Integrated Health and Nutrition Service Delivery Enhances Humanitarian Response in Conflict-Affected Darfur, Sudan

Kamal Eldin Mohammed Fadul; Eltighani Mirghani Elamin; Fadwa Hassan Ibrahim; Dirdiri Hassan Mahmoud

doi:doi:10.11648/j.wjhpm.20260101.13

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Integrated Health and Nutrition Service Delivery Enhances Humanitarian Response in Conflict-Affected Darfur, Sudan

Kamal Eldin Mohammed Fadul^*

, Eltighani Mirghani Elamin

, Fadwa Hassan Ibrahim

, Dirdiri Hassan Mahmoud

Published in World Journal of Health Policy and Management (Volume 1, Issue 1)

Received: 29 September 2026 Accepted: 13 October 2026 Published: 28 October 2026

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Abstract

Displaced and host populations in protracted conflict settings face compounded risks of poor maternal, child and nutritional health, driven by damaged health infrastructure, health worker shortages and disrupted supply chains. This paper examines the health and nutrition component in conflict affected area in South Darfur State, Sudan, targeting South Sudanese refugees, internally displaced persons (IDPs) and host communities around the Bilel primary health care (PHC) clinic and surrounding camps. Using a mixed-methods post intervention evaluation household knowledge-attitudes-practices (KAP) surveys, key informant interviews, focus group discussions, health-facility observation, and a SMART nutrition survey. The study assessed primary health care utilization, maternal health service coverage, referral system performance, and treatment of acute malnutrition. Findings show that 43,883 primary health care consultations were delivered against a target of 46,422, while the proportion of women whose deliveries were attended by skilled staff rose from 60% to 74% and referrals to the regional hospital in Nyala reached 371 against a target of 150. On nutrition, 8,738 children under five were admitted for treatment of severe or moderate acute malnutrition reduced from 2,000. The 2020 SMART survey found global acute malnutrition (GAM) at 11.9% and severe acute malnutrition (SAM) at 0.8% in the surveyed locality. Despite these gains, persistent staff shortages at the Bilel PHC clinic (relative to a caseload of up to 200 patients per day), intermittent drug stock-outs, and rainy-season access barriers to therapeutic feeding constrained the consistency of care. The paper argues that integrating health, nutrition and community-based referral systems anchored in trained lay cadres such as traditional birth attendants and lead mothers is a transferable model for sustaining essential services in protracted, access-constrained displacement settings.

Published in	World Journal of Health Policy and Management (Volume 1, Issue 1)
DOI	10.11648/j.wjhpm.20260101.13
Page(s)	13-19
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2026. Published by Science Publishing Group

Keywords

Primary Health Care, Nutrition, Severe Acute Malnutrition, Internally Displaced Persons, Conflict-Affected Area, Darfur, Sudan, Maternal Health, Humanitarian Evaluation

References

[1]	ACAPS. Impact of the Conflict on Children. 17 Nov 2023. https://www.acaps.org/en/countries/archives
[2]	Babughirana G, Onama V, Namutebi MR. Health and Nutrition Services in Sudan: A Situational Analysis of South and East Darfur States (2023-2024). J Health Care and Research. 2026; 7(1): 01-14. https://doi.org/10.36502/2026/hcr.6253
[3]	CHS Alliance, Groupe URD, HAP International. Core Humanitarian Standard on Quality and Accountability. CHS Alliance; 2014.
[4]	DCD. Nutrition Rapid Assessment Report - Geneina, 17-18 Sep 2023. Health Cluster; 2023.
[5]	Elkhidir HAM, Fadul KEM, Elamin EM, Lazim AMM, Khatir AA, et al. Impact of Climate Change Vulnerability on Agriculture, Forestry, Water Resources and Range Land in South Darfur State, Sudan. American Journal of Biological and Environmental Statistics. 2026; 12(1): 1-15. https://doi.org/10.11648/j.ajbes.20261201.11
[6]	Hussein EME, Mohamde KE, Ibrahim F, Marufu S. Norwegian Church Aid - Final Evaluation of DG ECHO Project in South and Central Darfur, Sudan. Draft Evaluation Report. Palm Associates Limited & Palm Gesamac Consulting; 2021.
[7]	United Nations Office for the Coordination of Humanitarian Affairs (OCHA). Sudan Humanitarian Needs and Response Plan 2024. 21 Dec 2023.
[8]	Omam L-A, Jarman E, O’Laughlin KN, Parkes-Ratanshi R. Primary healthcare delivery models in African conflict-affected settings: a systematic review. Conflict and Health. 2023; 17: 34. https://doi.org/10.1186/s13031-023-00533-9
[9]	REACH. Sudan Crisis: Assessment of Hard-to-Reach Areas in West Darfur, Sudan, 10-19 Sep 2023. REACH Initiative; 2023.
[10]	Sphere Association. The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response. 4th ed. Geneva: Sphere Association; 2018.
[11]	UNICEF. Humanitarian Situation in South Darfur. 2022.
[12]	UNICEF. Sudan Humanitarian Situation Report, December 2018 - Year End. 2018.
[13]	UNICEF. Humanitarian Situation Report No. 39, Reporting Period 1-31 January 2026. 2026. www.unicef.org/appeals/sudan/situation-reports
[14]	UNICEF. Humanitarian Situation Report No. 23. 2024.
[15]	United Nations Office for the Coordination of Humanitarian Affairs (OCHA). Sudan: Humanitarian Needs Overview 2021. OCHA; 2021.
[16]	World Health Organization. Guideline: Updates on the Management of Severe Acute Malnutrition in Infants and Children. Geneva: WHO; 2013. https://www.who.int/publications/i/item/9789241506328
[17]	World Health Organization. Quality of Care in Fragile, Conflict-Affected and Vulnerable Settings: Delivering Safe, Effective and People-Centred Care. Geneva: WHO; 2020.
[18]	UNICEF Sudan. State Profile - Central Darfur. UNICEF Sudan; 2022.
[19]	World Health Organization. What Do We Know About Community Health Workers? A Systematic Review of Existing Reviews. Human Resources for Health Observer Series No. 19. Geneva: WHO; 2021.

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APA Style

Fadul, K. E. M., Elamin, E. M., Ibrahim, F. H., Mahmoud, D. H. (2026). Integrated Health and Nutrition Service Delivery Enhances Humanitarian Response in Conflict-Affected Darfur, Sudan. World Journal of Health Policy and Management, 1(1), 13-19. https://doi.org/10.11648/j.wjhpm.20260101.13

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ACS Style

Fadul, K. E. M.; Elamin, E. M.; Ibrahim, F. H.; Mahmoud, D. H. Integrated Health and Nutrition Service Delivery Enhances Humanitarian Response in Conflict-Affected Darfur, Sudan. World J. Health Policy Manag. 2026, 1(1), 13-19. doi: 10.11648/j.wjhpm.20260101.13

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AMA Style

Fadul KEM, Elamin EM, Ibrahim FH, Mahmoud DH. Integrated Health and Nutrition Service Delivery Enhances Humanitarian Response in Conflict-Affected Darfur, Sudan. World J Health Policy Manag. 2026;1(1):13-19. doi: 10.11648/j.wjhpm.20260101.13

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@article{10.11648/j.wjhpm.20260101.13,
  author = {Kamal Eldin Mohammed Fadul and Eltighani Mirghani Elamin and Fadwa Hassan Ibrahim and Dirdiri Hassan Mahmoud},
  title = {Integrated Health and Nutrition Service Delivery Enhances Humanitarian Response in Conflict-Affected Darfur, Sudan},
  journal = {World Journal of Health Policy and Management},
  volume = {1},
  number = {1},
  pages = {13-19},
  doi = {10.11648/j.wjhpm.20260101.13},
  url = {https://doi.org/10.11648/j.wjhpm.20260101.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.wjhpm.20260101.13},
  abstract = {Displaced and host populations in protracted conflict settings face compounded risks of poor maternal, child and nutritional health, driven by damaged health infrastructure, health worker shortages and disrupted supply chains. This paper examines the health and nutrition component in conflict affected area in South Darfur State, Sudan, targeting South Sudanese refugees, internally displaced persons (IDPs) and host communities around the Bilel primary health care (PHC) clinic and surrounding camps. Using a mixed-methods post intervention evaluation household knowledge-attitudes-practices (KAP) surveys, key informant interviews, focus group discussions, health-facility observation, and a SMART nutrition survey. The study assessed primary health care utilization, maternal health service coverage, referral system performance, and treatment of acute malnutrition. Findings show that 43,883 primary health care consultations were delivered against a target of 46,422, while the proportion of women whose deliveries were attended by skilled staff rose from 60% to 74% and referrals to the regional hospital in Nyala reached 371 against a target of 150. On nutrition, 8,738 children under five were admitted for treatment of severe or moderate acute malnutrition reduced from 2,000. The 2020 SMART survey found global acute malnutrition (GAM) at 11.9% and severe acute malnutrition (SAM) at 0.8% in the surveyed locality. Despite these gains, persistent staff shortages at the Bilel PHC clinic (relative to a caseload of up to 200 patients per day), intermittent drug stock-outs, and rainy-season access barriers to therapeutic feeding constrained the consistency of care. The paper argues that integrating health, nutrition and community-based referral systems anchored in trained lay cadres such as traditional birth attendants and lead mothers is a transferable model for sustaining essential services in protracted, access-constrained displacement settings.},
 year = {2026}
}

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TY  - JOUR
T1  - Integrated Health and Nutrition Service Delivery Enhances Humanitarian Response in Conflict-Affected Darfur, Sudan
AU  - Kamal Eldin Mohammed Fadul
AU  - Eltighani Mirghani Elamin
AU  - Fadwa Hassan Ibrahim
AU  - Dirdiri Hassan Mahmoud
Y1  - 2026/10/28
PY  - 2026
N1  - https://doi.org/10.11648/j.wjhpm.20260101.13
DO  - 10.11648/j.wjhpm.20260101.13
T2  - World Journal of Health Policy and Management
JF  - World Journal of Health Policy and Management
JO  - World Journal of Health Policy and Management
SP  - 13
EP  - 19
PB  - Science Publishing Group
UR  - https://doi.org/10.11648/j.wjhpm.20260101.13
AB  - Displaced and host populations in protracted conflict settings face compounded risks of poor maternal, child and nutritional health, driven by damaged health infrastructure, health worker shortages and disrupted supply chains. This paper examines the health and nutrition component in conflict affected area in South Darfur State, Sudan, targeting South Sudanese refugees, internally displaced persons (IDPs) and host communities around the Bilel primary health care (PHC) clinic and surrounding camps. Using a mixed-methods post intervention evaluation household knowledge-attitudes-practices (KAP) surveys, key informant interviews, focus group discussions, health-facility observation, and a SMART nutrition survey. The study assessed primary health care utilization, maternal health service coverage, referral system performance, and treatment of acute malnutrition. Findings show that 43,883 primary health care consultations were delivered against a target of 46,422, while the proportion of women whose deliveries were attended by skilled staff rose from 60% to 74% and referrals to the regional hospital in Nyala reached 371 against a target of 150. On nutrition, 8,738 children under five were admitted for treatment of severe or moderate acute malnutrition reduced from 2,000. The 2020 SMART survey found global acute malnutrition (GAM) at 11.9% and severe acute malnutrition (SAM) at 0.8% in the surveyed locality. Despite these gains, persistent staff shortages at the Bilel PHC clinic (relative to a caseload of up to 200 patients per day), intermittent drug stock-outs, and rainy-season access barriers to therapeutic feeding constrained the consistency of care. The paper argues that integrating health, nutrition and community-based referral systems anchored in trained lay cadres such as traditional birth attendants and lead mothers is a transferable model for sustaining essential services in protracted, access-constrained displacement settings.
VL  - 1
IS  - 1
ER  -

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Author Information

Kamal Eldin Mohammed Fadul

Department of Silviculture, University of Khartoum, Khartoum, Sudan

Contact Email

http://orcid.org/0009-0004-0811-2186
Eltighani Mirghani Elamin

Agricultural Economics & Policy Research Center, Agricultur1al Research Corporations (ARC), Khartoum, Sudan

http://orcid.org/0009-0004-4189-3199
Fadwa Hassan Ibrahim

Agricultural Economics & Policy Research Center, Agricultur1al Research Corporations (ARC), Khartoum, Sudan

http://orcid.org/0009-0001-4640-1665
Dirdiri Hassan Mahmoud

Agricultural Economics & Policy Research Center, Agricultur1al Research Corporations (ARC), Khartoum, Sudan

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Plain Text BibTeX RIS

APA Style

Fadul, K. E. M., Elamin, E. M., Ibrahim, F. H., Mahmoud, D. H. (2026). Integrated Health and Nutrition Service Delivery Enhances Humanitarian Response in Conflict-Affected Darfur, Sudan. World Journal of Health Policy and Management, 1(1), 13-19. https://doi.org/10.11648/j.wjhpm.20260101.13

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ACS Style

Fadul, K. E. M.; Elamin, E. M.; Ibrahim, F. H.; Mahmoud, D. H. Integrated Health and Nutrition Service Delivery Enhances Humanitarian Response in Conflict-Affected Darfur, Sudan. World J. Health Policy Manag. 2026, 1(1), 13-19. doi: 10.11648/j.wjhpm.20260101.13

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AMA Style

Fadul KEM, Elamin EM, Ibrahim FH, Mahmoud DH. Integrated Health and Nutrition Service Delivery Enhances Humanitarian Response in Conflict-Affected Darfur, Sudan. World J Health Policy Manag. 2026;1(1):13-19. doi: 10.11648/j.wjhpm.20260101.13

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@article{10.11648/j.wjhpm.20260101.13,
  author = {Kamal Eldin Mohammed Fadul and Eltighani Mirghani Elamin and Fadwa Hassan Ibrahim and Dirdiri Hassan Mahmoud},
  title = {Integrated Health and Nutrition Service Delivery Enhances Humanitarian Response in Conflict-Affected Darfur, Sudan},
  journal = {World Journal of Health Policy and Management},
  volume = {1},
  number = {1},
  pages = {13-19},
  doi = {10.11648/j.wjhpm.20260101.13},
  url = {https://doi.org/10.11648/j.wjhpm.20260101.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.wjhpm.20260101.13},
  abstract = {Displaced and host populations in protracted conflict settings face compounded risks of poor maternal, child and nutritional health, driven by damaged health infrastructure, health worker shortages and disrupted supply chains. This paper examines the health and nutrition component in conflict affected area in South Darfur State, Sudan, targeting South Sudanese refugees, internally displaced persons (IDPs) and host communities around the Bilel primary health care (PHC) clinic and surrounding camps. Using a mixed-methods post intervention evaluation household knowledge-attitudes-practices (KAP) surveys, key informant interviews, focus group discussions, health-facility observation, and a SMART nutrition survey. The study assessed primary health care utilization, maternal health service coverage, referral system performance, and treatment of acute malnutrition. Findings show that 43,883 primary health care consultations were delivered against a target of 46,422, while the proportion of women whose deliveries were attended by skilled staff rose from 60% to 74% and referrals to the regional hospital in Nyala reached 371 against a target of 150. On nutrition, 8,738 children under five were admitted for treatment of severe or moderate acute malnutrition reduced from 2,000. The 2020 SMART survey found global acute malnutrition (GAM) at 11.9% and severe acute malnutrition (SAM) at 0.8% in the surveyed locality. Despite these gains, persistent staff shortages at the Bilel PHC clinic (relative to a caseload of up to 200 patients per day), intermittent drug stock-outs, and rainy-season access barriers to therapeutic feeding constrained the consistency of care. The paper argues that integrating health, nutrition and community-based referral systems anchored in trained lay cadres such as traditional birth attendants and lead mothers is a transferable model for sustaining essential services in protracted, access-constrained displacement settings.},
 year = {2026}
}

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TY  - JOUR
T1  - Integrated Health and Nutrition Service Delivery Enhances Humanitarian Response in Conflict-Affected Darfur, Sudan
AU  - Kamal Eldin Mohammed Fadul
AU  - Eltighani Mirghani Elamin
AU  - Fadwa Hassan Ibrahim
AU  - Dirdiri Hassan Mahmoud
Y1  - 2026/10/28
PY  - 2026
N1  - https://doi.org/10.11648/j.wjhpm.20260101.13
DO  - 10.11648/j.wjhpm.20260101.13
T2  - World Journal of Health Policy and Management
JF  - World Journal of Health Policy and Management
JO  - World Journal of Health Policy and Management
SP  - 13
EP  - 19
PB  - Science Publishing Group
UR  - https://doi.org/10.11648/j.wjhpm.20260101.13
AB  - Displaced and host populations in protracted conflict settings face compounded risks of poor maternal, child and nutritional health, driven by damaged health infrastructure, health worker shortages and disrupted supply chains. This paper examines the health and nutrition component in conflict affected area in South Darfur State, Sudan, targeting South Sudanese refugees, internally displaced persons (IDPs) and host communities around the Bilel primary health care (PHC) clinic and surrounding camps. Using a mixed-methods post intervention evaluation household knowledge-attitudes-practices (KAP) surveys, key informant interviews, focus group discussions, health-facility observation, and a SMART nutrition survey. The study assessed primary health care utilization, maternal health service coverage, referral system performance, and treatment of acute malnutrition. Findings show that 43,883 primary health care consultations were delivered against a target of 46,422, while the proportion of women whose deliveries were attended by skilled staff rose from 60% to 74% and referrals to the regional hospital in Nyala reached 371 against a target of 150. On nutrition, 8,738 children under five were admitted for treatment of severe or moderate acute malnutrition reduced from 2,000. The 2020 SMART survey found global acute malnutrition (GAM) at 11.9% and severe acute malnutrition (SAM) at 0.8% in the surveyed locality. Despite these gains, persistent staff shortages at the Bilel PHC clinic (relative to a caseload of up to 200 patients per day), intermittent drug stock-outs, and rainy-season access barriers to therapeutic feeding constrained the consistency of care. The paper argues that integrating health, nutrition and community-based referral systems anchored in trained lay cadres such as traditional birth attendants and lead mothers is a transferable model for sustaining essential services in protracted, access-constrained displacement settings.
VL  - 1
IS  - 1
ER  -

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