year’s hardships had taught displaced people and locals alike to be more strategic and economical with their food stocks.
A short drive from Loembre, The New Humanitarian also visited Al-Hilu, a sprawling camp where some 12,000 people had sought refuge in straw huts, many fronted by wide courtyards and makeshift fences that stretch for kilometres.
Said Adam, the camp’s manager, said he fears increased displacement this year and a poor harvest will make matters even worse for residents, who receive no regular food assistance and have no source of income.
Mudsir Muhammad, a former doctor who escaped to the Nuba Mountains from the capital city, Khartoum, and now helps run the camp’s clinic, said there is no water and food but that residents survive by helping each other.
That same day hundreds of displaced people were digging a ditch from a nearby town to the camp in an effort to transport water more easily and reduce the two-hour journey residents make to fetch it from boreholes.
“It was our idea. We didn’t wait for someone to help us. We just did it,” said Muhammad. “It was easy to gather people. Everyone was suffering because of a lack of water, so we all agreed to come quickly and do this.”
A few kilometres away, in the town of Tongoli, residents were celebrating a wedding of a couple whose marriage was arranged early last year – even as hunger was spiralling. Bowls of porridge and goat meat were being shared by the groom to the bride’s family.
Blocked aid
In an interview with The New Humanitarian, Amar Amoun, the SPLM-N secretary-general, described the humanitarian situation across the Nuba Mountains as “dire” and said the group is expecting a deep crisis during the coming rainy season.
Amoun acknowledged that fighting had escalated following the SPLM-N and RSF alliance and accepted it could increase the number of displaced people and lead to the SAF obstructing the passage of food to communities in need – as has happened in other regions like Darfur.
Juma Idriss Kuku, head of the SPLM-’s relief agency, shared data showing that the SAF intercepted a significant chunk of food delivered into the region between October 2024 and February 2025, while some food delivered via airdrops split on landing.
Few international aid groups are operating in the Nuba Mountains, and those that are typically choose to keep a low profile because of restrictions from the SAF-led government, which is recognised by the UN as the country’s de facto authority.
Much of the international aid that has got through has been delivered through unofficial cross-border routes from South Sudan, while some has also been airdropped – following sensitive negotiations between the warring parties.
WFP’s Sudan regional emergency coordinator Shaun Hughes said the agency has been reaching remote areas in the western Nuba Mountains but called for more funding to sustain those efforts.
“Famine was confirmed in the western Nuba Mountains months ago, and people have endured unimaginable suffering since,” Hughes said. “With the rainy season approaching and major funding shortfalls hitting our operations across Sudan, we may be forced to scale back when we should be ramping up.”
Kuku said cuts by the US to aid funding have already had an impact on the ground. “Since Trump, the quantity of promised aid decreased,” he said. “We were expecting things to come [but] they never did.”
Tom Catena, an American physician, who has been running the Mother of Mercy Hospital in the Nuba Mountains since 2008, said he expects things “will kick off” as a result of the RSF/SPLM-N pact. “We expect trucks of wounded people soon,” he said.
Catena said last year’s humanitarian emergency was “by far the worst” he had seen in his 17 years in the region – but he fears 2025 may yet surpass it. “We’re expecting it to be worse this year,” he said. “So much worse.“
Edited by Philip Kleinfeld.
