Disease outbreaks in Sudan worsen ongoing crisis

This article first appeared in the August edition of The Lancet © Lucy Clayton/MSF Click image for larger view Man climbing out after digging 5 metre trench for latrines at MSF health clinic for IDPs in Kebkabyia in North Darfur, Sudan. "Digging a latrine for every 20 people and providing 20lts of water a day per person saves more lives than any of our fancy medical programmes. It's up there with measles vaccinations in terms of a priority but just has not been done", complained Greg Elder who heads MSF's aid work in the region. The 5-year-old girl who developed polio comes from Habilla's Forparanga town situated close to Sudan's border with Chad. "This is another bad dream for us", says Maria Costales of UNICEF, because poliovirus originating from northern Nigeria has already reinfected ten previously polio-free African countries. "For more than three years the country did not have any polio", she said. UN says that during the past 16 months, around two million people, mostly from black African tribes, have been directly affected by violent raids. Around 30,000 have died and human-rights groups warn that despite a ceasefire agreement, killings, rape, and looting continue. 1.2 million people have been internally displaced, but UN and aid agencies have access to only half of them. Global malnutrition rates are as high as 25% simply because food supply is short. The crude mortality rate in Darfur is unacceptably high. Half of the deaths are among people who die without getting to a health centre, according to Médecins Sans Frontiès;res (MSF). This week WHO warned that at least 10,000 people in Darfur could die of common infectious diseases this month alone unless response to the crisis is not stepped up dramatically. "The sheer scale of the operations needed in terms of relief personnel, helicopters, trucks, and communications equipment is really way beyond what we as the UN ourselves can do, David Nabarro of WHO's unit for Health Action in Crises told journalists at the end of his visit to Darfur. "It is bigger than the Balkans, and certainly bigger than Iraq and Afghanistan." The rainy season in the Darfur region has just started and there is a real fear that a cholera epidemic could break out soon, affecting 20-30% of internally displaced people. "We have already seen a few cases of shigella, and if we don't see cholera this year it will be good luck and not good management. The mortality of these [diseases] would be huge", warns Greg Elder who heads MSF's aid work in the region. He complains that the UN as well as international aid agencies remain "greatly underprepared" to deal with diarrhoeal diseases in Darfur. All humanitarian sectors are late in their response to the crisis but unfortunately many of the big agencies with water and sanitation expertise have only just begun activities. "Digging a latrine for every 20 people and providing 20lts of water a day per person saves more lives than any of our fancy medical programmes. It's up there with measles vaccinations in terms of a priority but just has not been done", Elder complained. Overcrowding, poor sanitation, and rainfall have contributed to respiratory tract infections, watery diarrhoea, and malaria respectively, which account for much of the death and ill-health in the region. "All three diseases are exacerbated in children less than 5 years of age by the dangerously high rates of malnutrition which has a multiplying effect on the mortality", he told The Lancet. The number of measles cases is decreasing because of last month's vaccination campaign by the ministry of health, UN and international aid agencies - but malaria is on the rise and is likely to claim more lives this year because children are already weakened by malnutrition. There have been reports that some agencies are using only chloroquine to treat malaria, which is a violation of the national protocol where Artemisinin-based Combinational Therapy (ACT) is the treatment of choice. "If true, this would be a deadly insult added to the massive injuries already inflicted on people in Darfur. The availability of ACT will reduce malaria specific mortality", MSF said. As the rainy season peaks, the humanitarian situation in camps in Darfur will deteriorate further because they will become largely inaccessible. Aid agencies are also concerned that rains would also make it impossible to get aid to the majority of about 200,000 people who have taken refuge in camps in bordering Chad. And if aid does not come quickly, "then it's going to be too late to do it at all", Elder said. Many aid agencies hope that the aid situation in Darfur will improve as a result of last week's visits to Darfur by US Secretary of State Colin Powell and UN Secretary-General Kofi Annan. On July 3, Sudan pledged to disarm Janjaweed and withdraw visa restrictions for aid workers - a long-standing demand of aid agencies. But given Sudan's poor record of honouring its promises, this may not materialise, cautions Jemera Rone from Human Rights Watch, who has been persistently reminding the USA and the UN that the root cause of the humanitarian crisis in Darfur is the human rights abuses. And that only by addressing these atrocities can this crisis be solved.