On a dirt track somewhere outside Khartoum, Samar* ran. No plan, just a need to get away. “It is like being on fire”, she tells The Independent from the shelter of a refugee camp in Turkana, Kenya’s arid north. “You just run without realising it, until you reach a place you never even planned to get to. In Sudan there was nothing but death.”

She arrived stricken with cholera, travelling with children who were not all her own – nieces and nephews gathered along the way as families fractured under fire. Three years ago today two rival factions of the country’s military opened fire on each other in the capital Khartoum. What followed has became one of the world’s most catastrophic humanitarian disasters, with nearly one-in-three Sudanese having been driven from their homes. Millions, like Samar, have fled across borders into already overstretched neighbouring countries.

Kenya, one of the Horn of Africa’s most stable nations, is bearing an extraordinary share of that burden. In Turkana County – a remote, drought-prone region in the northwest – there are 311,491 registered refugees alone. Daniel, who oversees health operations for the Kenya Red Cross in the region, says 200 more people arrive each week and 400 births are recorded in the camp every month.

“The needs are increasing, but the resources are declining”, says Daniel – who has worked across multiple refugee crises over nearly two decades. But this time, he says, it feels different. Not because of the scale of displacement, but because of the absence of the funding that once followed it. During a humanitarian crisis in 2010 and 2011, international support surged. He recalls: “We did not have a lot of trouble. The humanitarian assistance was matching the influx.” Now the equation has reversed: “It is like the budget is almost half, but we are serving a bigger population.”

Funding to Kenya Red Cross operations has fallen by 54 per cent, causing both resourcing and staff losses. Daniel tells The Independent clinicians now see between 110 and 200 patients a day, The World Health Organisation (WHO) recommends 50. “We are supposed to close the clinic at around four, but we have to extend to clear the queue. The clinicians are burnt out because they are seeing too many patients… more than double, more than triple”, Daniel says.

Iron supplements for pregnant women have dried up, with potentially fatal consequences at delivery. Daniel says: “When women are anaemic, the chances of losing either the mother or the child become higher. Even a slight haemorrhage is riskier.” When supplies run out, agencies borrow from each other and hope the next delivery arrives in time.

The first stop for many is not Turkana but Kitale, a transit centre near Kenya’s western border with Uganda. Ruth has worked there since 2019. “Some we can manage and others are very complicated – like cancer, or cases needing urgent surgery – and those require referrals over very long distances,” she says. The nearest major facility is Kakuma, nearly 400 kilometres (249 miles) away.

It is not just the physical conditions that stay with Ruth: “When they arrive, there’s always a lot of pain and anxiety. Sometimes we have children who cannot express themselves,” she says. “[Some] are not able to speak, [some] don’t sleep for days and weeks. They have undergone traumatic experiences.”

The stories are almost unbearable in their accumulation. Idris, who fled Khartoum, lost his money, phone and clothes to robbers on the road. Now a farm labourer, he says: “It is difficult to find something here that provides a decent income and peace of mind.” Then, quietly, he adds: “But without the Kenyan government and the NGOs, our situation would be much worse.”

Malik, from El Fasher in North Darfur, was detained and tortured for two weeks, watched armed men kill his uncle and cousin and fled after his wife was raped. Her infections from the assault remain untreated. He tells The Independent: “I want to study and educate my children, at least try to give them a better future.”

The crisis at Kenya’s door is not Sudan’s alone, Daniel says: “We are receiving new arrivals from Sudan, South Sudan and also the Great Lakes region, mainly from Rwanda, the Democratic Republic of the Congo and Burundi.”

Recently, a woman arrived at Kitale from Burundi with four children and nothing else. Her husband was killed in front of her and she sexually assaulted on the road. The woman found out she was HIV-positive when she reached the centre. It is the case, Ruth says, that has shocked her most in recent weeks. “She was all alone and she had faced a lot of challenges, but she managed to get to the facility and once we were able to offer her assistance, we saw a change in even just her appearance alone,” she says. “There was a lot of hope that she finally had.”

It is that hope this keeps Ruth coming back. Over six years she has seen people rebuild their lives, children find futures few would have predicted. A boy sponsored through school now studying for a degree, another scouted in the camp now playing football professionally in Asia. “There is a story behind every refugee and it could happen to anyone. It could happen to me,” Ruth says.

But these kind of outcomes are getting harder to support. As Sudan enters its fourth year of war, needs accumulate and the global response has slowed, fractured and shrunk. One Red Cross assessment concludes: “Without further support, the situation will be catastrophic.”

*names changed to protect identities

This article has been produced as part of The Independent’s Rethinking Global Aid project