October 25, 2007 Darfur: New Attacks, More Displaced
"The media attention and political involvement means that everyone knows about the conflict here, but in the last four years the situation has not improved. In fact for most people things have gotten worse. Conditions in many of the camps and rural areas have deteriorated and the insecurity is a major concern for ordinary people. People are living in fear. Every day is a question mark for survival."
Banu Altunbas, MSF Head of Mission in South Darfur
As peace talks get underway in Libya, international attention will be focused once again on Darfur. Four years on the conflict continues. The fighting may be less intense than it was in 2003-2004, but it has become increasingly complex. Armed groups have split into a number of factions that fight for different interests. Alliances can change suddenly. Towns and displaced people's camps can be attacked with little warning. The impact on the civilian population is devastating. People live on edge, many of them ready to flee at a moment's notice. Those that have found refuge in camps or settlements near towns struggle to survive. Food aid is limited, medical services scarce and in many places humanitarian aid has actually deteriorated over the last two years.
Continued Displacement
As the conflict in Darfur becomes increasingly complex, and more and more armed groups pursuing different interests emerge, the violence shows no signs of diminishing. Camps for internally displaced people (IDP) litter the region, home to hundreds of thousands of people. MSF works in 11 of the largest camps, providing medical aid to around 300,000 displaced people as well as thousands of other displaced people who have gathered to form settlements near towns like Kebkabiya or Serif Umra.
People are still being displaced on an almost daily basis. In many of the places where MSF works new arrivals are putting more pressure on an already fragile situation.
"The aid that was implemented in Zalingei, West Darfur, in 2005 is still the same," explains MSF Medical Coordinator Mathilde Berthelot, "but the situation has changed dramatically. There are now more than 100,000 people here and hundreds of new people have been arriving every month for the last two years. For example, a number of nomadic families have come and settled in a new camp, which is now home to 15,000 people. Some of the newly displaced families have problems registering for food distributions, so the older displaced families have to share their rations with the new comers. Aid organizations need to adapt to the changes that are happening in Darfur"
In some parts of Darfur worrying signs of malnutrition are emerging. Food aid is being distributed, but it is not enough. Between July and September 2007 the number of severely malnourished children admitted to Zalingei hospital and Niertiti health center was three times higher than during the same period in 2006. This is the first time in three years that MSF teams have seen an increase in malnutrition in these areas. MSF has responded by admitting more children into its hospital program and by opening outpatient nutritional program. Hundreds of children are being treated on a weekly basis.
Challenges and Frustrations
Working in Darfur has its multitude of challenges and frustrations. MSF staff are faced with huge needs but also huge limits on what they are able to do. In a number of towns people are completely cut off from assistance. This is the case in Kaguro, a town in the Jebel Si at the foot of the Jebel Mara, which is controlled by rebel groups. The roads are so dangerous that the only way to get to Kaguro, and many other places in Darfur, is by helicopter. MSF is the only medical organization working in Kaguro. The health clinic is stretched to capacity, providing on average 3,500 consultations every month. Patients sometimes walk for 5 or 6 hours to get to the clinic, often at great personal risk. In the next few months MSF will attempt to open more health posts in the Kaguro area so that people will not have to make such long, dangerous journeys to receive medial care.
Many towns where MSF works are like enclaves, with the civilian population unable to leave. Patients, especially men, fear for their lives when crossing the frontline from rebel-held land into government controlled territory or vice versa. In towns like Kaguro or Kutrum referring patients who need surgery, such as people injured in fighting or women who need cesarean sections, to hospitals in Kebkabiya or Niertiti is difficult. MSF is unable to take them by car as the roads are unsafe. At times MSF staff have not had the facilities or equipment to treat some conditions and have had no option other than suggesting that patients make their own travel arrangements to get to a major government hospital.
Unable to Provide Continuous Assistance
In some parts of Darfur, humanitarian aid has decreased over the last two years, either because it is too dangerous for aid organizations to start work, or because they have been forced to evacuate for security reasons. The latter is the case in Tawila, a remote town in North Darfur, where MSF has recently started working in three camps — Dali, Argo and Rwanda. These camps, home to around 33,000 displaced people, are on the outskirts of Tawila, located around the African Union base where people felt a bit safer. In the past a number of organizations worked in Tawila, but by April of this year they had all left because of the ongoing insecurity. An estimated 35,000 people were left behind with no medical assistance. MSF started running mobile clinics in the camps, but the team had to be evacuated due to security incidents six weeks later and was only able to return to Tawila in mid October.
And Tawila is no exception. The insecurity regularly forces MSF to evacuate its international staff, leaving the population with little or no assistance. The only way that MSF is able to continue providing medical care is through the dedication and hard work of the organization's Sudanese staff. When armed groups attacked the town of Muhajariya, in South Darfur, on October 8 and 9, MSF had no choice but to evacuate 16 of its staff. While local Sudanese staff continued to treat around 100 patients a day, more than 35,000 people living in Muhajariya and its immediate vicinity were directly affected by these attacks and were in urgent need of humanitarian assistance. A skeleton team with additional medical supplies returned to the town two weeks later to support the main clinic and continue with mobile clinics for thousands displaced north of town.
On the morning of October 18, ongoing tension between different factions inside Kalma camp, one of Darfur's largest IDP camps, erupted in a violent clash between unidentified armed groups. Thousands of people fled to the surrounding bush and other camps or villages in the area. MSF, which has worked in Kalma since 2004, had to leave the camp to avoid being caught in the crossfire. Three days later the MSF team was able to restart activities and is now carrying out roughly 250 consultations per day, half at a clinic in the camp and half through a mobile team who are trying to reach the people who fled the camp. Large numbers of people appear to have left three of the camp's eight sectors; they have either moved to other sectors or left the camp.
Conclusion
Working in Darfur is a constant challenge. Aid organizations must be flexible and ready to respond to the difficulties of providing assistance in such a rapidly changing, complex, and unstable environment. Yet the frustrations and restrictions that MSF's staff face are nothing compared to what our patients endure on a daily basis. Four years on, with significant international attention on the crisis, the situation on the ground in Darfur only seems to be getting worse.
