The medical charity said the vast western region, which has been a major battleground over more than two years of fighting between the regular army and the paramilitary Rapid Support Forces, had been hardest hit by the year-old outbreak.

“On top of an all-out war, people in Sudan are now experiencing the worst cholera outbreak the country has seen in years,” MSF said in a statement.

“In the Darfur region alone, MSF teams treated over 2,300 patients and recorded 40 deaths in the past week.”

The NGO said 2,470 cholera-related deaths had been reported in the year to August 11, out of 99,700 suspected cases.

Cholera is an acute intestinal infection that spreads through food and water contaminated with bacteria, often from faeces.

It causes severe diarrhoea, vomiting and muscle cramps.

Cholera can kill within hours when not attended to, though it can be treated with simple oral rehydration, and antibiotics for more severe cases.

There has been a global increase in cholera cases, which have also spread geographically, since 2021.

MSF said mass displacements of civilians sparked by the war in Sudan had aggravated the outbreak by denying people access to clean water for essential hygiene measures, such as washing dishes and food.

“The situation is most extreme in Tawila, North Darfur state, where 380,000 people have fled to escape ongoing fighting around the city of El-Fasher, according to the United Nations,” MSF said.

“In Tawila, people survive with an average of just three litres of water per day, which is less than half the emergency minimum threshold of 7.5 litres needed per person per day for drinking, cooking, and hygiene.”

Since forces loyal to the regular army recaptured the capital Khartoum in March, fighting has again focused on Darfur, where the paramilitaries have been attempting to take El-Fasher.

The besieged pocket is the last major city in the western region still under the army’s control and UN agencies have spoken of appalling conditions for the remaining civilians trapped inside.

“In displacement and refugee camps, families often have no choice but to drink from contaminated sources and many contract cholera,” said Sylvain Penicaud, MSF project coordinator in Tawila.

“Just two weeks ago, a body was found in a well inside one of the camps. It was removed, but within two days, people were forced to drink from that same water again.”

MSF said that heavy rains were worsening the crisis by contaminating water and damaging sewage systems, while the exodus of civilians seeking refuge was spreading the disease.

“As people move around to flee fighting, cholera is spreading further, in Sudan and into neighbouring Chad and South Sudan,” it said.

MSF’s head of mission in Sudan, Tuna Turkmen, said the situation was “beyond urgent”.

“The outbreak is spreading well beyond displacement camps now, into multiple localities across Darfur states and beyond,” he said.

“Survivors of war must not be left to die from a preventable disease.”