Substance Use in Conflict-Affected Sudan (2021–2026): A Systematic Review of Prevalence, Patterns, and Risk Factors
This systematic review of 13 studies (2021–2026) reveals that armed conflict and state collapse in Sudan have triggered a severe public health crisis characterized by a surge in synthetic psychostimulants, widespread polysubstance use, and high prevalence of alcohol and cannabis among displaced and vulnerable populations, driven primarily by war trauma, poverty, and regulatory failures.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In the quiet corners of public health, there is a persistent understanding that when the structures of a society crumble, the well-being of its people often follows a different, darker path. When war breaks out, when governments dissolve, and when families are forced to flee their homes, the stress is not just emotional; it is a physical force that reshapes how people cope with daily life. One of the most visible ways this coping mechanism manifests is through the use of substances, from the tobacco people smoke to the alcohol they drink or the pills they take to quiet a racing mind. For decades, researchers have watched how conflict acts as a catalyst, turning hidden habits into open crises. They know that trauma, poverty, and the breakdown of law and order create a perfect storm for addiction to take hold, often in ways that are difficult to predict until it is too late. The question is not just whether people use these substances, but how the nature of that use changes when a country is torn apart by violence.
This is the specific territory explored by a team of researchers from the University of Malaya, who recently looked closely at what has been happening in Sudan. Since 2019, and accelerating dramatically after the full-scale armed conflict began in April 2023, Sudan has faced a catastrophic humanitarian emergency, with millions displaced and institutions collapsing. The researchers wanted to know how this chaos had altered the landscape of substance use over the last five years. They did not conduct new surveys themselves; instead, they gathered and carefully examined thirteen existing studies that had been published between 2021 and 2026. These studies covered nearly twenty thousand people, ranging from university students and community members to street children and refugees living in camps. By piecing together these separate reports, the team built a clearer picture of a rapidly shifting reality, moving beyond old assumptions to reveal a new, more dangerous pattern of addiction driven by the war.
The picture that emerged was stark. For a long time, the substance use story in Sudan was dominated by traditional habits: cigarettes, a smokeless tobacco paste known as toombak, and locally brewed alcohol. These remained common, with rates of tobacco use climbing as high as nearly half of some university student groups and even higher among displaced people in camps. However, the most alarming change was the sudden, massive arrival of synthetic drugs. The researchers found that crystal methamphetamine, a powerful synthetic stimulant, had surged from being virtually absent in the country's records to becoming the primary reason people were seeking treatment. In addiction centers in the capital city of Khartoum and the eastern state of Kassala, this single drug accounted for more than half of all new admissions in some facilities. It was no longer a hidden issue; it had become a central feature of the crisis, driven by the poverty and psychological trauma of displacement, as well as the easy flow of illicit goods across borders that were no longer being monitored.
The nature of the crisis was not just about new drugs, but about who was using them and why. The study highlighted that the most vulnerable groups were bearing the heaviest burden. Among street children in Khartoum, who had lost their families and were living on the streets, the misuse of volatile solvents like rubber glue was rampant, affecting the vast majority of those surveyed. In refugee camps, where people were confined and unemployed, the consumption of local alcohol and cannabis rose sharply, often serving as a way to endure the stress of confinement and the loss of a normal life. The researchers also noted that people were rarely using just one thing. A pattern of mixing substances—combining tobacco, alcohol, prescription painkillers, and synthetic stimulants—had become widespread. This polysubstance use appeared to be a desperate attempt to manage overwhelming psychological distress in an environment where mental health services had largely vanished.
The drivers behind this escalation were as clear as the drugs themselves. The researchers identified that the war had created a vacuum where regulation no longer existed. Prescription medications, which should be tightly controlled, were being diverted and sold without oversight, leading to widespread misuse of painkillers and sedatives. The lack of laws preventing the sale of tobacco to minors, combined with the economic desperation of families, meant that children and young adults had easy access to addictive substances. The trauma of the conflict, the loss of loved ones, and the uncertainty of the future created a deep well of anxiety that people were trying to fill with whatever was available. The study made it clear that this was not a simple increase in bad habits; it was a direct consequence of a state collapsing under the weight of armed conflict.
Looking ahead, the authors argue that the old ways of handling these problems are no longer enough. The centralized, hospital-based models of care that existed before the war are often inaccessible or non-existent in the current chaos. Instead, the researchers suggest that the response must be community-based, bringing support directly to the people who need it, whether they are in a refugee camp, a university dormitory, or on the street. They emphasize the urgent need to restore regulatory oversight over medicines and tobacco, and to integrate mental health support with addiction care, recognizing that the two are now inextricably linked. The findings serve as a warning that without addressing the root causes of the trauma and the structural breakdown that fuels it, the crisis of substance use in Sudan will continue to deepen, turning a public health challenge into a long-term humanitarian emergency.
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