March 06, 2009

On March 4 and 5, the Government of Sudan ordered a number of organizations, including the Dutch and French sections of Doctors Without Borders/Médecins Sans Frontières (MSF), to stop all their medical relief programs. This expulsion has serious medical and humanitarian consequences for the population of Darfur, one of which is that the outbreaks of meningitis in Kalma camp and at the base of Jebel Marra mountain range will possibly go without a medical response. This leaves an estimated 121,000 people in urgent need of vaccinations. MSF’s Dr. Anne Loarec explains.

Had outbreaks already been identified?

An outbreak has already occurred in the Kalma camp. The camp is near Nyala, the capital of South Darfur, where around 90,000 displaced persons live alongside approximately 40,000 people in the surrounding villages.

At the beginning of February, MSF teams started to notice suspected cases of meningitis. A surveillance system was immediately established to identify cases and ensure that MSF would be able to respond. A treatment facility was also set up and patients were referred to Nyala hospital.

An outbreak was officially declared by the Ministry of Health on March 2. To date, 32 cases have been seen, four of whom have died. Most cases occurred in the five to 14 age range.

What is the extent of the meningitis epidemic at the base of the Jebel Marra?

MSF teams in Niertiti have seen 17 suspected cases of meningitis since February 9. Laboratory tests have confirmed cases of meningococcal A meningitis. Patients have come from two areas: Thur, just east of Niertiti, and from several towns within the Jebel Marra. The epidemic threshold has been crossed in Thur and the alert threshold has been reached in the Jebel Marra.

How serious is the disease?

Meningitis is a very serious disease. If the patient receives appropriate and rapid treatment, the mortality rate is five to 10 percent. Without treatment, bacterial meningitis kills up to 50 percent of infected patients. MSF teams on site estimate that more than 15,000 people need to be rapidly vaccinated in Thur, 25,000 in the Jebel Marra, and 130,000 in Nyala and its surroundings.

What is the risk that the situation will worsen?

It is the middle of the dry season, which helps spread the disease. The air is dry and dusty and the body does not produce as much mucus or saliva. This means the throat does not serve as a barrier, and bacteria can enter the body more easily. People in Thur and in Kalma camp live in crowded quarters, which contributes to the spread of infection. These populations had not been immunized because the vaccine is usually only delivered during an epidemic.

In Niertiti, the risks are limited because MSF conducted a vaccination campaign last year, vaccinating approximately 20,000 people between the ages of two and 30 following an epidemic. However, in Thur and Kalma camp, the population has not been vaccinated against meningitis for several years and the vaccine is effective for only three years. In Kalma camp alone, 136 vaccinators were trained and a vaccination campaign was due to commence on March 7, with vaccines being flown from Khartoum to Nyala.

Vaccination campaigns are required to prevent further disease and death. We can only hope now that the Ministry of Health or remaining NGOs—if any—will take over this responsibility.

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