Insecurity and Aid Cuts Imperil Displaced in Darfur

In north Darfur, an MSF nurse looks for vulnerable patients in a crowd of IDPs from the Fur tribe who are waiting outside the health clinic. Photo © Lucy Clayton

Increased insecurity in the troubled Sudanese region of Darfur, combined with decreased international aid, is adding to the misery of the population there. Access to those in need is at an all time low, while disease and violence remain a daily fact of life for the millions who have been displaced since the beginning of the conflict in 2003. Today, most are entirely reliant on the dwindling external humanitarian aid, and the threat of full-scale war is once again looming.

MSF has been running projects in Darfur since early 2004 and today has 123 international and 2,233 national staff working across the region's three provinces. With a total budget in Darfur for 2006 of nearly $25 million, it is one of the most significant operations in the world for MSF.

North Darfur and the Jebel Mara

In Kebkabiya, some 200 kilomters to the north of the provincial capital, El Fasher, MSF is running three dispensaries and providing logistical support and medical supplies to the 67-bed hospital. In El Fasher itself, a cholera outbreak is currently being followed up by the MSF teams. By September 8, 120 cases had been reported, with 6-7 admissions daily. MSF is working to set up a cholera treatment center in the hospital.

A recent spate of insecurity is severely hampering operations in this area, with the projects in Kebkabiya only accessible by helicopter from El Fasher, due to a number of incidents against humanitarian agencies on the road. In Sarif Umra, following an attack by armed men, the project is being run by a skeleton team, while in Korma, the project has been closed due to security constraints.

Ambulatory medical projects are particularly vulnerable to attack on the roads, and an outreach project to Kaguro in the Jebel Mara region has also been put on hold.

The Jebel Mara, a mountainous area in the center of Darfur, has been especially affected by the increased insecurity. In June 2006, MSF began work in clinics in Killin and a month later in Gorni.

However, the project was evacuated for security reasons on July 22, when an MSF convoy was attacked on the Guildo-Golo-Killin road (only access road to Killin). The convoy was robbed and the staff beaten up.

Niertiti is a town of around 3,000 residents and as many as ten times that number are displaced in the foothills of the Jebel Mara. MSF has been running a hospital here since March 2004 and is today the only medical agency working in Niertiti. In the first six months of 2006 1128 hospital admissions were registered. Mobile clinics from Niertiti for local nomadic populations were abandoned in the summer, once again due to insecurity.

In the Jebel Mara itself, MSF has been running a health center in rebel-held Kutrum since March 2006. However, this project was evacuated on September 14.

West Darfur

In Zalengei, which today counts a population of approximately 20,000 residents and 95,000 displaced people, MSF operates a surgical ward and provides pediatric (around 180 admissions per month) and post-operative care (including an influx of 52 injured during several days in December).

In Mornay, the vast camp for the displaced houses around 80,000 people and the population is virtually cut off from external aid. MSF has been working here since 2004 and has constructed a hospital and a health center. In the first half of 2006, an average of nearly 4,900 medical consultations were carried out every month and 293 children were admitted into the MSF nutritional center between April and July.

Bordering Chad, in Um Dukhun, MSF offers surgical care, in-patient care, laboratory services, and general out-patient care including basic health, antenatal, and nutrition.

Outreach workers assist with health education and referrals. Following a recent influx of 12,000 refugees and displaced people, MSF assisted with medical care, a measles vaccination, and provision of non-food items.

In Shangil Tobaya, MSF provides health care services for the displaced people living in the Shangil and Shadat camps, as well as in Shangil Tobaya village. This project was evacuated on July 23 after a security incident and due to the overall deterioration of the security situation in the area. It officially re-opened on August 20 but with reduced activities and international staff.

A man in the local hospital in El Geneina. According to his family, armed men robbed him and then shot him in the head. Photo © Erik Refner

In Habilah, which houses over 22,000 displaced people and a 7,000 resident population, MSF runs a medical clinic with 20-bed inpatient ward. This includes therapeutic feeding for severely malnourished children and antenatal care and delivery. Outreach workers assist with health education and referrals. In Kerenek, with over 22,000 displaced, MSF runs a clinic with a 30-bed ward. Combined, these two projects carry out over 4,500 consultations per month. Mobile clinics provide medical care for mostly nomadic populations around these two areas.

In October 2006, a new project will open in the northern corridor of West Darfur, in the town of Seleah, where about 160,000 people live with very little assistance and access to medical care.

South Darfur

With around 90,000 people, Kalma remains one of the largest displacement camps in the world. MSF is running a primary health clinic with almost 1,000 consultations per week, a women's health center with antenatal and postnatal care, delivery assistance, and treatment for sexual gender-based violence. The project is complemented by community outreach activities and a mental health program addressing the profound psycho-social stress and trauma experienced as a result of the current living conditions and uncertainty, as well as past and continuing conflict-related psychological trauma.

In Muhajariya, a town with a population of more than 45,000, MSF offers surgical care to war-wounded, emergency obstetric services, and inpatient and outpatient departments. Mobile clinic teams provide basic health care services weekly to the towns of Labado and Angabo, as well as assisting displaced communities in the countryside.

In Shariya, despite numerous evacuations due to insecurity, MSF manages to support the local primary health clinic and has mobile teams visiting the displaced around the region, including weekly clinics to Khazan Jedid, Um Shegera, and Teisha when possible.

Emergency preparedness

A primary focus for MSF is to be able to react quickly to outbreaks of disease, fighting or new displacement throughout the whole region. In the past months, emergency teams have responded to an outbreak of watery diarrhea and cholera in Kalma camp, organized measles and meningitis vaccinations, and distributed plastic sheeting and emergency food rations to new groups of displaced. Currently, MSF is also working in Mornay to combat a cholera outbreak which has already claimed eight lives.

MSF is also continuously lobbying for increased aid and improved access in the region.