Epidemic Keratoconjunctivitis in Conflict-Affected Kassala, Sudan (2024–2025): A Qualitative Exploration of Community Experiences and Health System Response

Abstract Background Epidemic keratoconjunctivitis (EKC) is a highly contagious adenoviral eye infection that can spread rapidly in settings marked by overcrowding, displacement, and fragile infection-control systems. In conflict-affected eastern Sudan, these conditions have intensified both disease transmission and barriers to care. Methods We conducted a qualitative descriptive study in Kassala State, Sudan, between September 2024 and January 2025. Data were generated through 20 in-depth interviews with healthcare managers and 10 focus group discussions with patients/caregivers and community leaders. Participants were purposively sampled from public hospitals, rural clinics, and displaced communities. All interviews were audio-recorded, transcribed verbatim, translated from Arabic into English, and analyzed thematically in NVivo 14 using Braun and Clarke’s six-step approach. Trustworthiness was strengthened through triangulation, reflexive memoing, member checking, and an audit trail. Ethical approval was obtained from the Kassala State Ministry of Health. Results Participants described EKC as both a visible outbreak and a signal of wider health-system fragility. Key findings included uneven awareness, reliance on social media and informal community networks for information, delayed care-seeking, financial and geographic barriers to treatment, gender-related constraints on access, and a strong tendency to try traditional or home-based remedies before formal care. Health managers reported limited isolation capacity, staff shortages, medication constraints, and inconsistent outreach. The outbreak also caused anxiety, stigma, school and work absenteeism, and broader social disruption. Conclusion An effective EKC response in conflict-affected settings requires affordable treatment, mobile and decentralized eye care services, trusted local risk communication, and stronger coordination among health authorities, humanitarian actors, and community leaders.