Darfur: Operational Update

MSF projects in Darfur

West Darfur

At the end of 2007, MSF handed over its project in a Habilah, near the border with Chad, to another non-governmental organization. MSF’s activities, which started in 2004, consisted of providing medical care to about 22,000 people, including the resident population and the displaced. The main focuses of the project were women’s health care and mental health care for victims of violence.

In September 2007, MSF had to suspend mobile clinics around El Geneina because of worsening security. Activities in Seleia, in the north of the West Darfur province, were suspended in February 2008 due to a military offensive by the Sudanese armed forces. MSF staff had been supporting a health center in the town providing life-saving surgical care, reproductive health care, in- and outpatient care, management of severe malnutrition, and medical treatment for victims of violence.

At the beginning of the year, international staff had to be evacuated from Seleia for security reasons. Since then, MSF has repeatedly requested the necessary authorizations to allow these staff to return and support their Sudanese colleagues who stayed in Seleia in order to provide medical care to the remaining vulnerable population. These authorizations have been refused. The recent bombings and attacks have now forced all MSF staff to evacuate the area. On March 3, a small team was able to get to Seleia for a short period, but at present there is no possibility of resuming medical activities in the area.

MSF provides services (outpatient visits and hospital admissions) in Niertiti, at the foot of the Jebel Mara, where the population totals approximately 33,000 people, among whom there are about 20,000 displaced people. The clinic also sees patients from a number of villages around Niertiti, both in government- and rebel-controlled areas. Medical activities are increasing every year. In 2007, MSF teams performed an average of 5,500 consultations and 278 hospital admissions per month. About 20 complicated cases are referred to the hospital in Zalingei every month.

As the insecurity makes it difficult for people to move around, MSF staff travel to Thur, near Niertiti, twice a week. In Thur, the team sees about 200 patients a day, but often has to suspend activities. During 2007, MSF teams were only able to visit Thur for five months out of the year due to ongoing insecurity in the area.

In Kutrum, a rebel-held area, MSF staff perform around 1,900 consultations every month and refer emergency cases to Zalingei hospital. A polio and measles vaccination campaign in September and October reached a total of 9,620 children between six months and 15 years old, and covered most of the West Jebel Mara. It is difficult for MSF’s staff to move around in this isolated area, as it is very insecure and authorizations are required before any movement can take place. As a result, MSF is not able to meet all the needs identified and is sometimes forced to evacuate temporarily.

In Zalingei, where 100,000 displaced people are living, MSF is now working in three of the hospital departments: emergency care, performing 1,130 consultations per month; pediatrics, with 235 admissions per month; and surgical care, with 200 interventions per month. In 2007, there was a sharp increase in the number of severe malnutrition cases admitted to the hospital’s nutrition center—700 children, compared to 419 in 2006. In response, MSF opened two ambulatory nutritional centers, one in Hamedia camp in September, and one in Hassa Issa camp in December. These two clinics treated 1,400 malnourished children in 2007. At the beginning of 2008, the nutritional center in Hassa Issa was closed and MSF opened a new mother-and-child clinic in this camp. As the displaced population grows, so do the medical needs, and the current health facilities in the camps in Zalingei are not meeting these needs.

North Darfur

In the town of Kebkabiya, just over 150 kilometers to the west of the provincial capital, El Fasher, MSF runs three dispensaries and supports the Ministry of Health hospital. MSF’s work assists about 75,000 people, many of whom were displaced at the beginning of the conflict in 2003 and sought refuge in the city. Malnutrition is on the rise in the area, as people can still not cultivate or grow crops because of insecurity and continue to rely heavily on relief aid for their survival.

In June 2007, MSF was able to restart its project in Kaguro, located in the rebel-held Jebel Si. The project had been put on stand-by since August 2006, after a security incident. Working in one dispensary and supporting five health posts in the area, five international staff and about 60 Sudanese staff provide medical care to over 50,000 people who have been cut off from assistance since 2003, when the area was attacked and most villages burned. The dispensary sees about 3,000 patients a month. Referring patients in need of surgery, such as the war-wounded and women in need of caesarean sections, is very difficult, as many people fear for their lives when crossing the frontline to reach bigger health facilities. In January 2008, approximately 4,200 consultations were performed in the five health posts around Kaguro.

Serious security incidents forced MSF to evacuate its international team from Serif Umra in July 2006. Sudanese staff ran the dispensary—the sole medical facility for a population of 55,000, many of whom have been displaced—for over a year. An international team was able to return to Serif Umra in July 2007. In January 2008, 6,500 outpatient consultations were performed in the dispensary. Patients in need of secondary health care are transferred to hospitals in Zalingei or El Geneina, if security allows.

In Shangil Tobaya, MSF provides care for the 28,000 displaced people living in the Shangil and Shadat camps. MSF provides in- and outpatient care, a therapeutic feeding program, reproductive health services, and treatment for victims of sexual violence, as well as mental health activities.

In August 2007, MSF started working in Tawila, where close to 35,000 displaced people have gathered in three camps. These people had had no access to any health services since April 2007, when the last relief organization working in the area had to leave because of security problems. MSF started running mobile clinics in the three camps, including a nutritional program and mother-and-child health care, and has set up a small inpatient department in Tawila town. However, the security situation in the area remains very unstable. The MSF team had to be provisionally evacuated in mid-September. In November 2007, the team was able to return to Tawila and continue its activities.

In the coming months, MSF plans to increase the number of mobile clinics in Shangil Tobaya and Tawila in order to provide health care to more people.

South Darfur

With a population of over 90,000 people, Kalma is one of the largest camps for displaced people in Darfur. MSF works in the camp and runs an outpatient department with consultations for 2,800 patients every month. MSF is also focusing on mother-and-child health care and running a women's health center with up to 200 consultations per day. The center provides ante- and post-natal care, as well as delivery assistance for high-risk pregnancies and referrals for obstetric emergencies. Family planning is available and the MSF team is responding to the emergency needs of new arrivals when and if needed.

MSF is one of three agencies providing full treatment for survivors of sexual gender-based violence. A mental health program addresses the profound psychosocial stress and trauma experienced by the population as a result of the current, precarious living conditions, as well as the psychological trauma related to past conflict. Psychosocial care is given through several hundred private counseling sessions per month, workshops, and support groups. The project is complemented by community outreach activities. In October 2007, when heavy fighting in Kalma camp forced 25 percent of the camp population to flee, MSF medical teams followed them to the areas where they had taken refuge—Majok and Sakeli—to provide them with medical care and essential survival items, such as jerry cans for water, sleeping mats, blankets, and soap.

Located in a rebel-held area, Muhajariya is a large town in South Darfur, where MSF provides medical care to around 70,000 people. MSF offers surgical care and runs inpatient and outpatient departments and a laboratory, as well as providing reproductive health services with antenatal, postnatal, and family planning assistance. Treatment for survivors of sexual violence is available. Because the nutritional situation is still fragile, therapeutic and supplementary feeding remain integrated into the basic health care programs. MSF teams also provide water to displaced people in settlements around Muhajariya, where community outreach programs are carried out. When the town of Muhajariya was attacked in October 2007, MSF staff continued to treat around 100 patients a day at the height of the conflict. MSF teams then extended the care they provided by organizing mobile clinics to assist the thousands of displaced people who had moved to the north of the town.

The MSF team in Feina (East Jebel Mara) runs an antenatal care and home-based feeding program and sees around 130 outpatients per day. The feeding program has an average of 60 new admissions each month. MSF runs mobile clinics in the area, which includes Deribat, Suni, Jawa, Barkaro, Saboon el Fagor, Dulda, Logi, and Leiba, to bring services closer to these populations who remain scattered in an area of 10,000 square kilometers, and to obtain a more comprehensive overview of their health needs.

Since June 2007, newly displaced families have been arriving in the Bulbul area from other locations in West and South Darfur in search of security. There are now around 25,000 people living in Bulbul, however no relief has been provided for several months. When MSF managed to get to the area, water was a major concern, as there were three hand pumps for all 25,000 people. An MSF team is installing four water stations, which will be able to provide around 500 cubic meters of clean water per day. MSF also has distributed some essential survival items, such as soap and blankets.