Diary from North Darfur, Sudan: July 2004
The rainy season is continuing to cause problems. The only way I can communicate today with the team in West Darfur is by satellite phone. The rain plays such havoc with the atmosphere that even that connection is poor and I have to sit on the roof of a car near our office in Nyala to get any reception at all.
The rain and thunder storms have been going on for days and are making the situation of the displaced here in Darfur even more miserable: with scarcely any shelter from the rain, living in a shack hastily cobbled together from reeds and plastic.
These people are entirely dependent on food aid - which is still sluggish and irregular.
These people are entirely dependent on food aid - which is still sluggish and irregular. They are helpless. Their food supplies have been stolen or burnt and they have no means of growing new crops, having left their homes, fleeing the violence.
After the rainy season they will still be dependent on external aid. This predicament is clearly eating away at them.
There are hardly any roads in Darfur - apart from a few poorly asphalted connections between the larger cities. The rest is sand and clay; real off-road conditions. This makes it very difficult to get the aid through. And it costs time.
Because of the rain it now takes over four hours instead of an hour and a half to get from Garsilla to Mukjar in West Darfur. The routes have turned into a mud bath. The medical teams are getting stuck in the mud more and more often during the 'mobile clinics' despite very well-equipped all-terrain vehicles (a mobile clinic is a vehicle that carries a medical team and supplies to one or more villages where consultations are carried out on a specific day.)
The team and I decide that, from now on, some of the team will stay permanently at the second base in Mukjar. This base will be stocked next week, so there will be enough supplies for the next two months. The logistics coordinator in Nyala is taking care of the details.
This morning the team and I leave for the camp at Kalma, a 30-minute drive from Nyala. This camp gets a bigger every day. We reckon that it now holds about 40,000 people, including a great many children.
The number of malnourished children in the food programme is rising by the day. Some are definitely beyond saving - even with our intensive approach.
The first rainfall reveals that the camp is actually in a very poor location. There are huge puddles all over the place and some of the shacks are standing in water. We are afraid that the situation in the camp could get so bad during the rainy season that cholera or other contagious diseases will break out. We're already preparing for this. In a few days extra medical and logistical supplies are due to arrive by plane from the Netherlands.
The number of malnourished children in the food programme is rising by the day. There are now around 160 children in the therapeutic feeding programme and another 600 or so in the lighter programme for supplementary nourishment. During my visit I am shocked by the poor condition of some of the children. Some are definitely beyond saving - even with our intensive approach.
The mothers clearly realise that there is no hope for their children. Having fled unimaginable misery, they still haven't found the peace and quiet they are looking for. The accounts of the attacks on their villages, the loss of loved ones and sometimes even children, are disturbing and horrific. The reports of sexual violence inflicted on women during these attacks are heart-rending and beyond all comprehension.
It looks as if we will have to start a second feeding centre on the other side of the camp to deal with the continuing flow of refugees. I discuss this with the coordination team when I get back to Nyala. We decide that, together with the local authorities, we will look tomorrow for a suitable site.
Today the number of seriously malnourished children in the therapeutic feeding centre in Kalma camp has risen to 214. I suspect that a lot of people who were staying at two smaller sites near Nyala have been drawn to Kalma.
The clinic at Kalma camp can no longer cope with the work.
These sites were emptied this week because the owner wanted his land cleared and managed to get court permission to do so. The clinic at Kalma camp can no longer cope with the work. I discuss the situation with the medical team and we decide to set up another clinic in a week's time. The office in Amsterdam and the representative from the Ministry of Health agree immediately. Amsterdam promises to send us the required medical personnel as soon as possible.
In the morning I receive a message from the team in Mukjar. They have a ten-year-old boy in the clinic with multiple abdominal symptoms. The doctor suspects a perforated bowel. Unless the boy undergoes an operation he will die in a few days. The nearest hospital with operating facilities is in Nyala.
"Unless the boy undergoes an operation he will die in a few days."
The healthcare in this part of Sudan is dreadful; either there are no hospitals at all or the hospitals that do exist are non-operational. I contact a surgeon from the International Red Cross who works in Nyala. We decide to drive the boy there with his father and a doctor. The car leaves Mukjar at 11.30 and only arrives at the hospital in Nyala at 19.15 in the evening. And the distance was only 200 kilometres. The hospital was fully prepared for the operation. If the boy's condition is stable enough, they'll operate this evening.
The boy underwent surgery last night. He had an abscess near his appendix. The operation was a success and he is doing well.
Today I am invited to a meeting with the Sudanese Minister of Humanitarian Affairs, who is on a visit to Nyala and wants to speak to the international aid organisations. He says that the displaced people can return to their villages and that the aid organisations must help them there.
It has rained so heavily that our team cannot drive across the river bed. They have to wait until the water subsides and that could take hours.
I listen with mixed feelings. Many of these people might be willing to go back home, but two things are in short supply: food and safety. At the moment they're unlikely to find either in the villages that they were driven from. MSF believes that any return to their home villages should be on a voluntary basis. Some of the refugees we talk to say they are being pressurised into returning. We will keep on monitoring the situation closely.
In the afternoon I hear that some of the team members who left Garsilla yesterday for a destination south of Mukjar are stranded. They were heading for this area in order to reach a large group of refugees. It has rained so heavily there that they cannot drive across the river bed. They have to wait until the water subsides and that could take hours.
At around six in the evening I receive word that they have managed to cross the river in two four-wheel drives, with the team wading through the water in front of the vehicles. They'll never reach their destination today, so they've decided to spend the night in the vehicles.
They are always prepared for this. Also, the security situation has been assessed. Our radio operator in Khartoum will stay in touch with them throughout the night and keep me posted by phone.
After a bad night of sleep I am phoned at 7 a.m. by the team to let me know that everything is okay. They say that some military showed up at dawn. The military thought the cars belonged to rebels.
The military thought the stranded MSF cars belonged to rebels.
Back at the office I help the administrator sort out some problems about contracts with the Sudanese staff. I discuss the inflow of new aid workers and replacements for the people who are due to leave here shortly with the Personnel Department in Amsterdam. Sometimes I feel that I spend more time on personnel work than on getting humanitarian aid to refugees. Oh well, you cannot do one without the other.
I spend most of today sitting and waiting at the offices of various Sudanese government agencies in Nyala to get permits to travel to Shaeria, which is part rebel-controlled and part government-controlled. There are a lot of people there who have also fled their villages.
The healthcare situation is so bad there that we have decided to work in the whole area.
The healthcare situation is so bad there that we have decided to work in the whole area. It will take a lot of preparation to travel there and set up a base at two locations. It looks as if I'll have all the necessary papers at the end of the day, but you can never be sure until they are actually in your hand.
Early this morning I receive all the permits for the new project. The team leaves right away with two land cruisers and a truck full of supplies. I stay in contact with them all day. Around 3 p.m. I hear that they have reached their first destination and have started to work immediately.
Part of the route passes devastated and razed villages, the former homes of the displaced we are helping in the various camps.
Tomorrow I will go to our project site in Garsilla, West Darfur. Though it's only 260 kilometres away, it will take me all day to get there. Part of the route crosses savannah-like landscape where there are lots of camel herds. You feel as if you're on safari. Another part passes devastated and razed villages, the former homes of the displaced we are helping in the various camps. Two totally different scenes.
Let's hope that these people can soon return to their own environment and take care of themselves again. But first they need safety guarantees and enough food until the next harvest.