This paper analyses the changing patterns of infection with Schistosoma mansoni and S. haematobium in the Gezira Irrigation Scheme, Sudan. Taking a historical perspective, it shows the way in which factors such as ecology, biology, social and economic variables and politics have shaped patterns of infection, and how different kinds of strategies have been developed to control schistosomal infection over time. Wider political and economic issues at both national and international levels have shaped these strategies, influencing the prevalence and intensity of schistosomal infection at a local level. By highlighting the inter-play between the above-mentioned factors, the article reflects on the wisdom of prioritizing community-directed mass drug administration for the control of schistosomiasis in Gezira and elsewhere. The review demonstrates that not all efforts to control schistosomiasis are sustainable. A comprehensive control strategy involving political commitment, community participation and socioeconomic development is important for sustainable control of schistosomal infection.