Health aspects of the humanitarian crisis in western Sudan

KHARTOUM, June 7, 2004 (WHO) — Internal conflict has resulted in a massive humanitarian crisis in the Greater Darfur Region, Sudan, with more than one million internally displaced persons (IDPs) requiring assistance in more than 124 different locations. Host communities are suffering too. The United Nations estimates that as many as two million people are affected.

Because of a poor road network as well as insecurity along routes, not all IDP communities are accessible. Access has improved in recent weeks, but assessments of conditions in different IDP camps are grim, all indicating severe lack of food, water, health care and shelter. As IDP camps grow, so does the pressure on the health system, which is poor even at the primary level. Secondary and tertiary health care is practically non-existent outside of the state capitals.

The lack of primary health care particularly affects the most vulnerable groups: children under five and those separated from their families, pregnant and breastfeeding women, and the elderly. These groups make up the majority of IDPs.

With few hospitals working, many people lack access to health care and cannot get treatment for diseases such as malaria, measles, pneumonia and cholera. Lack of reproductive health care is also a huge concern, adding to maternal and child mortality. Urgent measures to address the physical and psychological needs of women, many of whom have reportedly been raped, are vital.

A major health concern is the lack of sanitation and safe, potable water at IDP camps. Assessments carried out by experts from WHO’s Regional Centre for Environmental Health Activities in Amman show that most water sources are under-chlorinated, household containers are contaminated, latrines are inadequate and environmental conditions are anything but satisfactory. It is estimated that only 12% of the potable water needed is currently available. Such poor conditions have led to a rise in mortality, with instances of daily under-five mortality rates of 6.8 per 10 000. The main causes of death are acute respiratory infections, diarrhoea, and malnutrition.

The situation is becoming even more critical as the rainy season sets in. Some camps will become unreachable and there will be an increased possibility of malaria and cholera outbreaks. A major increase in human resources, medical supplies, food, shelter and funds is essential to meet even the most basic needs. For health, the most urgent priorities are strengthening the provision and delivery of primary health care, establishing and/or rehabilitating health facilities in remote areas, and providing medical supplies and equipment. These are needed to respond to injuries associated with the conflict and obstetric emergencies, and to ensure safe blood transfusions.

WHO, along with other health partners, is working to scale-up interventions and presence in the Greater Darfur Region. Apart from deploying medical staff, equipment and supplies, WHO has been working tirelessly in recent months on:

– Disease surveillance and outbreak response – through an early warning system (EWARN);

– Measles vaccination campaign – the Ministry of Health, UNICEF, WHO, and partners are launching a measles vaccination campaign targeting 2.15 million children in the Greater Darfur Region starting in mid-June 2004;

– Environmental health – WHO is supporting 172 environmental health workers to ensure that vector control, waste disposal and health promotion are in place for 310 000 people in four locations;

– Health sector coordination – In response to a request from the Government of Sudan, WHO is helping to oversee international support for public health in Darfur and coordinating the health component of a six-month UN contingency plan for the rainy season in Darfur;

– Norms and guidelines – WHO is playing an increasing role in providing norms and guidelines for health partners operating in the Greater Darfur Region on malaria, cholera, and epidemiological surveillance.

The Greater Darfur Region in western Sudan covers approximately 510 000 square kilometers (an area the size of France). The inhabitants of this harsh environment, consisting mostly of arid land, are subsistence farmers and nomadic pastoralists. Out of the 6.7 million people in this region, almost half are between six and 24 years of age. Poor and underdeveloped compared to the rest of Sudan, the Greater Darfur Region has been underserved in terms of health services, with no investment reportedly made in health care since 1990. Infant mortality is about 120 per 1000.