Integrated Water, Sanitation and Hygiene Practices Enhance Humanitarian Service Delivery in a 
Conflict-Affected Area: Darfur, Sudan

Kamal Eldin Mohammed Fadul; Eltighani Mirghani Elamin; Fadwa Hassan Ibrahim; Dirdiri Hassan Mahmoud; Sona Mohammed Fadul; Hatim Abdalla Elkhidir

doi:doi:10.11648/j.ajhpm.20260101.12

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| Peer-Reviewed

Integrated Water, Sanitation and Hygiene Practices Enhance Humanitarian Service Delivery in a Conflict-Affected Area: Darfur, Sudan

Kamal Eldin Mohammed Fadul^*

, Eltighani Mirghani Elamin

, Fadwa Hassan Ibrahim

, Dirdiri Hassan Mahmoud, Sona Mohammed Fadul

, Hatim Abdalla Elkhidir

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

Received: 12 August 2026 Accepted: 25 August 2026 Published: 22 September 2026

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Abstract

Access to water, sanitation and hygiene (WASH) remains one of the most persistent gaps facing internally displaced persons (IDPs), refugees and host communities in protracted conflict settings. This study was conducted in July 2021, across six sites: Bilel and Al Radom (South Darfur State) and Hassa Hissa, Hamedia and Khamsa dageiga and Rokero (Central Darfur State). The study examines the performance of a WASH component implemented by NGOS in five camps and settlements in Central and South Darfur State, Sudan. Using a mixed-methods post-intervention evaluation design household knowledge-attitudes-practices (KAP) surveys (n = 320 household), key informant interviews; focus group discussions, facility observations and secondary programme data. The study assessed water access, water quality, sanitation coverage, hygiene behavior and the sustainability of community-managed infrastructure. Findings show that access to water rose from 174,403 to 191,121 beneficiaries, with 90.5% of the target population reporting adequate WASH services and hygiene practices, exceeding the 85% target. Safe hand washing at critical times rose from 85% to 91%. Despite these gains, 61.8% of surveyed households reported increased waiting times at water points and inconsistent access to chlorine limited water-quality. Monitoring, pointing to unresolved capacity constraints in camps that were designed as temporary but have become permanent settlements. The shift from diesel to solar pumping, the transition from PVC to high-density polyethylene (HDPE) piping, and the capacitation of community water-management committees and hand pump mechanics are identified as key drivers of technical and institutional sustainability. The paper argues that WASH programming in protracted, low-return-prospect displacement contexts must move from an emergency logic toward durable infrastructure and tariff-based operations and maintenance systems, and it draws out transferable lessons for similar interventions in fragile and conflict-affected areas. The novelty of this study lies in re-analysing routine post-intervention WASH monitoring data as an independent field study, disaggregating to the site level to expose inequities that are invisible in aggregate, donor-facing indicators, and situating the Darfur experience within a comparative body of recent WASH evidence from analogous displacement settings in South and Central Darfur and elsewhere in the region.

Published in	American Journal of Health Policy and Management (Volume 1, Issue 1)
DOI	10.11648/j.ajhpm.20260101.12
Page(s)	13-23
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

WASH, Internally Displaced Persons, Refugees, Conflict, Darfur, Sudan, Humanitarian Evaluation, Sustainability

References

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[6]	Hatim Abdalla Mohammed Elkhidir, Kamal Eldin Mohammed Fadul, Eltighani Mirghani Elamin, Ahmed Mohammed Musftafa Lazim, Abdelrahman Ahmed Khatir, Bushra Meheissi, Fadwa Hassan Ibrahim, Dirdiri Hassan Mahmoud, Sona Mohammed Fadul (2026). 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, Vol. 12, No. 1, pp. 1–15, https://doi.org/10.11648/j.ajbes.20261201.11
[7]	Hussein, E. M. E., Mohamde, K. E., Ibrahim, F., & Marufu, S. (2021). Norwegian Church Aid – Final Evaluation of DG ECHO Project in South and Central Darfur, Sudan (Draft Evaluation Report). Palm Associates Limited & Palm Gesamac Consulting, for Norwegian Church Aid (NCA) Sudan.
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[13]	Water. Sanitation and hygiene \| UNICEF Sudan. [cited 2024 Aug 31]. Available from: https://www.unicef.org/sudan/water-sanitation-and-hygiene
[14]	WHO/UNICEF Joint Monitoring Programme (JMP). (2021). Progress on Household Drinking Water, Sanitation and Hygiene 2000–2020: Five Years into the SDGs. World Health Organization and United Nations Children’s Fund.
[15]	Zinszer, K., & Abuzerr, S. (2024). Water, sanitation, and hygiene insecurity and infectious disease outbreaks among internally displaced populations in Gaza: Implications of conflict-driven displacement on public health. Journal of Water, Sanitation and Hygiene for Development, 14(11), 1182–1192. https://doi.org/10.2166/washdev.2024.361
[16]	Calderón-Villarreal, A., Schweitzer, R., & Kayser, G. (2022). Social and geographic inequalities in water, sanitation and hygiene access in 21 refugee camps and settlements in Bangladesh, Kenya, Uganda, South Sudan, and Zimbabwe. International Journal for Equity in Health, 21, 27. https://doi.org/10.1186/s12939-022-01626-3
[17]	Ali, S. I., Ali, S. S., & Fesselet, J.-F. (2021). Evidence-based chlorination targets for household water safety in humanitarian settings: Recommendations from a multi-site study in refugee camps in South Sudan, Jordan, and Rwanda. Water Research, 189, 116642. https://doi.org/10.1016/j.watres.2020.116642
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APA Style

Fadul, K. E. M., Elamin, E. M., Ibrahim, F. H., Mahmoud, D. H., Fadul, S. M., et al. (2026). Integrated Water, Sanitation and Hygiene Practices Enhance Humanitarian Service Delivery in a Conflict-Affected Area: Darfur, Sudan. American Journal of Health Policy and Management, 1(1), 13-23. https://doi.org/10.11648/j.ajhpm.20260101.12

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ACS Style

Fadul, K. E. M.; Elamin, E. M.; Ibrahim, F. H.; Mahmoud, D. H.; Fadul, S. M., et al. Integrated Water, Sanitation and Hygiene Practices Enhance Humanitarian Service Delivery in a Conflict-Affected Area: Darfur, Sudan. Am. J. Health Policy Manag. 2026, 1(1), 13-23. doi: 10.11648/j.ajhpm.20260101.12

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AMA Style

Fadul KEM, Elamin EM, Ibrahim FH, Mahmoud DH, Fadul SM, et al. Integrated Water, Sanitation and Hygiene Practices Enhance Humanitarian Service Delivery in a Conflict-Affected Area: Darfur, Sudan. Am J Health Policy Manag. 2026;1(1):13-23. doi: 10.11648/j.ajhpm.20260101.12

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@article{10.11648/j.ajhpm.20260101.12,
  author = {Kamal Eldin Mohammed Fadul and Eltighani Mirghani Elamin and Fadwa Hassan Ibrahim and Dirdiri Hassan Mahmoud and Sona Mohammed Fadul and Hatim Abdalla Elkhidir},
  title = {Integrated Water, Sanitation and Hygiene Practices Enhance Humanitarian Service Delivery in a 
Conflict-Affected Area: Darfur, Sudan},
  journal = {American Journal of Health Policy and Management},
  volume = {1},
  number = {1},
  pages = {13-23},
  doi = {10.11648/j.ajhpm.20260101.12},
  url = {https://doi.org/10.11648/j.ajhpm.20260101.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhpm.20260101.12},
  abstract = {Access to water, sanitation and hygiene (WASH) remains one of the most persistent gaps facing internally displaced persons (IDPs), refugees and host communities in protracted conflict settings. This study was conducted in July 2021, across six sites: Bilel and Al Radom (South Darfur State) and Hassa Hissa, Hamedia and Khamsa dageiga and Rokero (Central Darfur State). The study examines the performance of a WASH component implemented by NGOS in five camps and settlements in Central and South Darfur State, Sudan. Using a mixed-methods post-intervention evaluation design household knowledge-attitudes-practices (KAP) surveys (n = 320 household), key informant interviews; focus group discussions, facility observations and secondary programme data. The study assessed water access, water quality, sanitation coverage, hygiene behavior and the sustainability of community-managed infrastructure. Findings show that access to water rose from 174,403 to 191,121 beneficiaries, with 90.5% of the target population reporting adequate WASH services and hygiene practices, exceeding the 85% target. Safe hand washing at critical times rose from 85% to 91%. Despite these gains, 61.8% of surveyed households reported increased waiting times at water points and inconsistent access to chlorine limited water-quality. Monitoring, pointing to unresolved capacity constraints in camps that were designed as temporary but have become permanent settlements. The shift from diesel to solar pumping, the transition from PVC to high-density polyethylene (HDPE) piping, and the capacitation of community water-management committees and hand pump mechanics are identified as key drivers of technical and institutional sustainability. The paper argues that WASH programming in protracted, low-return-prospect displacement contexts must move from an emergency logic toward durable infrastructure and tariff-based operations and maintenance systems, and it draws out transferable lessons for similar interventions in fragile and conflict-affected areas. The novelty of this study lies in re-analysing routine post-intervention WASH monitoring data as an independent field study, disaggregating to the site level to expose inequities that are invisible in aggregate, donor-facing indicators, and situating the Darfur experience within a comparative body of recent WASH evidence from analogous displacement settings in South and Central Darfur and elsewhere in the region.},
 year = {2026}
}

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TY  - JOUR
T1  - Integrated Water, Sanitation and Hygiene Practices Enhance Humanitarian Service Delivery in a 
Conflict-Affected Area: Darfur, Sudan
AU  - Kamal Eldin Mohammed Fadul
AU  - Eltighani Mirghani Elamin
AU  - Fadwa Hassan Ibrahim
AU  - Dirdiri Hassan Mahmoud
AU  - Sona Mohammed Fadul
AU  - Hatim Abdalla Elkhidir
Y1  - 2026/09/22
PY  - 2026
N1  - https://doi.org/10.11648/j.ajhpm.20260101.12
DO  - 10.11648/j.ajhpm.20260101.12
T2  - American Journal of Health Policy and Management
JF  - American Journal of Health Policy and Management
JO  - American Journal of Health Policy and Management
SP  - 13
EP  - 23
PB  - Science Publishing Group
UR  - https://doi.org/10.11648/j.ajhpm.20260101.12
AB  - Access to water, sanitation and hygiene (WASH) remains one of the most persistent gaps facing internally displaced persons (IDPs), refugees and host communities in protracted conflict settings. This study was conducted in July 2021, across six sites: Bilel and Al Radom (South Darfur State) and Hassa Hissa, Hamedia and Khamsa dageiga and Rokero (Central Darfur State). The study examines the performance of a WASH component implemented by NGOS in five camps and settlements in Central and South Darfur State, Sudan. Using a mixed-methods post-intervention evaluation design household knowledge-attitudes-practices (KAP) surveys (n = 320 household), key informant interviews; focus group discussions, facility observations and secondary programme data. The study assessed water access, water quality, sanitation coverage, hygiene behavior and the sustainability of community-managed infrastructure. Findings show that access to water rose from 174,403 to 191,121 beneficiaries, with 90.5% of the target population reporting adequate WASH services and hygiene practices, exceeding the 85% target. Safe hand washing at critical times rose from 85% to 91%. Despite these gains, 61.8% of surveyed households reported increased waiting times at water points and inconsistent access to chlorine limited water-quality. Monitoring, pointing to unresolved capacity constraints in camps that were designed as temporary but have become permanent settlements. The shift from diesel to solar pumping, the transition from PVC to high-density polyethylene (HDPE) piping, and the capacitation of community water-management committees and hand pump mechanics are identified as key drivers of technical and institutional sustainability. The paper argues that WASH programming in protracted, low-return-prospect displacement contexts must move from an emergency logic toward durable infrastructure and tariff-based operations and maintenance systems, and it draws out transferable lessons for similar interventions in fragile and conflict-affected areas. The novelty of this study lies in re-analysing routine post-intervention WASH monitoring data as an independent field study, disaggregating to the site level to expose inequities that are invisible in aggregate, donor-facing indicators, and situating the Darfur experience within a comparative body of recent WASH evidence from analogous displacement settings in South and Central Darfur and elsewhere in the region.
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, Agricultural Research Corporations (ARC), Khartoum, Sudan

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

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

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

Agricultural Economics & Policy Research Center, Agricultural Research Corporations (ARC), Khartoum, Sudan
Sona Mohammed Fadul

Department of Forest Protections and Conservation, University of Khartoum, Khartoum, Sudan

http://orcid.org/0009-0007-6097-7728
Hatim Abdalla Elkhidir

Gum Arabic Research Programme, Agricultural Research Corporation (ARC), El-Obeid, Sudan

http://orcid.org/0000-0002-0779-6369

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APA Style

Fadul, K. E. M., Elamin, E. M., Ibrahim, F. H., Mahmoud, D. H., Fadul, S. M., et al. (2026). Integrated Water, Sanitation and Hygiene Practices Enhance Humanitarian Service Delivery in a Conflict-Affected Area: Darfur, Sudan. American Journal of Health Policy and Management, 1(1), 13-23. https://doi.org/10.11648/j.ajhpm.20260101.12

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ACS Style

Fadul, K. E. M.; Elamin, E. M.; Ibrahim, F. H.; Mahmoud, D. H.; Fadul, S. M., et al. Integrated Water, Sanitation and Hygiene Practices Enhance Humanitarian Service Delivery in a Conflict-Affected Area: Darfur, Sudan. Am. J. Health Policy Manag. 2026, 1(1), 13-23. doi: 10.11648/j.ajhpm.20260101.12

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AMA Style

Fadul KEM, Elamin EM, Ibrahim FH, Mahmoud DH, Fadul SM, et al. Integrated Water, Sanitation and Hygiene Practices Enhance Humanitarian Service Delivery in a Conflict-Affected Area: Darfur, Sudan. Am J Health Policy Manag. 2026;1(1):13-23. doi: 10.11648/j.ajhpm.20260101.12

Copy | Download

@article{10.11648/j.ajhpm.20260101.12,
  author = {Kamal Eldin Mohammed Fadul and Eltighani Mirghani Elamin and Fadwa Hassan Ibrahim and Dirdiri Hassan Mahmoud and Sona Mohammed Fadul and Hatim Abdalla Elkhidir},
  title = {Integrated Water, Sanitation and Hygiene Practices Enhance Humanitarian Service Delivery in a 
Conflict-Affected Area: Darfur, Sudan},
  journal = {American Journal of Health Policy and Management},
  volume = {1},
  number = {1},
  pages = {13-23},
  doi = {10.11648/j.ajhpm.20260101.12},
  url = {https://doi.org/10.11648/j.ajhpm.20260101.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhpm.20260101.12},
  abstract = {Access to water, sanitation and hygiene (WASH) remains one of the most persistent gaps facing internally displaced persons (IDPs), refugees and host communities in protracted conflict settings. This study was conducted in July 2021, across six sites: Bilel and Al Radom (South Darfur State) and Hassa Hissa, Hamedia and Khamsa dageiga and Rokero (Central Darfur State). The study examines the performance of a WASH component implemented by NGOS in five camps and settlements in Central and South Darfur State, Sudan. Using a mixed-methods post-intervention evaluation design household knowledge-attitudes-practices (KAP) surveys (n = 320 household), key informant interviews; focus group discussions, facility observations and secondary programme data. The study assessed water access, water quality, sanitation coverage, hygiene behavior and the sustainability of community-managed infrastructure. Findings show that access to water rose from 174,403 to 191,121 beneficiaries, with 90.5% of the target population reporting adequate WASH services and hygiene practices, exceeding the 85% target. Safe hand washing at critical times rose from 85% to 91%. Despite these gains, 61.8% of surveyed households reported increased waiting times at water points and inconsistent access to chlorine limited water-quality. Monitoring, pointing to unresolved capacity constraints in camps that were designed as temporary but have become permanent settlements. The shift from diesel to solar pumping, the transition from PVC to high-density polyethylene (HDPE) piping, and the capacitation of community water-management committees and hand pump mechanics are identified as key drivers of technical and institutional sustainability. The paper argues that WASH programming in protracted, low-return-prospect displacement contexts must move from an emergency logic toward durable infrastructure and tariff-based operations and maintenance systems, and it draws out transferable lessons for similar interventions in fragile and conflict-affected areas. The novelty of this study lies in re-analysing routine post-intervention WASH monitoring data as an independent field study, disaggregating to the site level to expose inequities that are invisible in aggregate, donor-facing indicators, and situating the Darfur experience within a comparative body of recent WASH evidence from analogous displacement settings in South and Central Darfur and elsewhere in the region.},
 year = {2026}
}

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TY  - JOUR
T1  - Integrated Water, Sanitation and Hygiene Practices Enhance Humanitarian Service Delivery in a 
Conflict-Affected Area: Darfur, Sudan
AU  - Kamal Eldin Mohammed Fadul
AU  - Eltighani Mirghani Elamin
AU  - Fadwa Hassan Ibrahim
AU  - Dirdiri Hassan Mahmoud
AU  - Sona Mohammed Fadul
AU  - Hatim Abdalla Elkhidir
Y1  - 2026/09/22
PY  - 2026
N1  - https://doi.org/10.11648/j.ajhpm.20260101.12
DO  - 10.11648/j.ajhpm.20260101.12
T2  - American Journal of Health Policy and Management
JF  - American Journal of Health Policy and Management
JO  - American Journal of Health Policy and Management
SP  - 13
EP  - 23
PB  - Science Publishing Group
UR  - https://doi.org/10.11648/j.ajhpm.20260101.12
AB  - Access to water, sanitation and hygiene (WASH) remains one of the most persistent gaps facing internally displaced persons (IDPs), refugees and host communities in protracted conflict settings. This study was conducted in July 2021, across six sites: Bilel and Al Radom (South Darfur State) and Hassa Hissa, Hamedia and Khamsa dageiga and Rokero (Central Darfur State). The study examines the performance of a WASH component implemented by NGOS in five camps and settlements in Central and South Darfur State, Sudan. Using a mixed-methods post-intervention evaluation design household knowledge-attitudes-practices (KAP) surveys (n = 320 household), key informant interviews; focus group discussions, facility observations and secondary programme data. The study assessed water access, water quality, sanitation coverage, hygiene behavior and the sustainability of community-managed infrastructure. Findings show that access to water rose from 174,403 to 191,121 beneficiaries, with 90.5% of the target population reporting adequate WASH services and hygiene practices, exceeding the 85% target. Safe hand washing at critical times rose from 85% to 91%. Despite these gains, 61.8% of surveyed households reported increased waiting times at water points and inconsistent access to chlorine limited water-quality. Monitoring, pointing to unresolved capacity constraints in camps that were designed as temporary but have become permanent settlements. The shift from diesel to solar pumping, the transition from PVC to high-density polyethylene (HDPE) piping, and the capacitation of community water-management committees and hand pump mechanics are identified as key drivers of technical and institutional sustainability. The paper argues that WASH programming in protracted, low-return-prospect displacement contexts must move from an emergency logic toward durable infrastructure and tariff-based operations and maintenance systems, and it draws out transferable lessons for similar interventions in fragile and conflict-affected areas. The novelty of this study lies in re-analysing routine post-intervention WASH monitoring data as an independent field study, disaggregating to the site level to expose inequities that are invisible in aggregate, donor-facing indicators, and situating the Darfur experience within a comparative body of recent WASH evidence from analogous displacement settings in South and Central Darfur and elsewhere in the region.
VL  - 1
IS  - 1
ER  -

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