BMJ No 7120 Volume 315
Education and debate Saturday 29 November 1997
Sudan: eating dust and returning to dust
Hans VeekenIn the early morning we drive out of the city. An asphalt road stretches like an endless ribbon, southwards into the desert. The wind is blowing, dust is seeping through every crack and cranny, entering the car but also my eyes, mouth, and ears. The area resembles a moon landscape: sand, rocks, and more sand.
After an hour's drive we turn off the road and see the camp. The land is dotted with small houses, shelters with mud walls, living spaces generally not much larger than 10 square metres. There is no shade. The place looks unfit for human habitation - but people have been living here for years.
| Summary points |
| About a fifth of the population of the Sudan has been displaced because of civil war |
| Most displaced people are living as squatters in slums around Khartoum |
| These slums are periodically razed and the inhabitants driven away |
| About 200,000 are living in four official camps in the middle of the desert |
| The water supply and the scarcity of food are pressing problems |
Life in the camps
| We drive to the clinic, a structure made of bamboo matting. It has
a sheltered courtyard adorned in the centre with a real flowerbed. The
clinic opens every day at 6 30 am; the three medical assistants see
some 150 patients a day. An old woman is patiently waiting. It takes
two interpreters to communicate with her. I ask my question in English;
the medical assistant translates into Arabic for the old woman's
companion; she, in turn, translates the Arabic into Dinka. The woman's
answer is translated the other way round. It seems that she arrived in
the city in 1993 with two of her four children. Her husband's fate
remains unclear, the children left behind have died. She looks about 60
but is only 40. She has fled the war and says: "Here I can't find
any rest either. I can't earn any money in the camp. I'm living from
what people give me."
The fate of most people in the camp is to survive the day, to make it to the evening. To get food before nightfall, that's what counts. The population seems to be resigned to its fate. It remains a mystery what these displaced people are living on. A nurse explains: "Some go and fish in the Nile, others go to Khartoum. They often work as day labourers in the building trade or they help unload trucks. But the camp is located far away from Khartoum and public transport is expensive. A ride on the bus takes 500 Sudanese pounds [1700 pounds=$1] and daily wages total a mere 2000 pounds. Others are engaged in bootlegging alcohol, and prostitution is rife. It's the daily fight against hunger. |  | |
| The camps are situated in the desert 40-50 km from
Khartoum. Water is of vital importance |
Medical assistants
I see a malnourished child on its mother's lap. The nurse picks up the card, which says that the weight is "right." According to the figures on the card, the child ought to be in good shape. It turns out that the assistant has wrongly interpreted the malnutrition criteria. The chart, with its Z scores and percentiles, is difficult to read. It's really important to stay alert and train the staff. The health workers at the post are displaced themselves and are living in the camp.
Simon is an older man. He is retired and recently joined his children, who had earlier fled to Khartoum. He comes from Equatoria, a province in the south. I ask him how he is doing. He replies: "There's nowhere rest, not there and not here. But I can't go back." How long has he been a medical assistant? "I was studying before you were born, young man," he answers somewhat haughtily. I don't believe him, but after some figuring must admit that he's right. He handles his otoscope and bloodpressure gauge with fastidious care.
No shade and no water
We drive on to Omdurman, across the Nile from Khartoum. As in Khartoum, thousands of people have descended on the edge of the city. We stop for breakfast at a roadside stand. The driver orders a large bowl of "fool," beans floating in fat. All three of us spoon the beans into our mouths with our hands. At 11 am I'm not surprised that we are unable to finish our meal to the last bean. We have barely risen from our chairs when three, four, five children pop up and fight over the leftovers. In 30 seconds flat the bowl is empty, there's not a breadcrumb left, and the boys are gone. They must have waited for this moment. You don't need a survey to conclude that there is hunger.
At the city's edge
We resume our journey, continuing on to Shekan, a district in Omdurman with a population of around 10 000. Some three months ago their dwellings were razed by the government. Suddenly the bulldozers came and reduced everything to rubble. However, the people are returning to their old dwelling places and, with sacks of mud and any other material, are building themselves shelters among the remnants of their former homes. It is a sad scene. This was not the first time such a thing happened here.
We talk to a family which has been "living" in Khartoum since 1992. The man has seven children. His wife has gone to the city to sell tea in the street. "How do you manage to survive?" I ask him directly. "I go to the city and work as a day labourer. I often stay away for a couple of days; travelling is expensive. I earn 4000 pounds [$2.50] a day. Buying water at the donkey cart costs us 600 pounds for the 100 litres we use per day. I don't have work every day," says the man. The nurse explains that when she makes house calls, she often finds children alone, without parents. The mother has gone to the city hoping to find work and sometimes does not return for days.
Displacement
Next we visit Omdurman el Salaam, a camp for displaced people. There happens to be a meeting of community health promoters. The participants are learning a song about tuberculosis, and we witness a rousing performance. I ask them what they consider the worst problems. One of the workers tells us that 200 families arrived at the camp this week without anything but the clothes they were wearing. We decide to have a look immediately. We drive to the far end of the camp; there is no real road. Round, igloo-like shelters made of sticks, burlap bags, and cardboard dot the area. Outside it's 45°C.
"Where are you from?" we ask a number of families who come walking up to us. An older man answers: "We were all living in the city, most of us near construction sites where we were working as day labourers or as guards. My wife and children were also sleeping there. Last week we were picked up without any explanation, our possessions were burnt, and we were dumped here at this camp. " He asks: "Do you have anything for us to eat?" Another person interrupts him: "I've lost one of my children. He was playing in the street when we were picked up. What can I do?" I'm dumbfounded. The community health promoter, who had come along with us, tells the people about our clinic.
|
Sudan and its displaced people With a population of 30 million spread over an area 10 times the size of the United Kingdom, Sudan is thinly populated. A civil war has been going on since 1955 (with a period of peace from 1972 to 1983). The civil war, plus a prolonged drought and famine, have left the country destitute. One fifth of the population has been displaced. The government of Sudan, which has its seat in Khartoum, is made up largely of Sudanese of Arab origin. The Muslim government does not want the displaced people to establish themselves permanently around Khartoum. They are mostly animists and Christians who have fled the civil war raging in the south of the country, and it considers them a threat to the Islamic image of the capital. Most displaced people are living as squatters in slum areas around Khartoum, and only 200 000 are living in the four officially recognised, temporary camps - which are located in the middle of the desert, far from the city and all economic activities. For years the displaced people have been exposed to the whims of the government, which regularly orders slum areas to be razed and the inhabitants driven away to areas far from the city. MSF-Holland is operating in the displaced camps Jewel Awlia and Omdurman es Salaam, providing basic health care. The country is bankrupt, but even so, war expenditure is estimated at a total of one million dollars a day. |
Pressing problems
Water seems to be the most pressing problem. It would have to be trucked in. A water pump cannot be used because the level of the ground water is too deep - hardly surprising in a desert. But the scarcity of food, too, is taking its toll. The soil is unfit for cultivating crops, and people do not have money to buy enough food.
The situation in Sudan seems hopeless. The endless misery, the lack of any prospects of change or hope for future improvement make it imperative that Médicins Sans Frontières continues to support the people, even if our efforts are mere drops in a burning desert. At least that is what I feel. A mother in the camp, however, thinks differently. Looking at me reproachfully, she said: "If we do not get any food, we won't need your latrines either.
Médecins Sans Frontières,
PO Box 10014,
1001 EA Amsterdam,
Netherlands
Hans
Veeken, public health
consultant
email: hans_veeken@amsterdam.msj
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