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MSF in Sudan, 2005
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Bringing assistance to desperate civilians
After more than 20 years of civil war between the government of Sudan and southern rebels, a peace deal signed in January 2005 seemed to open the possibility of a brighter future for the Sudanese. Yet as government forces and rebels agreed to lay down their arms, fighting continued in the country's western region of Darfur.
Since early 2003, the Darfur conflict has cost thousands of lives and forced millions to flee while government-backed militias have carried out a campaign of terror against civilians. While the peace agreement has brought hope to the country's devastated south, a better future is far from guaranteed for most of the region's inhabitants. Chronic underdevelopment combined with continuing violence in Upper Nile state indicate that even if the new peace does hold, any real improvement in living conditions remains a distant hope.
In southern Sudan, an estimated six million people rely on food assistance, and illness is rampant. The main causes of disease and death are treatable endemic illnesses including malaria, tuberculosis (TB), kala azar and sleeping sickness. Despite the peace initiative, it is likely that humanitarian aid will continue to be needed in Sudan for some time due to recurrent medical emergencies (caused by both disease and malnutrition), sporadic fighting and a massive return of refugees to areas with little or no access to care.
MSF works in hospitals, health centers and mobile clinics in both northern and southern Sudan to bring basic health care to those who most need it. MSF provides TB care in towns located in the provinces of Equatoria and Upper Nile.
MSF also cares for those who have kala azar (visceral leishmaniasis), a disease that is almost always lethal if untreated, and is spread by sand flies that live in the country's dense forest. Thousands of patients receive medical treatment for kala azar in Upper Nile province. A diagnostic lab in the town of Lokichokio, Kenya, allows MSF to monitor regional outbreaks of the disease, and staff members provide training, medicines and support to other groups treating kala azar patients. In June 2005, MSF's kala azar project in Um el Kher in the northern state of Gedaref closed after nine years. MSF had treated more than 29,000 patients and supported treatment in seven government- run clinics in the region that cared for several thousand additional patients.
Sleeping sickness, a parasitic disease carried by tsetse flies, is another common cause of death in Sudan. MSF teams carry out community screenings and treat those with the disease in numerous towns in West Equatoria state. Staff screened more than 37,600 people in 2004, treating 757 in the same period. During the first half of 2005, more than 10,000 people were screened.
Teams also provide food and medical care in areas where malnutrition is rife. Currently, MSF runs a hospital and five feeding centers in the town of Marial Lou to treat people affected by malnutrition. In Upper Nile state, during the first half of 2005, more than 1,000 malnourished children — nearly three times the number for the corresponding periods in 2004 and 2003 — were admitted to 11 clinics in which MSF operates feeding programs. MSF responded in September 2005 to acute nutritional needs in South Bor county, located in Jonglei state, by providing support to local health centers and ambulatory care programs.
In Aweil East county, located in northern Bahr el Ghazal state, in July 2005, MSF teams observed a significant increase in admissions to their nutritional centers in the town of Akuem. A nutritional survey conducted in late June 2005 showed that four percent of children were suffering from severe malnutrition and 26 percent from less severe malnutrition. MSF re-opened a therapeutic feeding center there and opened three additional mobile feeding centers. In addition, a team carried out two food distributions, each for 16,000 children under the age of five.
A similar situation unfolded in July in Bahr el Ghazal's Tonj district. At mid-year, more than 6,000 were estimated to be suffering from malnutrition and in need of emergency help. MSF distributed supplementary food rations to more than 5,000 children under five and their families in August 2005.
During 2005, MSF expanded its operations in some parts of Sudan. In March, a new project was opened in the Red Sea coastal city of Port Sudan, providing primary and secondary health care at the local hospital to people living in one of the city's shantytowns.
In Kajo Keji, in the south, MSF began offering care to HIV-positive patients in January 2005. Treatment with life-extending antiretrovirals (ARVs) began in April, and soon 12 patients were receiving them. In Malakal, Upper Nile state, and in Um el Kher, Gedaref state, MSF provided voluntary counseling and testing as well as care for opportunistic infections for HIV patients co-infected with TB or kala azar. In addition, a new primary health care project began in April in the former garrison town of Pibor, Jonglei state. In early 2005, MSF was able to establish a permanent presence in the Upper Nile town of Nasir, which was previously cut off from all outside assistance.
In Wau county, Bahr el Ghazal state, MSF's primary health care center and four outpatient centers were handed over to health authorities and another nongovernmental organization in June 2005. Similarly, in the Walgak area of Jonglei state in Upper Nile province, MSF handed over five health care units and a kala azar clinic to another medical relief organization. And, after 10 years, MSF ended its project in the Nuba Mountains. Over the years, teams had provided basic health care, carried out measles- vaccination campaigns, responded to two outbreaks of West Nile virus, provided TB treatment, and distributed drugs. The organization also had undertaken considerable work to combat malaria, conducting a study on parasite resistance to malaria medications, introducing artemisinin-based combination therapy and distributing 25,000 bed nets. Because the impact of the disease was reduced and regional stability improved, the project was handed over to an indigenous non-governmental organization.
Darfur: The crisis continues
Close to two years after the world began to notice the emergency unfolding in Sudan's western region of Darfur, little has changed to improve the lives of the people there. Despite reassuring statements to the contrary, the situation is not stabilizing, and the need for humanitarian assistance continues to grow as the conf lict goes on.
Hundreds of thousands of people are still living in displacement camps, receiving just enough assistance to keep them alive. Not only do they struggle with physical ailments but many suffer from mental trauma related to both the violence that drove them to these camps and the uncertainty that keeps them there.
By mid-2005 more than two million people had been displaced by the ongoing violence plaguing the region. This number includes more than 200,000 people who have f led to neighboring Chad. However, last year's scorched-earth campaign has been replaced by less overt, but equally devastating, forms of violence and intimidation against civilians, which still include sporadic fighting, beatings and sexual violence. In all locations where MSF provides medical care, teams continue to see a significant number of victims of direct violence. From January to May 2005, MSF staff treated more than 500 people for violence-related injuries and 278 women for rape. Rape and sexual violence remain pervasive, inf licted on women and girls who must venture beyond the borders of camps to find firewood, water and food for their families.
Although late to arrive, humanitarian assistance has increased significantly during the past year. Faced with high rates of diarrhea, respiratory infections, and malaria; appalling water and sanitation conditions in many areas; and outbreaks of meningitis and hepatitis, MSF has worked to provide medical care, nutritional help and safe water. Despite these improvements, the living conditions of the people in Darfur remain precarious. And while health indicators in some of the biggest camps and settlements have improved, aid has not reached some remote areas or parts of rebel-held territory.
Obstacles to giving aid
Security remains a limiting factor for the adequate provision of medical assistance in Darfur. Given the size of the region and the dispersed population, access is highly dependent on road transportation, which is sometimes interrupted by logistical problems and weather, but mostly by insecurity.
With hundreds of international staff and more than 4,000 national staff operating in 32 locations across the region in July 2005, MSF continues to make a priority of providing aid in Darfur. In the past year, teams throughout the region conducted more than a million medical consultations and treated more than 50,000 children suffering from malnutrition. MSF has also spoken out on a number of occasions, including before the UN Security Council, on what its teams have witnessed and called on other actors to provide more help to the region's civilians.
For the majority of the displaced people with whom MSF teams have spoken, returning home now is not an option. Some have started to buy land or construct homes with more permanent materials. Many have found ways to earn money, and others, who have become accustomed to living near medical services and schools, now prefer to stay in a more urban environment. Some of those who do attempt to leave the camps face continued intimidation and direct violence, and many end up returning to refuges that pose similar dangers but offer security in numbers and the limited, daytime presence of humanitarian aid organizations.