Survey concludes deaths in Darfur exceed the emergency threshold

Humanitarian efforts in Darfur to date have prevented even higher death rates

Geneva – A mortality survey has just been conducted by the World Health Organization (WHO) and Sudan’s Ministry of Health in two of the States in Sudan’s Darfur region. It concludes that death rates amongst internally displaced people still surpass the threshold for a humanitarian emergency, underscoring the need for urgent increases in, and focus on, assistance to displaced people in the region.

1.2 million people in Darfur region have fled their villages and are camped in 129 settlements across an area the size of France. The “crude mortality rate” that is usually used to define a humanitarian crisis is one death per 10 000 people per day. The WHO survey found the crude mortality rate to be 1.5 deaths per 10 000 people per day in North Darfur, and 2.9 in West Darfur. The survey looked at overall deaths and their causes between 15 June and 15 August 2004. Results show that displaced people, in North and West Darfur are dying at between three and six times the expected rate.

“This survey confirms what the humanitarian community has suspected for some weeks. The results, along with the other information gathered by our staff, tell us that the people in Darfur need more assistance. Thousands, including thousands of children under five, are dying every month from diseases which can be easily prevented and treated. Increased and better focused action is now vital,” said Dr LEE Jong-wook, Director-General of the WHO.

The survey team collected data by speaking directly to displaced people in 1500 households in each of North and West Darfur. The survey was also started in South Darfur, but data are so far incomplete. The team had to suspend work after a hold-up and robbery just outside Nyala, capital of South Darfur, at the beginning of September. Data from Kalma camp near Nyala indicate high death rates and underscore the urgent need to complete data collection in the South.

The survey found that diarrhoea in particular is linked to the deaths of half to three-quarters of the children under five. Diarrhoea is often caused by unsafe water and poor sanitation. The combination of crowded conditions in the settlements, shortage of clean water, inadequate latrines, insufficient soap, and the mire caused by rain-soaked mud mingling with excreta, have combined to make hygiene an impossible goal for people living in small, tarpaulin-covered huts.

Some households reported deaths due to violence – particularly among men in the age group 15-49 years. Injuries and violence were linked to 15% of total deaths. This data indicates the continuing need to improve health referral services in Darfur, so that people who are injured can be treated with adequate supplies and expertise in health clinics and hospitals.

In the several months since the Government of Sudan eased visa and access restrictions, UN agencies, non-governmental organizations and the Government of Sudan have ratcheted up the delivery of relief assistance. In August sufficient food was provided for more than 900 000 displaced people. 700 000 now have access to clean water. Nearly 30 000 latrines have now been constructed, and 127 health facilities are reaching 950 000 people. An early warning system is detecting and reporting early stages of disease outbreaks which are being contained through widespread measles and polio immunisation, cholera prevention and malaria control. All these interventions help to keep death rates down.

“In June of this year, a mass measles campaign targeting two million children throughout the Darfur led to a decline in measles incidence – and mortality. We have seen that interventions to protect the health of the vulnerable population do work, and this survey underlines the need for the expansion of public health interventions in Darfur.” said Dr Hussein Gezairy, Regional Director of WHO’s Eastern Mediterranean Region.

“The humanitarian community has already done much to reduce death and promote survival. The extra efforts, needed now, include increased water and sanitation in the camps, accessible primary health care, security for displaced people and humanitarian workers, improved camp management and the assurance of adequate financial resources for many months to come. It distresses me to hear that the level of funding for the international response in Darfur is still only half of what is needed. This shortfall is measured in lives lost,” said Dr Gezairy.

WHO, the Government of Sudan, UNICEF and all other relief agencies active in Darfur will step up their combined efforts to address the underlying causes of mortality, specifically in the areas of water and sanitation.

Survey methodology
The survey involved a collaboration between WHO and the European Programme for Intervention Epidemiology (EPIET). It is based on a random sample of cluster of households. Each cluster is a group of 30 households. The objective was to estimate the crude mortality rate of internally displaced people within the cluster in the 62 days prior to the survey. The persons present in households at the time of the survey were enumerated to describe demographic characteristics of the study population, and were asked questions about household members who had died, the major causes of death (fever, respiratory infections, diarrhoea, injury and violence-related deaths) and the availability of basic services for IDP populations in Darfur. Questions also covered the availability of water and sanitation, non-food items, food ration and access to medication.

The study population include all IDPs within the accessible areas of the three states of Greater Darfur estimated to be 498 528, 382 626 and 288 539 for the West, North and South Darfur respectively by the World Food Programme (WFP). 1500 households per state participated in the survey. A household is defined as people who usually live together, sharing the same meals and sleeping area at the time of the survey.

Mortality figures are of primary importance for monitoring humanitarian interventions in complex emergency situations. In Darfur Region reliable mortality information is both sporadic and limited. A retrospective mortality survey using appropriate epidemiological and statistical methods can provide baseline measurements of current mortality. Implementing the study proved to be a complex challenge for the Sudanese and international staff, as well as for EPIET, the Federal Ministry of Health, WHO and other agencies who joined in the endeavour. The responsibility for the results obtained rests with the World Health Organization.