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Darfur: Operational Update
December 1, 2008
MSF in Darfur
MSF has provided medical humanitarian aid in the Sudanese region of Darfur since 2003, when government forces and allied militia began fighting rebel groups seeking greater autonomy for the arid and impoverished region. In 2007, the political environment became increasingly complex, with the continued fragmentation of armed groups leading to outbreaks of violence and heightened insecurity. Aid organizations, including MSF, were the target of numerous attacks and robberies, at times making the continuation of aid extremely difficult. Harassment from members of armed forces, increased banditry, and clashes between nomadic tribes has led to new population displacements. The United Nations says that up to 300,000 people have died and more than 2.2 million have fled their homes since the conflict in Darfur erupted in February 2003. As of December 2008, MSF has 102 international staff and 1,625 national staff working in Darfur.
Following the evacuation of Seleia in February 2008 as a result of a military offensive, many people continue to live in several different areas scattered around the town. MSF teams are working in the so-called “northern corridor,” north of El-Geneina, the capital of West Darfur, running mobile clinics in five locations: Sirba; Abu Suruj; Seleia; Arafa; and Juruf. MSF is providing basic health care consultations, with an average of 170 consultations per day including antenatal care and referrals to El Geneina hospital. In this area, MSF is the only health actor providing basic health care in some locations, such Arafa and Juruf. However, the numerous constraints have meant that MSF teams were only able to run mobile clinics for 49 days in the last four months.
In April 2008, MSF opened two new projects in Golo and Killin, home to around 85,000 people, in the mountainous Jebel Mara region. In Golo, MSF teams are working in the town’s hospital, providing primary and secondary health care with both inpatient and outpatient capacity, obstetric care, and nutritional care. In Killin, MSF provides primary health care, including a small emergency room, in the town’s clinic, in addition to an outpatient nutritional program. In the first five months of activities, the MSF team performed 20,897 outpatient consultations, as well as 1,143 antenatal care consultations. A total of 447 patients were admitted to the hospital and the team performed 87 deliveries, 56 percent of which were complicated deliveries including four caesarean sections. There were 752 children admitted to the nutritional program.
In nearby Niertiti, where the population totals approximately 33,000, including around 20,000 displaced people, MSF provides outpatient and inpatient care in a health clinic. From January to September 2008, MSF teams performed an average of 6,000 consultations and 400 hospital admissions per month, of which 39 percent were children under five years old. Diarrhea, respiratory infections, and malnutrition are the main causes of hospitalization. In the therapeutic feeding center of Niertiti hospital, 986 malnourished children were hospitalized for medical complications. In February 2008, following a meningitis outbreak, 35 patients suffering from this disease were admitted to the clinic. In response, MSF launched a mass vaccination campaign, vaccinating over 28,000 people between two and 30 years of age, in five days.
Visits to Thur, where MSF runs an outpatient clinic, are quite difficult due to the insecurity in the area. The clinic serves the population of Thur as well as the nomadic population in the area. When possible, the teams now go there three times a week; an average of 1,320 consultations are provided per month.
In Kutrum, a rebel-held area, MSF staff run a health clinic that provides around 1,800 outpatient consultations each month and refers emergency cases to Zalingei hospital. In the first nine months of 2008, MSF teams performed 16,028 consultations, mainly for diarrhea and respiratory infections. About 1,840 antenatal consultations were performed during this period. An average of 17 patients are transferred per month to Niertiti, mainly for obstetrics.
As this southwestern part of the Jebel Mara has extremely poor immunization coverage, MSF is concentrating on vaccinating children between six months and 15 years of age. Two vaccination campaigns have already taken place, providing routine vaccinations to more than 26,000 children against diseases such as polio and measles. A third campaign was scheduled for October 2008. To continue routine vaccinations into the future, MSF runs a vaccination clinic in Kutrum, and is supporting a clinic in Kurifal to cover the population in the northern area of Jebel Marra.
MSF works in three departments of Zalingei hospital, supporting pediatric surgery and the emergency room. Between January and September 2008, the pediatrics department had 1,468 admissions, mainly for respiratory diseases. MSF teams also work in two camps for displaced people around Zalingei, providing nutritional care and transferring patients with medical complications to the reference hospital. From the beginning of the year up until July 2008, around 1,200 malnourished children had been admitted to the nutritional program. Since February this year, MSF teams have been providing mother and child healthcare in Hassa Hissa camp. By the end of September, the MSF teams in Hassa Hissa had provided around 10,950 mother and child consultations, predominantly to children under five years.
To try to limit the number of children suffering from malnutrition during the May-to-October hunger gap, MSF teams have distributed supplementary food to thousands of children between six and 36 months old in and around Zalingei. Around 11,000 children, both resident and displaced, received four weekly rations in May and June, but due to government restrictions this program was interrupted and has not resumed yet.
In the town of Kebkabiya, 150km (about 93 miles) west of North Darfur’s capital of El Fasher, MSF supports two dispensaries and one health post, providing basic health care, including vaccination and treatment of malnutrition. MSF also supports the obstetric department of Kebkabiya hospital and provides comprehensive emergency obstetric care. In addition, a team of home-visitors work in Kebkabiya town. They carry out health promotion, ensure that people adhere to specific treatments, and refer patients to other health structures when necessary.
As other organizations, such as UNICEF and the World Health Organization (WHO), are giving increased support to the hospital and the health centers, MSF will gradually hand over its activities in Kebkabiya to the health authorities in 2009. MSF teams will continue to treat malnutrition until the end of the hunger gap, next autumn, and will keep lobbying the World Food Program (WFP) to ensure regular food distributions. While decreasing its presence in Kebkabyia, MSF is looking at assessing other areas of North Darfur where civilians are still cut off from assistance.
In Jebel Si, MSF runs a dispensary in Kaguro and five health posts in the surrounding area. This dispensary and the health posts provide medical care to around 80,000 people who have been cut off from assistance since 2003, when the area was attacked and most villages were burned down. MSF teams in the dispensary provide outpatient and inpatient care, antenatal care, nutritional support and immunization. In the health posts, outpatient and antenatal care are offered. In 2008, an average of 4,500 consultations were provided, more than 40 patients were hospitalized and around 25 severely malnourished children were cared for each month.
As Jebel Si is a rebel-held area, it is extremely difficult to refer patients to health facilities that are outside the area, such as Kebkabiya hospital. To address this problem, MSF is developing the emergency surgical capacity of the Kaguro dispensary.
In Serif Umra medical teams provide primary health care, including vaccination, antenatal and inpatient care, and treatment of malnutrition. Each month, around 4,000 consultations are carried out, 110 patients are admitted to the dispensary, and more than 45 children receive nutritional care. Currently, when security conditions permit, patients in need of surgery or complicated secondary health care are transferred to hospitals in Zalingei or El Geneina. In the coming months, MSF plans to expand its activities in Serif Umra and offer emergency surgical and obstetrical care.
In Shangil Tobaya, 65 km (40 miles) south of El Fasher, MSF provides medical care for the approximately 28,000 displaced people who live in the Shangil and Shadat camps and to an additional 5,000 people in the surrounding villages. MSF provides inpatient and outpatient care, a therapeutic feeding program, reproductive health services, and treatment for victims of violence. Staff provide around 4,000 outpatient consultations and deliver 15 babies every month. Due to the constantly changing security situation in different areas of Darfur, there is a near constant influx of newly displaced people in these camps. MSF monitors the status of these new arrivals and provides the most urgent cases with additional assistance.
MSF started working in Tawila, 60 km (37 miles) west of El Fasher, where close to 35,000 displaced people have gathered in three camps, in August 2007. MSF set up mobile clinics in these camps, focusing on nutritional care and mother-and-child health care, and a 25-bed inpatient department in Tawila town. In 2008, MSF expanded its services, not only in Tawila but also in a number of villages in the surrounding area, where many people had lacked access to health care since 2003. The expanded services include outpatient and inpatient care; nutritional care; and vaccination. However, a recent security incident has forced the international team to be evacuated.
Since March 2008, fighting between two groups in Sania Afundu, around 60 km (37 miles) southeast of South Darfur’s capital, Nyala, has displaced around 60,000 people. Although the ongoing insecurity makes it difficult to reach these people, MSF has provided around 10,000 people with non-food items, such as jerry cans, blankets, and clean water.
Kalma camp, home to around 90,000 people, is one of the largest camps for displaced people in Darfur. MSF has worked in the camp since May 2004. Staff run an outpatient department, which provides an average of 4,500 consultations every month. MSF is also focusing on mother-and-child care and running a women's health center, with up to 200 consultations per day. The center provides antenatal and postnatal care, as well as delivery assistance for high-risk pregnancies and referrals for obstetric emergencies. Medical treatment is offered to survivors of sexual violence. The MSF team also responds to the emergency needs of new arrivals whenever necessary.
Following hostilities in Kalma Camp at the end of August, more than 65 wounded were admitted to the MSF clinic and 52 of the most severely wounded were evacuated to Nyala Teaching Hospital—over half of whom were women and children. Five of these severely wounded patients subsequently died.
Since May 2008, only half-rations of food have been provided in Kalma Camp. While malnutrition has not reached alarming figures yet, this lack of food will most certainly have a negative impact on the health status of the population in Kalma Camp. MSF is very concerned and urges the WFP to start providing full food rations again.
At the beginning of November, the government instructed MSF to stop admitting new patients into the mental health program which had been providing medical care to people suffering from profound psychological stress and trauma due to tenuous living conditions and the long-running conflict in Darfur. Since the mental health program started in 2006, a total of 1,600 patients have been treated with 84 percent showing improvement or a complete resolution of their symptoms. MSF regrets the fact that we will not be able to continue treating mental health patients and that we were unable to convince the authorities of the vital medical nature of this activity.
Through a 25-bed clinic, MSF provides medical care to around 70,000 people living in and around Muhajariya, a large town in South Darfur. MSF staff offer surgical care and run inpatient and outpatient departments and a laboratory, in addition to providing reproductive health services. Treatment for survivors of sexual violence is also available. As a result of 2007’s bad harvest and the annual hunger gap, there was an increase in malnutrition, so MSF started therapeutic feeding for children in Muhajariya. In April 2008, MSF also restarted mobile clinics in the nearby areas of Labado and Um Shegeira to enable better access to healthcare for the population living in the vast area of Jebel Mara, where a two-hour trip by car takes up to a full day by donkey. To date, more than 450 malnourished children have been assisted through the MSF clinics. However, insecurity often prevents MSF teams from visiting these two locations.
In the mountains of the eastern Jebel Mara, an MSF team in Feina runs a clinic providing outpatient care, antenatal care, and an ambulatory feeding program. There is also an inpatient department for severely malnourished children and emergency cases that require overnight care. The travel distances can be very long in such a mountainous area. For example, traveling from Gulombei to Feina can take up to six hours by donkey. Since May 2008, MSF has run a mobile clinic in Gulombei, with a focus on children under five and pregnant women. This MSF mobile clinic treats children for the most common diseases, like diarrhea and respiratory infections, and provides antenatal care for pregnant women. The Gulombei mobile clinic means that patients from even further away in this mountainous area, where the population is widespread, can access health care. In Feina and Gulombei, MSF sees about 3,000 patients per month.
Ongoing insecurity has meant that people living in and around Adila, in the east of southern Darfur, near Kordofan, have been cut off from significant humanitarian assistance for the last four years. In March, an assessment in Adila found a 14 percent rate of acute malnutrition. MSF teams responded by opening an inpatient feeding center and ten ambulatory feeding centers in April. By the end of October, more than 4,700 malnourished children had received treatment in the centers.
View the Darfur operational update from July 2008.