BMJ  2006;333:846-847 (21 October), doi:10.1136/bmj.38986.426354.68

Analysis and comment

Darfur—dependent population at risk of another catastrophe

¹ Prinses Margrietstraat 8, 5056 HL Berkel-Enschot, Netherlands R.vandepas{at}gmx.net

When I arrived in south Darfur in late 2005, the humanitarian situation, although fragile, seemed under control. The estimated 100 000 internally displaced people at Kalma camp, where I worked in a primary health clinic, had stable health indicators. My colleagues and I worked hard on training local health workers and building infrastructure within the community. The first months of 2006 were hopeful, but six months later the situation has changed dramatically.

Since February 2006, displacement has increased in all states of Darfur. New internal refugees arrive daily in the camps on the edge of Nyala. These camps have few facilities available, and violence and sexual abuse are rampant.

The World Health Organization and United Nations agencies have medical professionals trained in managing outbreaks of disease and coordinated approaches to complex emergencies. Unfortunately, many of these trained professionals have already left Darfur as a result of the insecurity and reduced funds available for non-governmental organisations in the region. WHO has introduced incentives to hospital staff and compensates hospitals for operating expenses by providing essential medicines. Although this strategy is a valid response to the initial crisis, it becomes counterproductive in the long term. Health workers and the local community become dependent on this aid without creating a viable health system.

Humanitarian aid

International non-governmental organisations share responsibility with WHO for this flawed situation. In 2004, they flocked to confront an emergency situation, as this was the place where substantial funds could be obtained. In the health sector, ambitious programmes were set up hastily and focused on accessible camps for displaced people rather than on isolated or insecure areas that were difficult to reach.¹ This led to an imbalance in available services. In some places two organisations provided the same essential non-food items, such as blankets and bed nets, and some camps had three health clinics whereas others had none. Kalma camp has become politicised and violent partly as a result of this dynamic.

People in Darfur lack food and medicines

 

Humanitarian access is currently hampered by an escalation of violence. Twelve humanitarian workers were killed in July and August 2006. Access is at its lowest since the beginning of the conflict in 2003. Forty per cent of the affected population in north Darfur is not receiving health care, and 370 000 people across Darfur did not receive monthly rations in July.²

Humanitarian indicators for Darfur (www.reliefweb.int) Population dependent on humanitarian aid: 3 million Number of internally displaced people: 1.9 million Cumulative excess mortality: 130 000400 000 deaths3 Crude mortality: 2.6/10 000/day (2004) < 1.0/10.000/day (2005) Maternal mortality: 590 deaths/100 000 live births Women's lifetime risk of dying from pregnancy related causes: 1 in 30

One of the most important lessons is that without durable peace, the health gains can easily be lost. Health indicators must be used as an advocacy tool in the political process. The international community must critically examine its efforts in order to achieve sustainable results. Non-governmental organisations must start small scale programmes, as these can be managed over a prolonged time, even with reduced funds or fewer health professionals. Darfur is on the edge of yet another humanitarian catastrophe. We are obliged to prevent it.

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Competing interests: None declared.

References

1. UN Office for Coordination of Human Affairs. Sudan: NGOs/UN coverage per locality in Southern Darfur (as of 11 Jun 2006). www.reliefweb.int/rw/RWB.NSF/db900SID/LPAA-6QTPB4?OpenDocument&rc=1&emid=ACOS-635PJQ (accessed 5 Oct 2006).
2. UN Office for Coordination of Human Affairs. Sudan: Briefing by Jan Egeland, under-secretary-general for humanitarian affairs and emergency relief coordinator, on the humanitarian situation in Darfur, 29 Aug 2006. www.reliefweb.int/rw/rwb.nsf/db900SID/KKEE-6T4QX5?OpenDocument&emid=ACOS-635PJQ&rc=1 (accessed 5 Oct 2006).
3. Petersen AH, Tullin L. The scorched earth of Darfur: patterns in death and destruction reported by the people of Darfur, January 2001-September 2005. Copenhagen: Bloodhound, 2006.

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