Every day, Amina Khalafallah spends 10,000 Sudanese pounds ($1 at the parallel market rate) on water for herself and her four children. Over a 30-day month, that amounts to 300,000 pounds ($30) – the equivalent of her entire monthly salary.

Khalafallah lives in the Deim Mayo neighbourhood of Port Sudan, in eastern Sudan, where her home is not connected to a piped water network. Instead, she depends on street vendors, who charge 1,000 pounds ($0.10) for 18 litres.

Khalafallah works in a cafeteria at a private institution, while her husband works in another state and sends money to help her out when he can.

Between them, the family barely scrambles enough money to get by, but Khalafallah says she often has to borrow money. It’s a typical story in Sudan, where, according to the United Nations Development Programme (UNDP), the country’s more than three-year-long war has pushed average incomes back to levels last seen in the early 1990s. The hotter months bring additional challenges, as water prices rise and vendors become harder to find.

“We make sure to set aside money for water in the summer before covering our other household needs, even if that means going without some essentials,” Khalafallah told Al Jazeera.

According to the African Development Bank (AfDB), access to safe water is one of Sudan’s most urgent needs, with millions of children at risk of waterborne diseases.

In Port Sudan, relatively safe from the fighting that has plagued other areas of the country, the arrival of people displaced by the war has put additional pressure on already fragile infrastructure. The AfDB has reported that the city’s water supply was meeting less than 40 percent of demand.

One of the major issues Port Sudan has faced is the collapse of the Arbaat Dam. Located in the Red Sea Hills northwest of Port Sudan, it once supplied half of the coastal city’s daily water needs.

But in August 2024, heavy rainfall and flooding caused the dam to collapse, destroying villages downstream and damaging pipelines and wells. As a result of the collapse entire neighbourhoods are dependent on expensive water deliveries by truck.

A donkey-drawn cart, locally known as a ‘karo’ or ‘saqqa’, used to transport water in Sudan. Each cart carries about 250 litres [Fatima Edam/Al Jazeera] Rising costs for water vendors Ahmed Osman, 30, has spent the past three years working at a water distribution station that supplies street vendors who deliver water to households.

When Sudan’s war began in April 2023, Osman said he charged vendors 4,000 Sudanese pounds ($0.40) to fill a donkey-drawn cart carrying at least 250 litres of water.

Those prices have since risen sharply, he said, because of increasing operating costs, particularly the fuel needed to transport water to his distribution station.

“A water tanker carrying 50,000 litres of water now costs 1.5 million Sudanese pounds [$150], compared with about 450,000 pounds before the war,” Osman told Al Jazeera.

Osman keeps the water in storage tanks before pumping it into the vendors’ carts. He charges 16,000 pounds ($1.60) to fill a cart carrying 250 litres.

After his expenses, Osman typically makes a profit of about 70,000 pounds ($7) per day, split between him and his partner.

Ahmed Osman works at a water distribution station supplying street vendors in the Deim Mayo neighbourhood of Port Sudan [Fatima Edam/Al Jazeera] Repairs yet to end water shortages Rehabilitation work has restored parts of the damaged water network.

According to the UNDP, the restoration work has included drilling or rehabilitating 15 boreholes, laying 17 kilometres (10.5 miles) of new pipelines, as well as installing solar-powered pumps. The UNDP said the restored system could supply water to nearly 230,000 people.

However, that would still not be enough to supply water to all of Port Sudan, which the UNDP estimates to now have a population of one million people.

Other projects are therefore necessary to meet the water needs of residents – including one launched in June by the AfDB and UNICEF, which intends to expand access to safe water for up to 750,000 people in the city.

Water shortages threaten public health Emad Hafez, medical director of the emergency department at Port Sudan Teaching Hospital, told Al Jazeera the water crisis poses serious risks to public health, increasing the risk of waterborne diseases and making it harder for families to maintain basic hygiene.

He warned that disruptions to water supplies can force families to rely on untreated water, increasing the risk of cholera and other diarrhoeal diseases, particularly during the rainy season and in overcrowded displacement camps.

“Water shortages can also make it harder for families to maintain adequate hygiene, increasing the risk of skin infections and other hygiene-related illnesses,” Hafez said. “Meanwhile, storing water in uncovered containers can create breeding sites for mosquitoes, raising the risk of vector-borne diseases such as malaria and dengue fever.”Water shortages also threaten healthcare services, Hafez said, explaining that hospitals require reliable supplies for infection prevention, cleaning and patient care.

“Beyond its immediate health consequences, water insecurity can worsen food shortages and malnutrition by disrupting agricultural activities and placing additional financial pressure on already vulnerable households,” he said. “Children under five and pregnant women are particularly vulnerable to the effects of inadequate nutrition.”