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Rethinking cholera response: an orchestration framework for future preparedness in fragile conflict-affected
Fatima Abdalrahman Ayyad1, Ahmad Izzoddeen1,2, Maisoon Elbukhari Ibrahim3
1Federal Ministry of Health, Khartoum, Sudan.
Frontiers in Public Health
|July 15, 2026
Summary
Sudan
Area of Science:
- Public Health
- Epidemiology
- Conflict Studies
Background:
- Sudan faces a severe cholera outbreak (83,245 cases, 2,124 deaths by June 2025) exacerbated by ongoing conflict.
- Fragile health systems and volatile environments challenge traditional outbreak response.
- Existing hierarchical models are insufficient for dynamic, conflict-affected settings.
Purpose of the Study:
- To propose an innovative framework for managing public health emergencies in fragile and conflict-affected settings.
- To introduce the Orchestrated Symphony Model for cholera outbreak response in Sudan.
- To integrate systems thinking and orchestration governance for adaptive outbreak management.
Main Methods:
- Utilized Sudan's 2024-2025 cholera outbreak as a case study.
- Developed the Orchestrated Symphony Model, conceptualizing the Ministry of Health as a conductor.
- Applied systems thinking theories (Iceberg and Biomatrix models) to identify governance and coordination leverage points.
Main Results:
- The model visualizes diverse stakeholders as an orchestra, with coordinated actions ensuring a harmonized response.
- Identified key leverage points for effective governance, coordination, and resource optimization within the outbreak response.
- Demonstrated the potential for adaptive and integrated management of public health crises.
Conclusions:
- The Orchestrated Symphony Model offers a novel approach to cholera outbreak management in conflict zones.
- This framework serves as a policy reform and practice improvement guide for public health emergencies.
- The model promotes a more coordinated, adaptive, and effective response in fragile settings.
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