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MSF activities in Darfur, Sudan
December 1, 2004
By December 2004, 197 international volunteers and 2,582 national staff for Doctors Without Borders/Médecins Sans Frontières (MSF) were providing emergency assistance in 27 locations in Darfur in areas with more than 600,000 displaced people. MSF doctors and nurses conducted an estimated 78,000 consultations each month. MSF's main activities continued to focus on treating malnourished children in therapeutic feeding centers (TFCs) and supplementary feeding centers (SFCs); treating patients suffering from diseases like respiratory infections, diarrhea, hepatitis E, and malaria; running blanket feeding programs; and providing clean water and improving sanitation to reduce the risk of disease.
MSF Teams carry out medical, nutritional, hygiene and sanitation activities in hospitals, health centers and therapeutic feeding centers. There are currently estimated to be 100,000 residents, and 80,000 Internally Displaced Persons (IDP) in the town. MSF works in the pediatric department of El Geneina hospital and runs a therapeutic feeding center. The hospital operation theatre has been restored and MSF now works in the surgery department. MSF is working in Abu Zhar Camp, located in the center of town with an estimated 8,800 IDPs. A clinic established just outside the camp provides curative and preventive care to the camp population as well as the surrounding community. MSF is also working in Al Ryad Camp, with an estimated population of 15-18,000. A comprehensive outpatient consultation center and a small admission ward have been established. Other activities include antenatal care and nutritional screening. MSF also works on the chlorination of water wells throughout El Geneina town and follows-up a small camp called Madina with a population of about 5,000.
The population of 22,300 IDPs and 7,000 residents benefit from an MSF 20-bed clinic. Blanket supplementary food distribution has been given and therapeutic food treatment is ongoing.
There are 22,000 IDPs living in a camp and 5,000 residents. MSF activities include outpatient consultations and an inpatient clinic with 20 beds. Blanket supplementary food distribution has been done and therapeutic food treatment is ongoing.
There are about 80,000 people living in Mornay, 95% of whom are IDPs. MSF works in the hospital, runs two out patient departments and a therapeutic feeding center. MSF teams also carry out blanket feeding distribution and work on water supply.
MSF works in the pediatric ward; runs two out patient departments; runs a therapeutic feeding center; carries out blanket feeding; and works on water supply. Zalingei has a population of 30,000 residents and 60,000 IDPs.
Niertiti has 15,000 IDPs and 10,000 residents. MSF runs an inpatient department, an outpatient department and a therapeutic feeding center, as well as working on water supply and providing blanket feeding.
MSF is running the outpatient department in Golo Hospital, providing rehabilitation and antenatal care. There is an ongoing measles vaccination campaign in Golo and Gildo which has covered 15,000 people to date.
Garsila, Deleig, Um Kher, Mukjar, Bindisi and Um Dukhum
MSF is running therapeutic, supplementary and blanket feeding programs focusing on children under 5, their families and malnourished pregnant women. MSF is providing basic health and antenatal care through fixed and mobile clinics, as well as in-patient care. MSF is also working on water and sanitation, sexual violence and mental health.
In total, MSF is providing assistance to a target population of more than 350,000 displaced people in West Darfur.
General Health Situation
Teams are giving nearly 54,000 consultations per month in the eleven locations where MSF works. There are currently about 800 inpatient admissions per month into MSF facilities in west Darfur. The main pathologies are still diarrhea, malaria, acute respiratory infections, hepatitis and urinary tract infections.
Malaria is still the main cause of inpatient admission and has remained a major problem towards the end of the rainy season. In Kerenek, malaria accounted for 42% of all inpatient admissions in recent months.
Admissions due to the Hepatitis E epidemic have been particularly high in the Kerenek and Habila areas accounting for 6 to 9% of the consultations in these towns. Hepatitis E admissions are now stable in Niertiti and there has recently been a reduction in cases in Mornay and Zalingei (a total of 5,500 cases in Mornay and Zalingei so far).
There are still sporadic cases of measles, and some children are under TB treatment in Zalingei and Mornay.
The fact that the populations in the camps have been predominantly affected by communicable diseases such as diarrhea and hepatitis can be clearly attributed to the water and sanitation problems associated with crowded temporary settlements. With the onset of the dry season, additional health problems such as meningococcal meningitis, diarrheal diseases, typhoid and shigellosis are anticipated.
In general, the nutritional situation in the camps has dramatically improved over the last month. There are now very few patients in the therapeutic feeding centers in El Geneina, Mornay, Zalingei and Niertiti. More than 5,000 severely and moderately malnourished children have been treated in MSF therapeutic feeding centers in West Darfur to date.
MSF is still distributing survival rations to several sites, to make up for the shortfall in general food distributions made by the World Food Program (WFP). MSF has distributed almost 350,000 supplementary rations so far. These distributions will be end by mid-December and some of our nutritional activities are now being handed over to other organizations.
Living Conditions for Displaced People and Residents
The structure of the shelters varies from camp to camp. Those who were displaced a year ago have more structured semi-permanent housing but those who migrated recently or fled their villages in a hurry are still living in poor makeshift structures in over-extended camps.
The water supply, drainage and sanitation status also varies from camp to camp. MSF reports that a huge amount of work has been done to improve the living conditions of the displaced people in the sites where they are working (Mornay, Zalingei, El Geneina and Niertiti) especially in terms of water distribution. However, there is still much work to be done to improve living conditions in some of the other camps, such as Habilah and Kerenek. A survey conducted in September in these two camps indicated that only 20 to 30% of the displaced population have basic utensils required for daily cooking and carrying water.
Kass, Kalma (Nyala), Shariya, Muharia, Labado, El Seref
The MSF teams carry out about 3,000 consultations a week over the five locations, with a total target population of 225,000 IDPs.
The teams run therapeutic, supplementary and blanket feeding programs focusing on children under 5, their families and malnourished pregnant women. They also provide basic health care through fixed and mobile clinics, as well as antenatal and in-patient care. 20% of patients are under 5 years old. There are also programs targeting victims of Sexual and Gender Based Violence and those suffering from mental health problems. Water and sanitation work continues and there are currently 939 latrines under construction. MSF is providing about 2,500 cubic meters of chlorinated water per day.
General Health Situation
The main diseases seen are watery and bloody diarrhea, acute respiratory infections, eye problems, pneumonia and malaria.
Admissions into the therapeutic feeding center are stable in Kalma, decreasing in Kass and Labado and increasing in Muhajuria and Shariya. In the last week of November there were 805 admissions into the MSF TFCs in South Darfur, and 4,624 beneficiaries of the supplementary feeding program.
The team have shifted the focus of operations from working in the Ministry of Health hospital to running three outpatient health centers in different parts of town. However, supervision of nursing care, consultations and drug consumption continues in the hospital. Over the three months of August, September and October, MSF gave 30,000 outpatient consultations in the hospital outpatient department and the three Kebkabyia health centers. Respiratory infections were the most common health problem. A measles vaccination campaign was completed in Kebkabyia in September, with an estimated coverage of 75%.
MSF is supporting the health center, with a short-stay capacity of 30 beds. It provides an average of 700 consultations per week, 33% of which are for children under 5. There is also a therapeutic feeding center run by MSF in Seraf Umra, currently caring for 62 children. Teams are assessing villages in the surrounding area and providing measles vaccinations.
The team has been trying to set up a permanent base in Korma but work has been interrupted several times because of security incidents. A health center which had been damaged back in March was refurbished by MSF and nurses and medical assistants were given training. The team started giving medical consultations in the third week of November, but had to evacuate on November 24th due to fighting in the town of Tawilla. They have since returned to Korma and are giving 500 consultations per week. The team is also working in Seraf Ayat, a nearby village where there are 1,500 IDPS. MSF has provided food and non-food items and is vaccinating against measles.
Jebel Si region
A mobile team vaccinated 8,000 children in the south region of the Jebel Si during November, and confirmed there to be a measles outbreak in the area. They also did a fast nutritional screening and gave 400 medical consultations, mainly for diarrhea suspected measles cases, respiratory infections and conjunctivitis. The team will now set up a new project in the area, with mobile clinics. A blanket food distribution is planned.
El Fashir, Tunjur, Shangil Tobaya, Dar es Salaam
MSF teams are running therapeutic feeding centers in El Fashir and Shangil Tobaya; supplementary feeding centers in El Fashir, Tunjur, Shangil Tobaya and Dar es Salaam. Outpatient clinics are operating full time in Zam-Zam camp, Shangol Tobaya and Dar es Salaam and twice a week in Tunjur.
Measles vaccination campaign
Teams vaccinated 15,660 children in three IDP camps and eight villages.
General Health Situation
The main diseases seen in the clinics throughout North Darfur are acute respiratory infections, watery diarrhea and skin and eye infections. Malaria cases are dropping significantly since the end of the rainy season. After a peak of 230 cases of malaria in Seraf Umra during the first week of November, malaria cases have now dropped to account for about 5% of all consultations. It is now the winter period and is getting very cold at night so teams are preparing for an increase in problems such as meningitis.