Living Conditions and Public Health Challenges in Temporary Camps for Displaced Populations in Shendi Locality, Sudan

Abstract

Background

Humanitarian aid aims to address the essential needs of displaced populations, especially regarding shelter, water supply, sanitation, and hygiene. This study evaluates the living conditions of displaced populations in Shendi, River Nile State, Sudan, based on the Sphere Guidelines.

Methods

A cross-sectional descriptive study was conducted between August and October 2024. Structured face-to-face interviews, a standardized questionnaire (administered to 100 household heads), a checklist-based assessment, and non-structured interviews were employed. Data were analyzed using SPSS software.

Results

Most displaced families (52%) live in overcrowded rooms, and 48% are near cooking areas. Food security is critical, with 92% of families relying on grains, while only 6% consume meat and 2% consume dairy. Health coverage is low, with only 52% of women vaccinated against tetanus, and 4% and 2% are vaccinated for meningitis and yellow fever, respectively. While 72% of women gave birth in hospitals, 28% gave birth in camps. Water is accessible to 95% of families, but only 60% consume the recommended daily amount, and 20% face difficulties accessing it. In terms of sanitation, 44% practice open defecation, and 90% dispose of waste openly. Additionally, 96% lack sufficient soap, and 96% face health threats from flies and mosquitoes, with only 32% using mosquito nets.

Conclusion

The displaced families face significant challenges, including overcrowding in shelters, poor nutrition, limited access to healthcare and clean water, and inadequate sanitation. These conditions pose serious health risks, especially for children and vulnerable populations. Immediate intervention is necessary to address food security, healthcare, sanitation, and overall living conditions.

Introduction

The ongoing armed conflict in Sudan, characterized by civil wars, internal strife, and political instability, has led to widespread displacement across the country. As a result, millions of individuals have been forced into temporary camps, primarily in regions such as Shendi locality in River Nile State. These camps, housing an estimated 5950 displaced persons across 35 centers (schools), serve as emergency shelters for displaced populations, where the living conditions are often overcrowded, unsanitary, and severely lacking in essential services. These displaced persons face heightened vulnerabilities due to inadequate access to clean water, sanitation, food, healthcare, and shelter, which intensify the public health challenges they experience [22]. The lack of basic needs in temporary camps significantly raises the risk of infectious diseases, malnutrition, and mental health problems, thus exacerbating the humanitarian crisis in the region [21, 24].

Armed conflict often results in the destruction of infrastructure and disruption of local health services, leaving displaced populations without adequate healthcare access. The collapse of essential services such as transportation, communication, and medical facilities makes it increasingly difficult for humanitarian organizations to reach and provide relief to those in need. The exposure to harsh environmental conditions in camps, coupled with inadequate shelter and sanitation facilities, accelerates the spread of diseases, contributing to higher mortality rates and further health deterioration [17]. This situation highlights the urgent need for effective, coordinated humanitarian interventions that adhere to internationally recognized standards [16] in order to improve the living conditions and health outcomes of displaced populations (United Nations, [20]).

Humanitarian organizations such as the United Nations (UN), World Health Organization (WHO), and various non-governmental organizations (NGOs) emphasize the importance of adhering to minimum humanitarian standards during crises. These standards, outlined by organizations like the Sphere Project, cover essential areas such as water, sanitation, shelter, nutrition, and healthcare. Their purpose is to ensure that displaced individuals receive life-saving assistance while maintaining human dignity and upholding fundamental rights. However, the implementation of these standards in emergency settings is often hindered by logistical challenges, resource constraints, and coordination issues among agencies [5, 11]. Despite these challenges, it remains critical to assess how effectively these standards are being applied, especially in the context of displacement camps in Sudan.

Previous studies, such as those by El-Din and colleagues [7] and Alhaj et al. [3], have examined displacement camps in Sudan and the broader region. These studies highlighted the critical gaps in meeting humanitarian standards, particularly in water and sanitation, healthcare access, and food security. El-Din's study focused on the displacement camps in Darfur, finding similar challenges with overcrowded shelters and inadequate healthcare services, while Alhaj's research in South Kordofan underscored the impact of poor hygiene practices and insufficient nutrition on the displaced populations, [3, 7]. These studies provide valuable context for understanding the broader challenges faced by displaced populations across Sudan and emphasize the need for improved humanitarian responses in these settings.

This study aims to examine the living conditions and public health challenges faced by displaced populations in temporary camps, specifically focusing on the application of humanitarian standards in Shendi locality, River Nile State. It will evaluate the extent to which these standards are met in the areas of water, sanitation, healthcare, and shelter, and assess their impact on the health and well-being of displaced persons. The study will also explore the barriers and challenges that hinder the effective implementation of these standards and provide recommendations for improving humanitarian responses.

The choice of Shendi locality in River Nile State is particularly significant due to its vulnerability to the effects of ongoing conflict and the large number of internally displaced persons (IDPs) in the region. The region is one of the many parts of Sudan affected by displacement due to armed conflict, and the situation in Shendi represents the broader crisis faced by many displaced populations across Sudan. The camp populations in Shendi are often forced to live in overcrowded conditions with limited access to clean water, adequate sanitation, and healthcare services, making it a critical area for studying the public health implications of displacement and the challenges of meeting humanitarian standards.

By focusing on Shendi, this study not only addresses the specific challenges faced by the displaced populations in this region but also provides insights that can be applied to similar contexts of displacement in other conflict-affected areas of Sudan and beyond. The region’s context allows for a deeper understanding of the real-world implications of humanitarian standards in emergency settings, particularly when resources are scarce, and coordination among various agencies is weak. This makes Shendi an important case study for identifying gaps in the implementation of humanitarian aid and exploring ways to improve future responses to displacement crises.

This study aims to evaluate the living conditions and public health challenges faced by displaced populations in temporary camps in Shendi locality, River Nile State, Sudan, with a specific focus on the implementation of humanitarian standards. The research will assess the effectiveness of these standards in improving health and well-being within the camps and identify the gaps and barriers that hinder their full implementation. By addressing these objectives, the study will contribute to a better understanding of the real-world challenges in applying humanitarian standards in emergency displacement contexts. The findings will offer insights into how improving the adherence to these standards can mitigate public health risks and enhance the overall quality of life for displaced individuals in Shendi and similar regions.

Materials and Methods

Study design: Cross-sectional descriptive and household based study was conducted on the displaced shelters in the temporary camps in Shendilocality; between August to October 2024 for the purpose of observe theLiving Conditions and Public Health Challenges in Temporary Camps for Displaced Populations.

Study area: The study was conducted in Shendi locality, located in the River Nile State of Sudan, which has become a major destination for displaced populations fleeing conflict zones in other parts of Sudan. Due to ongoing crises, many individuals and families have sought refuge in temporary camps within this area, which currently house a significant population of 5,950 displaced individuals. A significant reason for selecting Shendi as the study location is its high concentration of displaced populations, providing an ideal setting to assess the living conditions and public health challenges faced by these individuals. The community residing in the area obtains their water through a public network with a distribution point within the camps. However, the flow rates are low, and water is typically collected using common plastic containers and stored accordingly. Regarding sanitation, most of the temporary camps are former schools, equipped with a sewage system such as siphons. However, they face challenges such as improper disposal of solid waste and unhealthy behaviors among the residents.

Sample and Sampling Techniques: The study sample comprised 100 households, systematically and randomly selected from a total of 750 households across 35 temporary shelter camps in Shendi locality, River Nile State. The sample size was determined by selecting 10% of the households, which equated to 75 households. This was subsequently increased to 100 households to address potential sampling biases and ensure robustness in the findings. It is important to note that the majority of households shared similar housing characteristics, particularly in terms of quality and overcrowding, as most shelters exhibited comparable living conditions. The selection process followed a systematic random sampling technique, with a sampling interval of every 7th household. This approach ensured a representative sample from the overall population in the camps. The camps included all the temporary shelter schools in the area.

The methodology for gathering data involved several techniques aimed at obtaining a comprehensive understanding of the living conditions and public health standards within the camps:

Interviews with Camp Administrators

An unstructured interview was conducted with the camp administrator to gather detailed information on the size of the displaced population, the area of the camp, and the availability of facilities. The interview also explored the suitability of the camp as a shelter and the implementation of sanitation and public health programs within the camp. This provided essential contextual information necessary for understanding the challenges faced by displaced populations and the resources available to address these challenges.

Household Survey Using a Questionnaire

A structured questionnaire was developed and administered to the head of each selected household (100 households in total). The questionnaire aimed to assess the living conditions of the displaced families and gather information related to basic humanitarian needs. The questions focused on various aspects of the household's situation, including:

Demographic information (age, gender, education level, occupation).

Water source and storage capacity (availability of clean water, methods of water storage, etc.).

Human and solid waste management (methods of disposal, availability of facilities for waste management).

Personal hygiene practices (availability of soap, handwashing habits, sanitation practices).

Vector control (use of mosquito nets, control measures for vectors such as flies and mosquitoes).

Checklist for Direct Observation

A checklist was designed to allow direct observation of environmental factors around the camp that could impact the health of displaced populations. The checklist focused on key items related to the camp's sanitation and hygiene standards, including:

Cleanliness of water storage containers: Observing whether water containers were covered, clean, and properly stored to prevent contamination.

Distance of water storage from potential sources of contamination: Notes were taken on the distance between water sources and sanitation facilities or waste disposal areas.

Solid waste management: Observations were made regarding the availability of solid waste containers, their proper maintenance, and methods of disposal.

Liquid waste management: Special attention was given to how liquid waste, especially children's feces, was disposed of and whether it met the necessary standards.

Personal hygiene practices: The checklist noted any evidence of personal hygiene practices within households and whether proper sanitation protocols were followed.

Food preservation: The checklist included observations regarding how food was stored and protected to prevent contamination.

Mosquito net usage: The checklist also recorded the availability and use of mosquito nets, as part of the efforts to control vector-borne diseases.

Interview Description

An unstructured interview was conducted with the camp official to gain a deeper understanding of the camp's management dynamics, the effectiveness of the sanitation and public health programs being implemented, and the overall support systems in place for displaced populations. The interview provided valuable insights into the distribution of food and non-food supplies, the organizations supporting the camp, and how households respond to sanitation programs. It also highlighted the challenges faced by the camp authorities in ensuring the health and safety of the displaced population.

Data Entry and Preparation

• Data Coding: All responses from the questionnaires and checklists were coded numerically to ensure that the data could be efficiently analyzed. For categorical variables (e.g., yes/no responses, education level, type of waste disposal), numerical values were assigned (e.g., “1” for Yes, “2” for No). For continuous variables (e.g., number of family members, quantity of water used), raw data were entered directly.

• Data Cleaning: The data were reviewed for any inconsistencies, missing values, or outliers. Missing data were handled by using imputation techniques or excluding certain cases based on the pattern of missingness. Outliers were identified using descriptive statistics and visual inspection of histograms.

Data Analysis

To analyze the data collected from the questionnaires, checklist observations, and interviews, the Statistical Package for Social Sciences (SPSS) version 22 was used. SPSS is a widely utilized software for statistical analysis, particularly in the field of social sciences, as it provides a robust platform for managing, analyzing, and interpreting data.

Descriptive Analysis of Survey Data

Descriptive statistics were applied to analyze the demographic and health data gathered from the households in the camps. This involved calculating frequencies and percentages for categorical variables like age, gender, education level, and occupation, as well as continuous variables like family size and income. The analysis provided insights into the socio-economic profile of the displaced population, with key findings such as:

• A predominance of female-headed households.

• A significant portion of the population falls within lower income brackets.

• Education levels

For health and nutrition standards, descriptive statistics were used to highlight discrepancies in vaccination status and nutritional intake, emphasizing critical gaps such as:

• Percentage of women and children remaining unvaccinated, posing a public health risk.

• Insufficient availability of nutritious food, with most households relying on legumes, while meat and milk consumption was minimal.

Water Supply Analysis

For the analysis of water supply, both descriptive and comparative analysis was conducted:

• Water Source

• Water Quantity

• Water Storage and Hygiene

Hygiene and Sanitation Analysis

The analysis of hygiene and sanitation was based on the frequency and practices related to waste disposal, handwashing, and access to soap:

• A significant gap in soap availability

• sanitation,

• Solid waste disposal

Observational Data Analysis

Direct observation data focused on assessing sanitation and hygiene practices in the households:

• The presence of toilets close to food preparation areas

• A large percentage households regularly remove waste

• mosquito control

Integration of Qualitative Data (Interviews)

The qualitative data from unstructured interviews with camp officials were analyzed thematically to supplement the quantitative findings. Key themes from the interviews included:

• Camp Management: Officials highlighted the challenges in managing overcrowded shelters and providing adequate sanitation facilities.

• Public Health Programs: Limited access to vaccinations and health services was a recurrent issue, which corresponds with the low vaccination rates found in the survey data.

• Water and Hygiene Programs: The absence of basic hygiene materials, such as soap, and the inadequate provision of water, were identified as major barriers to maintaining public health.

Results Interpretation

After analyzing the data using SPSS, the results were interpreted to assess the compliance with humanitarian standards in the displacement camps and identify areas of improvement in the living conditions and health outcomes of displaced populations.

Accepted Standards Based on Sphere Guidelines

1. Space Allocation per Person (Shelter)

2. Sphere Standard: At least 3.5 m² per person in emergency shelters.

3. Accepted: Shelters with less than 3.5 m² per person are considered overcrowded and may result in insufficient ventilation, safety concerns, and increased health risks.

4. Room Occupancy

5. Sphere Standard: A maximum of 8 persons per room.

6. Accepted: Rooms with more than 8 persons per room (such as those accommodating up to 24 persons) violate this standard and can cause overcrowding, reduced privacy, and health issues.

7. Sanitation Facilities (Toilets)

8. Sphere Standard: One toilet for every 25 people.

9. Accepted: Shelters with more than 25 people per toilet (such as those with 31 people per toilet) fail to meet this standard and can lead to sanitation problems, spread of diseases, and health risks.

10. Water Supply

11. Sphere Standard: A minimum of 15 L of water per person per day.

12. Accepted: A water supply of 1–2 L per person per day (such as the 60% of households receiving this quantity) is insufficient and violates the minimum Sphere standard. This could lead to dehydration, poor hygiene, and the spread of waterborne diseases.

13. Hygiene and Health Conditions

14. Sphere Standard: Access to soap (200g per person per month) and sanitary facilities, including safe waste disposal.

15. Accepted: A majority of households lacking soap (96%) and those engaging in open defecation (44%) fail to meet basic hygiene standards, leading to increased risks of infections and diseases. Lack of formal solid waste management systems (90% relying on open dumps) is a significant health concern.

16. Food Security

17. Sphere Standard: 2100 kcal per person per day.

18. Accepted: A majority of households reporting sufficient food availability (66%) but lacking balanced nutrition (e.g., high reliance on legumes) indicates potential nutritional deficiencies and violation of minimum standards for protein, fat, and micronutrient intake.

19. Vector Control (Mosquito Nets)

20. Sphere Standard: All people exposed to mosquitoes should have access to mosquito nets.

21. Accepted: A significant proportion (70%) of households without access to mosquito nets and inadequate vector control practices present risks for vector-borne diseases such as malaria.

22. Waste Management

23. Sphere Standard: Solid waste should be managed in a way that prevents health risks and environmental pollution.

24. Accepted: Open dumping of solid waste in 90% of the camps indicates non-compliance with Sphere standards, leading to environmental pollution and health risks for the displaced population

Results

The table indicates the evaluation of temporary shelters used by individuals, focusing on the space available per person, the number of people per room, and the number of people per toilet. The conditions are classified as “Acceptable” or “Not Acceptable” based on criteria such as personal space (in square meters) and the ratio of people in rooms and sanitary facilities. In many cases, shelters suffer from severe overcrowding (such as 24 people in one room), leading to a lack of privacy and space. The ratio of people to toilets is also high in some cases, affecting cleanliness and overall health. While some shelters provide good space (such as 11 m² per person), improvements are needed in balancing the number of people per toilet and room.

The demographic characteristics of household heads were examined, including age, gender, education, occupation, family size, and income, (see Table 1). The table presents demographic data of household heads, highlighting their age, gender, education level, occupation, family size, and income. Most heads of households are over 30 years old (60%), with a significant majority being female (88%). In terms of education, 36% have completed secondary education, and 66% of heads are homemakers. Family sizes vary, with 46% having 4–6 members, and 50% earn less than 100 thousand, indicating economic constraints.

Table 1.

Distribution demographic information of household heads in temporary displaced camps, Shendi locality- River Nile State

Demographic variables of household heads		No	%
Age	15–20 years	8	8%
	21–25 years	14	14%
	26-30years	18	18%
	More than 30years	60	60%
Gender	Male	12	12%
	Female	88	88%
Eduacation level	Un educate	24	12%
	Primary	30	30%
	Secondary	36	36%
	University and above	22	22%
Occupation	Homemaker	66	66%
	Employee	8	8%
	Free job	26	26%
Number of family members	Less than 4members	20	20%
	4-6members	46	46%
	7–9 members	26	26%
	More than 10 member	8	8%
Family income	Less than 100 thousand	50	50%
	100–150 thousand	30	30%
	160–200 thousand	2	2%
	More than 200 thousand	18	18%

The table provides information on health and nutrition standards among displaced populations. It shows that 52% of women are vaccinated against tetanus, but vaccination rates for meningitis (4%) and yellow fever (2%) are low, indicating gaps in health coverage. While 72% of women gave birth in hospitals, 28% gave birth in camps, suggesting limited access to proper maternity services. Food availability meets minimum standards for 66% of households, though 34% face food shortages, and 90% store food in closed containers. However, only 30% have access to mosquito nets, leaving many at risk of vector-borne diseases.

The table outlines water quality standards in a temporary camp. 95% of individuals have access to tap water, while 5% rely on wells, indicating low health risks. 78% of people have water sources within 50 m, but 20% are farther, creating accessibility challenges. 60% consume less than the daily required amount of water, highlighting a scarcity issue.

Environmental health practices such as toilet proximity to food preparation areas and waste management were observed in the camps (as shown in Table 6). The table provides an analysis of environmental health factors in households, showing the percentage of households adhering to sanitation standards, such as using toilets for defecation, proper disposal of waste, and handwashing after cleaning children's stool. It highlights the importance of health practices like disposing of stagnant water and using mosquito nets, while also showing challenges in certain areas like toilet usage and insect prevention.

Table 6.

Direct observation for environment around sheltersin temporary displaced camps, Shendi locality- River Nile State

Observed items around households shelters		Yes	No	Minimum standers and acceptability analysis
Toilet close to where food is prepared		52(52%)	48 (48%)	The p-value of 0.89 indicates that there is no significant difference between households with toilets close to where food is prepared and those without. Therefore, the proximity of toilets to food preparation areas does not significantly impact sanitation
Defecation in toilet		78(78%)	22 (22%)	The p-value of 0.002 is significant (p < 0.05), indicating a strong relationship between having a toilet used for defecation and maintaining proper sanitation. The high percentage of households with toilets used for defecation is a positive sign in terms of meeting sanitation standards
Proper disposal of children’s feces		82(82%)	18 (18%)	The p-value of 0.06 is marginally significant (p close to 0.05), suggesting that there may be an association between proper disposal of children's feces and sanitation practices. However, further data or analysis may be needed to draw stronger conclusions
Wash hand after cleaning child’s a stool		93(93%)	7 (7%)	The p-value of 0.04 is significant (p < 0.05), showing that a majority of households wash their hands after cleaning a child’s stool. This practice is critical for preventing the spread of infections and maintaining hygiene
Covers for garbage cans		60(60%)	40 (40%)
Garbage disposal		84(84%)	16 (16%)	84% of households manage waste properly, indicating positive practices in this area, which help minimize health risks related to waste mismanagement
Dispose of stagnant water		42(42%)	58 (58%)	58% of households do not dispose of stagnant water properly, which poses a health risk, especially in environments where vector-borne diseases like malaria could spread
Children play in stagnant water		29(29%)	71 (71%)	29% of households report that children play in stagnant water. This is a significant health hazard as stagnant water is often a breeding ground for harmful bacteria and mosquitoes
Household waste removed regular		96(96%)	4 (4%)	Only 32% of households use mosquito nets, which reflects a lack of protection against mosquito-borne diseases. This needs improvement as mosquitoes can spread diseases like malaria and dengue
Breeding of files and rodents		96(96%)	4 (4%)	22% of households still practice open defecation, posing a significant public health risk, particularly in areas with inadequate sanitation facilities
Used mosquito nets		32(32%)	68 (68%)	Only 32% of households use mosquito nets, which reflects a lack of protection against mosquito-borne diseases. This needs improvement as mosquitoes can spread diseases like malaria and dengue
Use enough water for washing and bathing		58(58%)	62 (62%)	58% of households use enough water for washing and bathing, but the remaining 62% face limitations in water access, which affects hygiene practices and personal cleanliness
Washing facilities available		60(60%)	40 (40%)
Open defecation		22(22%)	78 (78%)	22% of households still practice open defecation, posing a significant public health risk, particularly in areas with inadequate sanitation facilities
House fly		42(42%)	58 (58%	The presence of flies, mosquitoes, and rodents in 96% of households is a significant concern. This indicates a high risk of environmental contamination and possible disease transmission
Mosquito		48(48%)	52 (52%)
Cockroach		10(10%)	90 (90%)
Method used for mosquitoes	Spraying	3	3%	73% of households use repellents to control mosquitoes, while others use traps and spraying methods. This shows a variety of approaches, but the overall usage of mosquito nets is still low, highlighting a gap in preventive measures
	Using repellents	73	73%
	Traps	24	24%
Mosquito nets available	Yes	30	30%	Mosquito activity peaks in the evening (67%), suggesting that interventions during this time may be more effective in controlling mosquito-related health risks
	No	70	70%
Time during connected	Morning	2	2%
	Evening	67	67%
	Night	31	31%

Discussion

This study aimed to assess the living conditions of displaced populations in Shendi camps according to Sphere Project standards. The findings reveal significant gaps in space allocation, sanitation, food security, and healthcare, highlighting the urgent need for improved living conditions and humanitarian support.

Managing temporary camps during emergencies is critical, and schools are frequently used as temporary shelters due to their existing facilities for cooking and sanitation. Table 2 indicates that schools were the most commonly used shelters for displaced individuals, despite concerns about privacy, room sizes, and overcrowding. Nevertheless, schools were the most accessible option due to their spaciousness, adequate health facilities, and access to safe drinking water. Additionally, schools are close to public facilities such as hospitals, markets, and transportation, which is an added benefit. These findings align with previous studies such as Al-Tuwaijri et al. [4], who highlighted that educational facilities are an effective temporary shelter solution in cases of displacement due to conflicts or natural disasters. The availability of large spaces and immediate access to facilities are essential in these situations. Furthermore, Hassan et al. [10] demonstrated that adequate health facilities in shelters improve displaced populations' health, and Gonzalez et al. [9] noted the importance of proximity to community resources for improving well-being in temporary shelters.

Table 2.

standard of temporary camps management for displaced population in Shendilocality, River Nile State- Sudan

Temporary shelters	No of individuals	m2/ Person	Persons/room	Persons/ toilet	Acceptability and risk analysis
	623	2	10	10	Not Acceptable: The space per person is too small, leading to significant overcrowding
	27	11	2	7	Acceptable: Adequate space per person, but the number of people per room is slightly high
	93	6	3	8	Acceptable: Space is moderate, but the number of people per toilet is still high
	417	2	24	26	Not Acceptable: Overcrowding in rooms is severe, indicating inadequate living conditions
	251	3	22	31	Not Acceptable: Overcrowding in both rooms and toilets, leading to unhealthy living conditions
	171	3.5	15	21	Acceptable: Reasonable balance between space and room occupancy, though the number of people per toilet is high
	307	6.5	14	31	Not Acceptable: The number of people per toilet is excessively high
	202	10	9	20	Acceptable: Excellent space per person, but the number of people per toilet needs improvement
	186	9.5	14	23	Acceptable: Good space, but the toilet-to-person ratio needs improvement
	167	7	13	21	Acceptable: Adequate space, but improvements are needed for the toilet-to-person ratio
	86	9	8	14	Acceptable: Sufficient space, but room occupancy is still high
	96	6	10	16	Acceptable: Space is adequate, but improvements are needed for the toilet-to-person ratio
	211	10.5	12	21	Acceptable: Excellent space, but the number of people per toilet needs improvement
	135	14	9	17	Acceptable: Excellent space, but toilet-to-person ratio could be improved
	86	6	12	22	Acceptable: Space is moderate, but the toilet ratio needs improvement
	286	7	(3	36	Not Acceptable: The number of people per toilet is unreasonably high, indicating poor sanitation
	257	10	15	26	Acceptable: Good space, but improvements are needed for the number of people per toilet
	59	10	12	15	Acceptable: Adequate space with a reasonable toilet ratio
	87	7	12	22	Acceptable: Adequate space, but the toilet-to-person ratio needs improvement
	141	12.5	8	14	Acceptable: Good space per person, though the toilet ratio needs some improvement
	91	13	8	15	Acceptable: Excellent space, but improvements are needed for the toilet-to-person ratio
	78	6.5	15	20	Acceptable: Reasonable space, but the number of people per toilet needs improvement
	88	8	10	15	Acceptable: Space is acceptable, but the toilet-to-person ratio requires improvement
	251	7	15	25	Acceptable: Space per person is fine, but improvements are needed for the toilet ratio
	109	17	8	14	Acceptable: Excellent space per person, though the room occupancy is still high
	46	11	9	12	Acceptable: Space is good, but improvements are needed for the number of people per toilet
	37	16	5	10	Acceptable: Excellent space, but toilet conditions need improvement
	185	12	14	23	Acceptable: Reasonable space, though the toilet-to-person ratio needs improvement
	93	19	8	12	Acceptable: Excellent space per person, but the toilet ratio needs improvement
	113	10.5	8	14	Acceptable: Adequate space, though improvements are required for the number of people per toilet
	229	8.5	13	23	Acceptable: Space is fine, but the toilet-to-person ratio could be improved
	153	11.5	10	19	Acceptable: Reasonable space, but improvements are needed for the toilet-to-person ratio
	215	8	16	22	Acceptable: Adequate space, though improvements in the toilet-to-person ratio are necessary
	127	4.5	11	21	Not Acceptable: The space per person is too small, leading to severe overcrowding
	247	10	14	25	Acceptable: Adequate space, but improvements are needed for the toilet-to-person ratio

Access to healthcare in the area significantly eases the challenges faced by displaced populations. The proximity to hospitals and the freedom of movement are critical, particularly for pregnant women, children, and other vulnerable groups. The study found that many women were able to access vaccination and maternal health services at hospitals, as reflected in Table 3, which shows a high rate of vaccination for Tetanus. However, some children missed vaccinations due to a lack of awareness and guidance from mothers, as indicated by the 8% of missed vaccinations. This finding is consistent with a study by Brooks et al. [6], which found that limited maternal health education in refugee camps contributed to missed immunizations and other healthcare services, leading to preventable diseases among children.

Table 3.

Health and nutrition standards among displaced households in temporary camps management for displaced population in Shendy locality, River Nile State- Sudan

Information about health and nutrition standards		No (%)	Minimum standers and acceptability analysis
Woman Vaccination status	Unvaccinated	42 (42%)	There is a clear difference in the vaccination rates for Tetanus. A significant portion of the population has received this vaccine, which is essential for maternal and child health Regarding meningitis and yellow fever: show a much lower rate of vaccination compared to Tetanus, indicating potential gaps in the health coverage of displaced populations
	Tetanus	52 (52)
	Meningitis	4 (4%)
	Yellow fever	2 (2%)
Woman's delivered in last pregnant after displacement	In hospital	72 (72%)	Maternity services must be available to pregnant women in ideal health conditions
	In camp	28 (28%)
Under one year children vaccination status	Un applicable	82 (82%)	Acceptable standard: All children should receive vaccines
	Vaccinated	10 (10%)
	Unvaccinated	8 (8%)
Availability of Mosquito net	Available	30 (30%)	30% reported having access to mosquito nets, which is well below the required standard for preventing vector-borne diseases The risk of diseases like malaria would likely be higher in the absence of mosquito nets and a comparison of health outcomes between those with and without nets could provide meaningful conclusions
	Unavailable	70 (70%)
food available in sufficient quantities	Yes	66 (66%)	66% of households reported sufficient food availability, which aligns with the minimum standard of 2100 kcals per person per day A significant 34% of households reported insufficient food, which may correlate with increased risks of malnutrition
	No	34 (34%)
Food consumed among displaced household	Legumes	92 (92%)	10 per cent of total energy provided by protein, 17 per cent of total energy provided by fat, Adequate micronutrient intake
	Meat	6 (6%)
	Milk	2 (2%)
Food be stored in closed container	Yes	90 (90%)	Food is kept in suitable containers and covered to prevent insect access and to protect it from the surrounding environmental conditions
	No	10 (10)%

Regarding food security, the study found that many displaced families rely on grains as their primary food source (92%), with limited consumption of meat (6%) and nearly no milk intake (2%). This lack of dietary diversity is a significant cause of malnutrition, particularly among children. According to UNICEF [19], poor economic conditions and the lack of resources to purchase diverse foods are major factors contributing to malnutrition in displaced families. Smith et al. [15] also highlighted dietary diversity as a challenge in refugee populations, urging efforts to diversify food aid to improve nutritional outcomes. Similarly, a study by Ahmed et al. [2] showed that reliance on grains in Sudanese camps led to deficiencies in essential nutrients such as proteins and fats, contributing to higher rates of malnutrition. Ghosh et al. [8] also found that displaced families often suffer from protein and fat deficiencies. Additionally, Thompson et al. (2023) pointed out that long-term reliance on grains exacerbates the risk of vitamin and mineral deficiencies, especially among children and pregnant women.

Water availability is crucial for health and hygiene. According to Table 4, 98% of households rely on tap water, while 2% depend on well water. However, water supply was sometimes intermittent, which violates Sphere Project [17] standards, which recommend 7.5 L of water per person per day. The study also found that the water quality was compromised by the presence of stagnant water near the camps, increasing the risk of waterborne diseases. Previous studies, such as IOM [12] in South Sudan, have shown that camps lacking clean water are more prone to outbreaks of diseases like cholera and dysentery. These findings are consistent with the JMP [13] report, which emphasized the importance of providing clean and accessible water to reduce health risks. WHO [23] also confirmed that inadequate access to clean water in displacement settings leads to higher morbidity and mortality rates from waterborne diseases, urging a reevaluation of water distribution strategies in camps.

Table 4.

Status of water supply standard, source, storage, quantity and quality in temporary displaced camps, Shendi locality- River Nile State

Investigated water standards		No (%)	Minimum standards and acceptability analysis
Water source	Tap	95 (95%)	Given that 95% have access to tap water; the access to safe drinking water is high. However, only 5% rely on well water, which may indicate a minimal risk to public health if well water is not properly treated
	Well	5 (5%)
Distance of water point	Less than 50 m	78 (78%)	A significant number (78%) have water sources within 50 m, which is an acceptable distance for quick access. However, 20% being farther than 50 m may pose a barrier, especially for women and children who need to carry water
	More than 50 m	20 (20%
	Outside the temporary camp	4 (4%)
Container capacity	Less than 20 L	78 (78%)	78% of the population uses containers less than 20 L, which could be insufficient for daily needs. Ideally, larger containers (20–40 L) should be used for larger families
	20 to 40 L	22 (22%)
Water quantity	1–2 L/P/D	60 (60%)	60% of individuals consume only 1–2 L of water per day, which is below the minimum daily requirement. This indicates that water scarcity is an issue for a majority of individuals in the camp
	3-4L/P/D	34 (34%)
	5-6L/P/D	6 (6%)
Water containers clean	Yes	74 (74%)	74% of individuals use clean containers, which is a good practice for preventing contamination. However, 26% using unclean containers poses a significant risk for waterborne diseases
	No	26 (26%)
Defecation near a water source	Yes	20 (20%	20% of individuals defecate near water sources, posing a significant risk for contamination. Proper sanitation practices and further distancing of latrines from water sources are recommended
	No	80 (80%)
Water source protected from contamination	Yes	70 (70%)	70% of water sources are protected from contamination, which is acceptable. However, 30% of sources are unprotected, which increases the risk of waterborne illnesses
	No	30 (30%)

Sanitation and hygiene were also major concerns in the camps. Table 5 indicates that 44% of households practice open defecation, and 90% of the camps use open waste disposal, both of which significantly increase the risk of disease outbreaks. Moreover, 96% of households reported lacking soap for personal hygiene, which does not meet the international standards requiring 200 g of laundry soap and 250 g of bathing soap per person per month. This hygiene gap contributes to the spread of skin diseases, respiratory infections, and other hygiene-related illnesses. Studies by Parker et al. [14] and Stern et al. [18] have also emphasized the link between inadequate sanitation and the spread of infectious diseases. Adnan et al. [1] also reinforced the importance of improving sanitation infrastructure and hygiene practices to reduce the incidence of infectious diseases in refugee camps. Environmental health practices such as toilet proximity to food preparation areas and waste management were observed in the camps (as shown in Table 6).

Table 5.

Situation of hygiene and sanitation standards in temporary displaced camps, Shendi locality- River Nile State

Surveyed hygiene and sanitation standards		No (%)	Minimum standards and acceptability analysis
Availability of soap for household/month	Not available	96 (96%)	A large percentage (96%) of households do not have soap available, which is well below the minimum standard. This lack of soap creates a significant health risk. Only 2% have access to sufficient soap, indicating that most households are not meeting hygiene standards
	Less than 4 soups/household/month	2 (2%)
	4–6 soups/household/month	2 (%)
Open defecation	Exist	44 (44%)	With 44% of households practicing open defecation, the risk of water contamination and the spread of diseases is high. Proper sanitation facilities are essential to meet hygiene standards
	Not exist	66 (66%)
Solid waste disposal	Open dump	90 (90%)	A vast majority (90%) of households use open dumping, which presents serious health risks and environmental pollution. Only 10% have access to formal waste disposal, which is in line with minimum standards for sanitation
	Formal disposal	10 (10%)

Conclusion

This study underscores the critical challenges faced by displaced populations in Shendi's temporary camps, such as overcrowded shelters, limited healthcare access, poor food security, and inadequate water, sanitation, and hygiene standards. These factors significantly increase health risks and vulnerability among displaced individuals. Based on the study's findings, there is an urgent need to improve the living conditions in these camps by enhancing food security, improving waste management, and promoting better hygiene practices. Clean and safe water sources must be provided, along with awareness campaigns on hygiene and public health. Collaboration between humanitarian organizations and governments is essential to provide financial support and improve the living standards of displaced families.

Abbreviations

AIDS

Acquired immune deficiency syndrome

ECO-SAN

Ecological sanitation

HIV

Human immunodeficiency virus

IDP

Internally displaced person

JMP

Joint monitoring programme

PH-RAM

Public health risk assessment model

SPSS

Statistical package for social sciences

UDT

Urine division toilet

VIP

Ventilated Improved

WASH

Water supplies and sanitation and hygiene promotion

Author Contributions

ASMA designed the study and wrote the manuscript. RAAK collect and analyzed the data and designed tables. All authors reviewed manuscript. All authors read and approved the final manuscript. All authors contributed significantly to this work, conceiving the idea of the research, collection and analysis of data, writing and editing of the manuscript. All authors read and approved the manuscript.

Funding

The researchers did not receive any fund from any source.

Data availability

The datasets used and analyzed during this study are available from the corresponding author or reasonable request.

Declarations

Conflict of interest

The authors declare no competing interests.

Ethical approval and consent to participate

The study was initially approved by the ethical committee of the Faculty of Public Health (Institutional Research Board) at Shendi University. In addition, permission was obtained from the Health and Population Department—Shendi locality, directors of temporary camps, and household heads in shelters to be studied. We have also ensured that all names and personal data were completely secured to protect the privacy and confidentiality of the participants. This revision now provides full transparency regarding the ethical considerations involved in the study.

Consent for publication

Not applicable.