Evaluation of the early warning alert and response system mobile pilot for East and Central Darfur, Sudan

In conflict-affected areas like Darfur in Sudan, the disruption of health infrastructure and disease surveillance systems has severely hindered timely detection and response to disease outbreaks. To address the gap, the Sudan Federal Ministry of Health (FMoH), with support from the World Health Organization (WHO) and Health Cluster partners, piloted an emergency disease surveillance system using WHO´s Early Warning Alert and Response System Mobile Application (EWARS Mobile) in East and Central Darfur from mid-2024. The pilot phase was evaluated using standard WHO and the United States Centers for Disease Control frameworks for surveillance system assessment, focusing on quantitative epidemiological attributes and qualitative stakeholder feedback. Data from health facilities managed by partners were analyzed, and stakeholders´ perspectives were gathered through remote consultations and two evaluation meetings in December 2024 and February 2025. Over the pilot period, 52934 cases of ten monitored syndromes were reported from a total of 166663 consultations. The system demonstrated high completeness and low but gradually improving timeliness, with enhanced geographic representativeness and the generation of actionable alerts, enabling communication and data sharing through seamless integration with the national surveillance platform. Though several epidemiological attributes, such as sensitivity and specificity, could not be fully assessed, the EWARS Mobile was found to be highly useful, acceptable, flexible, and simple, with minimal resource requirements and strong partner interest in expansion. The EWARS Mobile pilot effectively generated critical health intelligence in East and Central Darfur States, hard-to-reach areas in Sudan, underscoring the system´s feasibility and sustainability in low-resource, volatile settings where no functional surveillance mechanisms existed following the escalation of the conflict.