Humanitarian Crisis in Darfur, Sudan
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PENNY MARSHALL: At first light the dead are buried in the early morning, every morning. Aboul Aziz was 18 months old. He became ill during last night’s storm and died. They’re burying him with their bare hands, and praying that their children’s suffering will end. But it doesn’t.
In the children’s health center, another desperately ill newborn is brought in. There were 33 deliveries while we were at the camp. Two of them died. Niamber is 18 months old and weighs 5.5 kilos. With no food to offer her here at Breijing camp, where it’s run out, it’s likely that she, too, will be buried soon in the early morning light. It’s mostly the children who die.
RIA TEMMERMAN (Translated): The children have the danger of malaria, respiratory infection, diarrhea, losing weight, getting severely malnourished and, of course, severely malnourished children are very, very vulnerable.
PENNY MARSHALL: Hello, pretty girl.
PENNY MARSHALL: On entering this camp, it’s impossible not to notice the children.
PENNY MARSHALL: How are you?
PENNY MARSHALL: Dozens of them at first intrigued by our cameras and questions. (Laughter ) Despite their suffering, like children everywhere, they still wanted to laugh and play. (Laughter )
There are 25,000 children here compared with 8,000 women and only 2,000 men. We wanted to know where the men were. Were they back in Sudan fighting in their own army? Too many children and no fathers. Where are the fathers?
MAN: Their fathers are dead by the Janjaweed, I think, dead, killed.
PENNY MARSHALL: That’s quite a claim, one you’d expect. The men all killed by enemy militia, but we wanted to establish if it was true. We asked the children. Can they put up their hands if they’ve lost somebody in their family that has been killed? And then we asked them who.
MAN: His brother.
PENNY MARSHALL: The girl next to her on the left?
PENNY MARSHALL: The father. Behind her, the girl?
PENNY MARSHALL: Little boy in the front?
MAN: A brother.
PENNY MARSHALL: Abu?
MAN: His brother.
PENNY MARSHALL: Who did it?
PENNY MARSHALL: Arab, they all replied, government soldiers and Janjaweed. The children here have known nothing but war and persecution. The only memories they have of their lives and of their homeland are those of violence. We’d brought pens and paper with us to the camp, and we asked some boys to draw anything they liked.
Almost without exception, they drew images of war: Their villages being attacked, then burned, soldiers with automatic weapons. There were as many drawings of government soldiers, airplanes and helicopters, as there were of the militia on horseback or camel, the so-called Janjaweed. War may have left them traumatized and impoverished, but even a brick or a snail shell can still produce a smile.
With so little to play with, imagine their delight when we produced a football. But the relief is temporary, only a childish distraction from reality. Aboul Aziz was buried in the shallow dust by his own people, forced into a foreign land. It’s feared at least 300,000 more will die, some of them the children here, before this refugee crisis ends.
RAY SUAREZ: For more on this humanitarian crisis, we’re joined by Dr. Rowan Gillies, the international president of Doctors Without Borders. He recently returned from a month-long mission in Darfur.
Well, Dr. Gillies, is this a situation that at least is stabilizing, or are more people being displaced and pouring into the camps?
DR. ROWAN GILLIES: I think the condition of massive displacement that was happening early this year and the end of last year, is not happening now. However, there are certainly areas which are experiencing… where the camps are getting larger and there are more people coming to these camps. So the violence and the displacement has not stopped, but it’s not as massive as it was before.
RAY SUAREZ: For people working on the ground trying to help these people, is the Sudanese government at this point providing any help? It’s assuring international authorities that it is.
DR. ROWAN GILLIES: There’s certainly some of the administrative constraints have been lifted. There’s no doubt about that. Getting visas, getting work permits– that has changed. I think I would be more prepared to comment, I suppose, on what’s happening to the displaced people. They are still very, very afraid of what’s happening. They’re very afraid of returning to their villages, and they’re very concerned about where their next food is coming from.
RAY SUAREZ: Well, what’s the situation in some of the more crowded camps? If you had enough material, could you keep these people healthy until they’re able to go someplace permanently?
DR. ROWAN GILLIES: Certainly, yes. We certainly have ability. And there are one or two camps in Darfur where this is happening, where there is enough water, enough sanitation, and they’re well-spaced camps. And there’s enough medical care and food. But this is happening in only one or two camps throughout the whole of Darfur.
RAY SUAREZ: So what’s the conditions like in those other camps?
DR. ROWAN GILLIES: In the other camps, sanitation is horrendous. There is not enough water. People are supposed to have 20 liters of water a day. In many camps, they get a maximum of ten liters of water a day. The number of latrines available to prevent what we call fecal-oral transmission of disease is just… the latrines are nonexistent in many camps.
And we’re seeing the results of this. I treated some pregnant women who had died from a disease related to jaundice. We feel it’s most likely Hepatitis E, which is related to pretty much poor hygiene. So we’re seeing the results of this poor sanitation, and as well as that, the results of not enough food aid to these people.
RAY SUAREZ: In the horrifying pictures that have come back from the camps, we’ve seen people of all ages. Who are the most vulnerable in these different situations?
DR. ROWAN GILLIES: Traditionally it is the children under five, and pregnant women. But when I was working there I noticed a large number of elderly people who have often given their food to the rest of their family, or have lost their family in the displacement. So there is certainly a cohort of elderly people who are dying slow deaths because of lack of assistance.
RAY SUAREZ: Now, if this is a situation that has no ready remedy, are you keeping people alive who are threatened by one thing, only to have them die of something else– if they get their diarrhea medications, for instance, to have them die of malnutrition down the road?
DR. ROWAN GILLIES: There is certainly the ability for the world to respond, and for agencies to respond. And there are areas where response is adequate, which proves that it is possible. So I wouldn’t have such a despairing picture. It is certainly possible. If these people get regular food once a month, if they have improved sanitation, and there is adequate medical care to them, certainly they will survive and will improve whilst they wait for the political situation to improve.
RAY SUAREZ: So where is the bottleneck? Has the world not responded enough? Has the problem been with the Sudanese government? Where… what’s standing between these people and the help they need?
DR. ROWAN GILLIES: I think there are many places of bottlenecks. Certainly the world responded very slowly, and certainly the government of Sudan did not allow us to get in there in the earlier months of this year.
In addition to that, I think there has been a slow response from the aid community, with specifically respect to food, but also in the response of different organizations. So there’s been a multitude of people not living up to their responsibilities in many ways.
RAY SUAREZ: Is there any sign that that’s changing? Is the world starting to get mobilized?
DR. ROWAN GILLIES: I think certainly things have changed to a degree. I’m concerned over the urgency of the response and the size of the response that still hasn’t happened. The food availability has increased, but it’s still hitting around about 50 percent of the requirements of these people.
And these people haven’t had food… adequate food for the last six months, so it’s not as though they can cope with one month of no food or half food. They’re at the edge of their coping mechanisms. And unless we really specifically… with food but also with sanitation, unless there is a massive response in the next few months, there will be a high mortality.
RAY SUAREZ: What do you do with a large number of people whose health status has been undermined by living in these conditions? What do you do first, and what do they need most?
DR. ROWAN GILLIES: It does vary, but our organization, being a medical organization, we certainly set up clinics, and we treat the people who have diseases related to the malnutrition and diseases of overcrowding. But also at that stage, we treat the malnutrition. We bring children into therapeutic feeding centers where we give five to seven meals a day and slowly feed them up so that they are no longer as vulnerable as they were.
As well as that, we’re doing an injection of food into the population by giving a ration to all the children under five in certain groups. So these are responses that we can do. Unfortunately, what we can’t do is give them a general food distribution. We can’t do all the water and all the sanitation for these people. And that’s where we need a combined response from different organizations and from the UN to avert what is a potential disaster.
RAY SUAREZ: Well, we’ve talked about water, food, medicines. But you also mentioned that the people still are afraid. Would it help to have international police, armed personnel between these people and those that they’re afraid of?
DR. ROWAN GILLIES: It’s a difficult question, to be honest. The first responsibility is for the Sudanese government to provide protection for their people. The people in… the displaced people that we speak to, our patients, they are afraid to a degree because of what has happened in the past– the massive violence that has forced them to displace– but also because there is a degree of ongoing violence. How this is stopped and what is the road map to peace, if you will… I’m not really prepared to give a formula because I think it is the responsibility of the national government, Sudanese government, to come up with a plan to make it happen.
RAY SUAREZ: There have been numbers said up to a million people in threat. From what you’ve seen, is that a good number to be working with? Could there be death on a massive scale if nothing is done soon?
DR. ROWAN GILLIES: I would always urge caution at large extrapolations of mortality figures. I think certainly there are at least a million people that have been displaced, and almost certainly more. We have contact with about 550,000 people that we are working with, in populations that we’re working with.
There are certain pockets where the mortality is high. And we’re concerned the pockets will increase as epidemics may hit. To extrapolate and give figures, I think, is something we haven’t done, and we haven’t really done the figures on that because I think it’s very difficult to be clear and concise about those figures.
RAY SUAREZ: You’ve differentiated between some of these settlements. The ones that are the worst off, what are they on the precipice of? What’s the number one fear from a public health point of view?
DR. ROWAN GILLIES: Epidemic disease, most likely diarrheal disease, whether it’s a… a lot of people will have diarrhea– watery diarrhea, bloody diarrhea– over the next months. So it’s ability to respond to that diarrhea, to rehydrate people. But as well, epidemics… and there is talk about cholera. But cholera hasn’t been seen in this area for many years. But certainly the camps are ripe for an outbreak of dysentery or diarrhea of some sort.
RAY SUAREZ: Dr. Gillies, that you very much.
DR. ROWN GILLIES: It’s a pleasure.