Urbanization and Health in Greater Khartoum

Introduction:
Sudan is one of the fastest urbanizing countries in the world. Population figures show that the country was already
41% urbanized in 2009, excluding the displaced of Darfur and the large numbers of unregistered migrants and
squatters in Khartoum.
Migration to Khartoum started after Sudan independence in 1956. For some years, migration was seasonal, and
migrants often returned to their areas of origin. But since the 1970s, most migration to Khartoum has been a
response to natural and man-made disasters and the inequality of resource distribution.
Throughout the 1970s and 1980s, Khartoum was the destination for hundreds of thousands of refugees fleeing
conflicts in neighboring nations such as Chad, Eritrea and Ethiopia The Eritrean and Ethiopian refugees assimilated
into society while some of the other refugees settled in large slums at the outskirts of the city.
Due to the drought of 1983 a large number of displaced people migrated to Khartoum from drought areas.
Migration continues due to the continuous degradation of the environment.
Most of Sudan’s economic capital and social services are concentrated in Khartoum. Just as economic resources
flow to the center and not the peripheries, so too do people move to the capital. The long civil war in southern
Sudan destabilized communities and pushed millions of internally displaced persons northward. Today, more than
2 million IDPs live in Khartoum—almost one quarter of the city’s population. 500.000 IDPs are living in official
camps and around 1.5 million are distributed in different squatter and peripheral areas.
On the other side 16.5% of Sudanese are living in Khartoum with an annual increase rate of 4.3% (2005-2010).
The increase in urban population has also been attributed to natural growth. The growth rate of the country is 2.5
(2010).
The growth rate is a factor in determining how great a burden would be imposed by the changing needs of its
people for infrastructure (e.g., schools, hospitals, housing, roads), resources (e.g., food, water, electricity), and
jobs.
Khartoum has a thriving economy. In recent years Khartoum has seen significant development, driven by Sudan’s
oil wealth. The center of the city is well-planned, with tree-lined streets, but unfortunately this scene is surrounded
by poor districts and miserable slums. The widening gaps between those living in peripheral areas and camps pose
a risk that needs to be recognized and countered. The major threat in Khartoum is that many people live in poverty
with high birth rates.
The figure below shows the trend of increased population of Khartoum. This is not only due to a natural increase of
population but also due to immigration of IDPs from conflict areas. It is a pathological urbanization. It is the
aggregation of people without their integration into a social and political system.
Year Population of Khartoum
1956 245,800
1973 748,300
1983 1,340,646
1993 2,919,773
2007 8,363,915
Specific effects of urbanization in Khartoum have not been traced but the environmental burden of diseases in
Sudan shows high prevalence of the following diseases and reflect to some extent the problem of urbanization:
Environmental burden of disease (preliminary) per year
Disease group World’s lowest country Country Rate World’s highest country
rate rate
Diarrhoea 0.2 17 107
Respirator indicators 0.1 9.1 71
Malaria 0.0 11 34
Other vector-borne 0.0 1.5 4.9
diseases
Lung cancer 0.0 0.1 2.6
Other cancers 0.3 1.7 4.1
Neuropsychiatric disor- 1.4 1.6 3.0
ders

1
Cardiovascular disease 1.4 3.7 14
COPD 0.0 0.9 4.6
Asthma 0.3 1.2 2.8
Musculoskeletal diseases 0.5 0.6 1.5
Road traffic injuries 0.3 6.8 15
Other unintentional 0.6 9.1 30
injuries
Intentional injuries 0.0 3.7 7.5
In the state of Khartoum, piped water is available to 71 per cent of households: 73 per cent of the urban and 58
per cent of the rural households. Seventeen per cent still obtain their drinking water supply from wells, rivers and
canals. Since the early 1980s, the quality of piped water has ceased to meet World Health Organization (WHO)
standards.
The majority of the state’s households (69 per cent) are served by pit latrines while only 3 per cent have public
sewerage systems and 15 per cent have no toilet facility of any sort. Seventy-four per cent of the state’s
households use charcoal as fuel (77 per cent of urban and 56 per cent of rural households).
Lessons:
It has been estimated by UNICEF and other UN agencies that the total cost of providing basic social services in
developing countries including health, education, family planning, clean water, and all of the other basic social
goals agreed upon at the World Summit for children in 1999 would be around $ 39-40 billion a year, two thirds of
which could come from the developing countries themselves. Sudan is rich enough to carry out the needs of its
population through control of conflicts, social justice, equitable distribution of resources and developing practical
strategies for provision of health services in Khartoum.
Evaluations of health care services provided to the displaced have taken place for years in many workshops. The
effectiveness of these evaluations has been limited by shortfalls in the information system, by the fact that they
did not reach community and facility levels and due to the ongoing internal conflicts.
The range of health services activity in Khartoum is, however, wide enough to embrace an advance in occupational
and environmental health and at the same time training of TBAs and the control of Shistosomiasis. Different
functions for different Health Areas may improve provision of health services and reduce the effect of urbanization
on health.
Urgent and drastic action is needed to combat poverty.

Dr Abdelmageed Osman Musa, Associate Professor/Community Medicine

Faculty of Medicine; International University of Africa; Sudan
Email: majeed_osm@yahoo.com