In Darfur, cholera follows reduction in aid

As of June 2006, UNICEF had received only 3.1 percent of the amount requested for Darfur, primarily from Western governments. It was thus unable to fund the Mornay WES, the organization responsible for managing the water distribution system. The system is now failing because proper and regular maintenance is not performed. This is key to explaining why cholera has appeared in Mornay.

Eight people — including a child under five — have died from cholera in Mornay, western Darfur, in the last two weeks. Médecins Sans Frontières (MSF) team has already treated more than 60 patients. This situation occurred after various aid agencies withdrew assistance to people living in the Darfur displaced persons' camps.

All the conditions contributing to cholera's appearance are present in Mornay. In 2003, it was a small village of 5,000 inhabitants. Today, more than 75,000 people have taken refuge there, fleeing killings and violence. For more than two years, people have been crammed into makeshift shelters. The crowding, lack of latrines, poor waste management, and inadequate drainage combine to make the displaced persons particularly vulnerable.

MSF set up the water distribution system in 2004. It was later managed by Oxfam and is now overseen by WES, a local organization funded by UNICEF. Today, that system is failing—both in terms of quantity and quality. While a minimum of 20 liters of water per person per day is required to meet daily needs, the displaced persons receive only 12.

In addition, two water boreholes were replaced by a system that pumped water from a well that proved to be muddy and contaminated by bacteria (fecal coliform). The muddiness makes it difficult to chlorinate the water. Several broken water taps have not been replaced.

Funding in free fall - aid dropping

"Cholera has appeared and eight people are already dead," says Hiam El Zein, head of MSF's mission in western Darfur.

"These deaths are the result of inadequate aid to the displaced persons. In Mornay, as at other sites where tens of thousands of displaced persons have assembled, some organizations are pulling back from vital services. That may be because donors governments and institutions have stopped or reduced their funding or because these groups have become involved in development activities. In Mornay, UNICEF has not kept its promises because of lack of financing."

Indeed, in June 2006, UNICEF announced that it had received only 3.1 percent of the funding required from donors (primarily Western governments). Of the $89 million necessary, only $2.81 million had been paid.

Because they lack drinking water to meet their daily needs, the displaced persons who live in Mornay must rely on contaminated water. This situation, along with poor health conditions, could promote cholera's spread. Eight people have already died and in a camp like Mornay, more than 2,000 cases may be expected.

As a result, in Mornay, WES is not receiving sufficient UNICEF funding. The lack of proper and regular maintenance of the water supply system—along with the poor health conditions in which the displaced persons have been forced to live for more than two years—is crucial to explaining why cholera has appeared in the camp.

The MSF team in Mornay treated the patients quickly and set up a cholera treatment center in tents next to the hospital. Eight satellite rehydration centers were also set up. In a camp like Mornay, more than 2,000 cases may be expected. Everything is ready in case the treatment center needs to increase its capacity to 180 beds if the number of patients rises significantly.

Tragic consequences for the displaced persons

"We also have to invest in the water distribution system again because WES does not have the staff or all the necessary UNICEF funding to do it," El Zein added. "We are going to set up a system that will allow us to use surface water, which is clear, and then decontaminate and chlorinate it. Our teams have also helped to apply chlorine spray to the contaminated areas."

In 2005, when many aid organizations arrived in Darfur, MSF pulled back from managing the water distribution system to refocus on medical activities and remain responsive to new emergencies. The need for assistance was, and remains, very high for the populations who must live in these camps. They are totally dependent on external aid for their survival. Although the Darfur situation is now of a more chronic nature, punctuated by violent episodes, there is still a state of emergency.

The people have the same assistance needs and reduced aid can have tragic impacts on their living conditions. Last May, MSF was troubled by the effects of reduced World Food Program (WFP) food distributions during the most critical period of the year, resulting from lack of funds. Today in Mornay, MSF is witnessing the tangible effects of aid agencies' withdrawal on the health of displaced persons.