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Darfur: "Medically Stable, but Humanly, Completely Unacceptable"

November 6, 2006


Women draw water from Tawilla's main water point as their children fasten filled jugs on the backs of their donkeys. Photo © Jehad Nga

Dr. Rowan Gillies, International Council President of Doctors Without Borders/Médecins Sans Frontières (MSF), recently returned from a visit to Khartoum and Sudan's Darfur region. In the past year, MSF has experienced more than 40 violent security incidents, forcing the organization to close or reduce the staff of the majority of its assistance programs in the Jebel Marra region. In western Darfur, MSF can no longer refer surgical patients and has had to postpone relief efforts for some 160,000 people living with little access to assistance or medical care in the town of Seleia. While in southern Darfur, MSF teams have had to evacuate the towns of Muhajariya and Shariya on numerous occasions. Dr. Gillies met with Sudanese government officials to express MSF's concerns over the worsening security situation in Darfur as well as to assess the humanitarian needs in the region. Here he discusses the current situation.

You worked in the west Darfur town of Mornay in July 2004, and now you just returned in October 2006. What has changed?


"These people have been stuck in these camps for more than 30 months. They cannot go outside of the camp to collect the basic necessities of life like food and water because they have a high risk of being killed or raped. And these are supposed to be the lucky ones; the people who were able to access some assistance."
– Dr. Rowan Gillies, MSF International Council President
The situation has certainly changed since I was in Darfur over two years ago. At that time, there were people who had been newly displaced within the previous six months. There had been massive violence and killings against large swathes of the population. The people in the camps required immediate assistance—food and water. There were outbreaks of diseases like hepatitis E. There was a need for a massive humanitarian response, and at that stage the response was just starting to scale up. Today, the situation is quite different. MSF has had to reduce its activities due to intensified fighting and mounting insecurity throughout Darfur. When it comes to medical data within the so-called islands of assistance—the large displaced persons' camps in the government-controlled towns—that we can actually access, some of the parameters are okay, in terms of nutrition and mortality. However, there is a crisis of human suffering. These people have been stuck in these camps for more than 30 months. They cannot go outside of the camp to collect the basic necessities of life like food and water because they have a high risk of being killed or raped. And these are supposed to be the lucky ones; the people who were able to access some assistance.



A child is vaccinated against polio by an MSF staff member in Kebkabiya. Photo © Jehad Nga
This insecurity is happening to varying degrees around Darfur. There are many places that MSF cannot get to because of the security situation and we simply don't know how these populations are coping. We recently responded to a displacement of 35,000 people in Muhajariya in southern Darfur. These people had been displaced just in the past three weeks. They have acute needs for water and food. And if they stay displaced they are going to face the same problems of the people who fled their homes in 2004. The situation of the people is what you could describe as medically stable, but humanly, completely unacceptable.

MSF has been working in Darfur for more than two years, yet this year there have been over 40 violent security incidents involving MSF staff in Darfur—the majority of which have occurred on roads and in cities controlled by the Sudanese government. Are we being targeted?

There have been a number of violent attacks on MSF, ranging from banditry to attacks that are obviously targeted against aid workers. We don't think specifically against MSF, but certainly against aid workers. A number have happened in government-controlled areas as well as other parts of Darfur. Whoever is in charge, and especially the government, must take responsibility for what happens in the areas they control. These targeted attacks have led us to stop activities, meaning that, as medical humanitarian workers, we have been forced to make the difficult decision to leave populations that need assistance because it is just too dangerous to try to reach them. And that has happened most recently in the Jebel Marra mountains in the midst of a cholera outbreak, where we had to pull out our teams. We had to reduce our teams when we should be increasing them to provide lifesaving care. Today in the Jebel Moon area, it remains very difficult to assess the situation of people displaced by the recent fighting..

Are these attacks part of a strategy to limit aid?

It is difficult to know. There are plenty of people predicting what strategies exist and don't. The actual final result is that the aid is being reduced to these people. There are certain people who need medical assistance and aren't getting it, and we don't know what is happening in a large part of Darfur. That is the result, whatever the strategy happens to be.

You met recently with Sudanese government officials in Khartoum to raise our concerns. What was their response? Are they prepared to take any action?




Mothers sit with their children under a tree before the children are examined by MSF clinic staff. Photo © Jehad Nga
The ministers that I met made it clear that they are responsible for the safety of humanitarian aid workers in the areas that they control. There was a positive response from these officials to ensuring the safety of humanitarian workers and our ability to move freely to independently assess the needs of the affected populations. But it remains to be seen if their assurances will be matched with action on the ground and that means the concrete existence of an ability to move along roads in Darfur. Today that is still not the case

MSF has a number of programs that, until recently, were built around a referral system for patients in need of surgery, but we can no longer transfer these critically ill patients because the roads are too dangerous. In 2004, I drove on most of the main roads in Darfur. Today, all but one of the main roads is too risky to travel on. All staff movements need to be done by plane.

Some humanitarian aid organizations have taken a position on the deployment of UN peacekeeping troops in Darfur. What are the dangers inherent in taking this kind of stance?

It is frustrating when you are working in Darfur and you see violence against civilians, and you see women coming into your clinic after they have been raped, and you see a nasty war going on and a reduced ability to provide assistance. There is a desire to find a solution, and a temptation to advise a 'quick fix' to resolve the situation, however illusory it may in fact be. However, the responsibility of humanitarian organizations is to assist populations and describe what they see. That is the way we see our responsibility.



A baby girl eats a biscuit while waiting with her mother in one of MSF's outpatient feeding centers in Kebkabiya, northern Darfur. Photo © Jehad Nga
Once humanitarian organizations become involved in peace negotiations or engaged in calls for military intervention, they are stepping outside of their humanitarian responsibility. Some humanitarian aid organizations have called for an armed intervention in Darfur. The problem is that these organizations are damaging—really compromising—the neutrality of humanitarian aid organizations, which is essential for working in war zones and crucial for the safety of humanitarian aid workers. MSF needs to maintain our neutrality to allow us to negotiate with combatants on all sides of a conflict in order to access populations in danger.

Once you start recommending an armed intervention—especially one that could potentially end up being without the consent of the government—you are essentially recommending that another party should enter the war. As a humanitarian aid agency, that is something we must not advise one way or another. It is not our role to choose sides in a conflict since such actions can put our staff in grave danger and deny the very argument of neutrality that allows us to work in the first place.

Tags: Sudan, Mental Health, Darfur

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