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Darfur, SUDAN :: The upheaval has been on a massive, astonishing scale These days, harrowing images of the blighted region of Darfur in western Sudan appear on our TV screens and in our newspapers almost on a daily basis. The pictures of malnourished babies with fly-ridden eyes, old women huddling wretchedly under bare trees and ragged makeshift shelters battered by the wind, rain and sand are becoming rapidly and horribly familiar. The suffering is easy to see in people’s faces, but the story that lies behind it is a complex one. The fact that the media spotlight has been focused on Darfur for only the last couple of months gives the impression that this is a new war. In fact, the current spate of violent conflict started back in February 2003, more than seventeen months ago, and clashes over resources have been a characteristic of the region for decades.
Darfur has historically been home to a number of different ethnic groups who have fought, co-operated, traded and raided over the years. Although the current conflict has been depicted by some as a straightforward clash between nomadic ‘Arabs’ (the ‘Janjaweed’) and ‘African’ farmers, the reality, as with most wars, is more complicated. For a start, drawing a distinction between ‘Arabs’ and ‘Africans’ is misleading since all are African, all are Muslim and in fact it is hard to see striking differences in physical appearance between the groups. Some of the non-Arab tribes, such as the Zaghawa, are camel nomads rather than settled farmers. Many of the tribes have inter-married, formed political coalitions and cut deals over access to water and land resources, making it difficult to unravel the real nature of tribal allegiances and alliances. What is clear is that the swathe of extreme violence which has cut through the region in the last year is a radical departure from the traditional methods of solving tribal disputes. It has been estimated that around one million people have been forced to flee their homes since February 2003, many of whom are now living in camps for displaced people and urban enclaves inside Darfur, or as refugees in neighboring Chad. It is almost impossible to know how many have been killed, but estimates range between 10,000 and 50,000. Women and girls have been raped, men and boys have been beaten and people’s entire livelihoods have been destroyed. Médecins Sans Frontières, like almost all other aid agencies, only discovered the true horror of what was happening in Darfur long after the brutality began. We were alerted by the arrival of hundreds of refugees into eastern Chad, and sent a team to check out what was going on in mid September last year. The stories our patients told us all fitted the same appalling pattern: their villages had been bombed by planes and then militiamen on horseback had surrounded the remains and attacked. Men had often been beaten or shot on the spot, whilst other villagers were forced to flee, many of them unable to take any belongings with them. One man told us that 56 people were killed in his village on a market day. A woman talked to us about how she had had to bury her brother on the road. He had died from a gun wound and she was not able to carry his body to the city to bury him properly. Arriving in Chad with almost nothing, many had been taken into the homes of relatives and local people in the border region. But as time went on, food and water resources ran low and both refugees and locals struggled to survive. When Médecins Sans Frontières started to set up health clinics in September there were an estimated 65,000 refugees spread along the border region, many of them severely traumatized and in dire need of clean water, food, shelter and medical help. With very few other aid agencies on the ground and with more refugees fleeing Darfur each day, the situation became desperate. Refugees were sleeping on the ground in the open air, in night-time temperatures as low as zero degrees. Unsurprisingly, many started to suffer from respiratory infections, as well as diarrhea, malaria, meningitis and skin infections. Nearly a year on, there are now an estimated 170,000 refugees in Chad and there are still more arriving. On 17th August UNHCR reported that more than 500 people had just crossed the border. For some of them it was a repeat journey – they had tried to go back to their lands and villages but had been forced to leave yet again because of continuing harassment and looting. There can be no doubt that Darfur is currently still both violent and volatile, despite an agreement signed in July between the Sudanese government and the UN in which the government pledged to control and restrain armed militias, the army and rebel groups. The tens of thousands of people living in camps for displaced people within the region are traumatized, terrified and trapped. Having fled from their villages to the cities in search of safety, many now find that they are unable to leave again – the risk of being attacked if they return to their homes, or even move outside the city boundaries, is too high. Women cannot even forage for firewood without risking being raped or killed. We were recently told about a young mother who went to fetch wood with her baby strapped to her back. Both of them were shot dead. In some areas of Darfur, the desperate living conditions of displaced people are immediately shocking. Its these images which reach our TV screens each night. Yet the awful position in which many people find themselves in is sometimes not so immediately evident. The town of Kebkabyia appears on the surface to be a thriving desert town. In the bustling market place, or 'souk', stall-holders sell tea and tomatoes, beans and batteries; young men wheel round on shiny Chinese bicycles; small donkeys bray raucously and groups of kneeling camels blink and yawn in the dazzling Saharan sun. Watching piles of bricks being carted around, it takes a while to realize that the population here is in fact largely made up of displaced people: only about 16,000 of the current inhabitants are actually residents - the other 50,000 fled their homes from the surrounding region. “The majority of displaced people in Kebkabyia are entirely dependent on the aid agencies for their survival,” says Dan Sermand, who has been Médecins Sans Frontières Head of Mission in Sudan since January. “They receive food rations each month from the World Food Programme. The distributions have gone smoothly in July and August, but if supplies of food dry up it will be a disaster for them. It’s a very precarious situation. Although there was a hospital and drug dispensary in Kebkabyia before Médecins Sans Frontières arrived, the health facilities simply couldn’t cope with the needs of the rapidly swelling population. ” A Médecins Sans Frontières team first set to work rehabilitating the Kebkabyia hospital back in May. The place was desperately run down, ill equipped and manned mainly by staff lacking even the most basic training. The general hygiene in the hospital was very bad and when Dr Anders Krondhal saw an operation being performed for the first time he was shocked by the conditions in which the surgery took place. “The operation table was stained with blood and looked like it had not been cleaned in a long time,” recalls Ann Ottosson, who worked for three months as emergency field coordinator in Kebkabyia. “Some of the nurses did not know how to take a patient's temperature. There was no water supply to the hospital since the water-pump was broken, and the sanitation and waste management situation was terrible. There were needles lying on the floor, empty vials of drugs were not taken care of and people were even using the patient showers as toilets. We spent several days just cleaning and disinfecting the wards and surgical theatre and collecting medical waste from the hospital compound to be burned."
The staff in Kebkabyia, like the Médecins Sans Frontières teams spread throughout Darfur, are currently mainly dealing with cases of respiratory infections, diarrhea, suspected malaria and skin infections. Now that the rainy season is in full swing, they are preparing for outbreak of water-borne diseases such as cholera and shigellosis. There has recently been an outbreak of Hepatitis E in west and south Darfur, which is extremely dangerous for pregnant women, and the threat of a measles epidemic is increasing. Some of the patients have conditions which have become serious simply because the lack of free health care in the past made it impossible for them to get treatment previously. A cheerful boy in the paediatric ward, Mohammed, cannot walk. When Dr Krondal lifts him up and supports him, he can only hop along, dragging his twisted left foot behind his right. In fact, Dr Krondhal believes that Mohammed will be able to walk fine after some simple physiotherapy and daily leg exercises. "I think that what probably happened is that the boy was left lying down for a long time when he had severe malaria," he explains. "Because he was just lying in one position, some nerves in his leg were damaged and he was left unable to move his foot. I have shown the mother the leg exercises she should help him with each day, and we should soon see an improvement in the mobility of his foot." With firearms a common sight on the streets, there are also some patients arriving with recent gunshot wounds. According to Dr Krondhal, "One young girl was brought to us with a very serious gun wound - the bullet had ripped across her jaw and only just missed her carotid artery. She's now doing well, but she's extremely lucky to be alive. She's only about 14 years old." Unfortunately, for every story of a close escape there are manifold shocking accounts of civilian deaths throughout the region. The upheaval in Darfur since the start of this conflict has been on a massive, astonishing scale. Although the world seems to be finally paying attention, political solutions are nebulous. The situation is complex at many levels – from the interplay between different tribal groups and politicians within Darfur, to the international debate about whether the conflict constitutes a ‘genocide’ and warrants sanctions or foreign military intervention. As the discussions play out in endless meetings and debates, one thing is crystal clear for aid workers on the ground – the international aid community is going to have to be committed for the long haul. Lucy Clayton » Find out more
› We have compiled an index on the latest news + updates from Darfur, Sudan
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