July 26, 2006
Unable to defeat the rebel movements that emerged in the Darfur region of western Sudan in 2000, the Sudanese government started punishing the rebels' base of social support. In May 2003, the government launched widespread attacks against the civilian population, accusing it of supporting the rebellion in Darfur. The army and paramilitary forces–often called janjaweed–carried out assaults on the Fur, Massalit, and Zaghawa populations. Killing, burning of villages, looting, torture, and rape caused huge population displacements. By the end of 2004, nearly two million people had been forced to flee their villages to take refuge in Chad or in towns controlled by the army. Despite the signing of a peace agreement in early May, violence has escalated. While the government and rebels have clashed and attacks on civilians have continued in certain areas of Darfur, fighting between different branches of the rebellion has increased, plunging Darfur into deeper insecurity.
The situation in the state of West Darfur, where I was the head of mission for MSF in February, illustrates the daunting task of assisting the conflict-affected Darfurian population. MSF is trying to meet the ongoing medical needs of hundreds of thousands of displaced people who are too scared to return to their homes and continue to live in camps that amount to open-air jails. At the same time, MSF needs to remain flexible enough to respond to emergencies both in and outside of the camps.
The past few months have tested MSF's flexibility. Our teams have responded to several intense bouts of violence in all three states of the Darfur region. On May 8, MSF treated 46 wounded people following an attack on the town of Labado in South Darfur state. The MSF team worked through the night operating on gunshot wounds to abdomens, shoulders, arms, legs, and chests. An MSF team in Muhajariya, also in South Darfur, received a steady influx of casualties during the month of April, admitting 127 patients with violent trauma.
When the town of Golo in North Darfur state and its surroundings were attacked at the end of January, uprooting 60,000 people who fled to the neighboring mountains, MSF teams were forced to evacuate the town. Since then, MSF has been trying to reach the displaced in the face of numerous attacks on vehicles operated by humanitarian aid agencies, including several of MSF's. In recent weeks, in the three states of Darfur, a spate of serious security incidents affecting MSF and other organizations has impeded movements and limited the possibility of providing assistance.
The violence has spilled over into Chad. The same paramilitary forces that launched attacks in Darfur have been implicated in fighting in eastern Chad. This fighting, combined with the emergence of various rebel groups in eastern Chad that is seeking to overthrow the government in N'Djamena, has increased the instability for the local population and the more than 200,000 Sudanese refugees living in camps there.
During the second week of May, at least 10,000 people fled attacks on villages in southeastern Chad and crossed the border to take refuge in Um Dukhum, a small town in the southwestern corner of Darfur, located near the junction of Sudan, Chad, and Central African Republic. Most of the new arrivals were Chadian, but the displaced also included Sudanese who fled the conflict in Darfur up to three years ago and had been displaced again.
The refugees told MSF that their villages in Chad had been attacked, usually in broad daylight, and that their animals, food stocks, money, and even their clothes had been looted. The MSF team in Um Dukhum treated more than 20 people with violence-related injuries, including those caused by gunshots, axes, swords, and beatings. Following their arrival, the MSF team provided basic medical assistance, vaccinated 5,200 children against measles, and supplied plastic sheeting for temporary shelters.
Bearing an increasing workload
Beyond the ongoing violence, MSF is facing the possibility of fewer aid agencies operating in Darfur. MSF is not an exception, having been forced to suspend some of its activities in recent weeks. Some aid agencies have had to evacuate certain regions of Darfur due to insecurity and attacks. Moreover, for months, nongovernmental organizations that depend on government funding have been forced to cut back their programs. If other aid agencies reduce the scope of their programs, if the quality of the water delivered becomes inadequate, if malnutrition rates increase, if epidemics emerge, MSF teams may have to compensate, and our own capacity is already reaching its limits. In March alone, MSF responded to an outbreak of meningitis with a vaccination campaign for 100,000 people in Zalengei, a town in West Darfur.
Funding streams for organizations that rely on government support have been tenuous at best. The US Agency for International Development/Office of Foreign Disaster Assistance has reduced its 2006 fiscal year budget by 40 percent. The funds were only later replenished through an emergency spending bill. These uncertainties can lead to serious breaks in the pipeline of aid for a displaced population that is almost exclusively surviving on humanitarian assistance.
In April, the World Food Program (WFP) announced that it was halving its food allocations for the displaced because of large funding shortfalls. WFP received increased funds after this announcement, but it is still incapable of providing full food distributions. Other than these food distributions, displaced Darfurians have virtually no resources to ensure their survival. People cannot farm because of the insecurity that reigns outside the camps. At most, they can earn a little money selling firewood gathered in the nearby bush, but even there they risk being attacked.
And the toughest months lie ahead. The months of July to October bring both the "lean" period and the rainy season. The first is characterized by limited food in the markets and among families who are still able to farm and would ordinarily be in a position to help their neighbors. The rainy season is traditionally associated with an increase in potentially life-threatening diarrheic illnesses.
Over the past year, temporary breakdowns in the food distribution system have resulted in a significant increase in malnutrition. In Mornay, where 75,000 displaced people are housed, the number of admissions for severe malnutrition in the MSF hospital rose from 10 to 20 admissions per month from January to May 2005 and from 80 to 120 admissions per month from July to October. This increase, which coincided with delays in food distributions to the camps, is too great to be the result of seasonal fluctuation.
The importance of independence
One of the challenges of working in Darfur is to overcome barriers to assisting affected populations, including nomadic communities. In this ever-evolving situation, nomads are often perceived to be the perpetrators in the fighting–members of the janjaweed. While this is true for some of them, it is not true for all. Indeed, some nomadic communities have been hurt by the fighting. Their migration patterns have been disrupted; they sometimes lose access to water sources and medical care; and, their food stocks have been diminished. In response, MSF has helped repair water pumps and runs mobile clinics that provide their primary medical care.
The case of nomads illustrates in the best way possible the fact that, to work efficiently in Darfur, one has to spend time there to understand the relations among the different groups and authorities. Much of MSF's safety in the region depends on our capacity to be accepted by the groups involved–or simply affected by–the conflict. Therefore, much time and energy are spent explaining MSF's role and objective of providing independent humanitarian assistance.
More than three years after the start of the violence, Doctors Without Borders/Médecins Sans Frontières (MSF) is maintaining its largest aid effort worldwide. MSF has posted more than 2,500 staff in 30 locations across the three states of Darfur in an effort to meet some of the vast medical needs. MSF is also assisting Sudanese refugees who crossed into neighboring Chad. Michael Neuman, program officer for the US section of MSF, describes the evolving humanitarian situation in the region and the difficulties of carrying out humanitarian operations there.
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)