Doctor Of The Displaced

"When I arrived, El Genina hospital was half-empty. People had to pay for medical care, which was not always of high quality, to be specific, there was a lack of drugs. There was an armed guard stationed at the entrance to the hospital, and even visitors — who were absolutely necessary because the hospital did not provide patients with food — had to pay to enter.

Our initial agreement with the Sudanese authorities was for MSF to start up surgery in the city hospital. However I quickly realized that the urgent task was not so much to resume surgical activities as it was to drastically improve access to medical care for the displaced people. So we renegotiated our agreement with the authorities, adding management of the emergency and paediatric departments to the task of restoring the operating room.

It took a little time for that to happen because in spite of the improvements we made to the hospital, patients did not always come to see us. So my colleagues and I went to find them in the camps, where the horrible living conditions (precarious shelters, lack of drinking water and latrines, etc.) were conducive to the spread of disease.

In just 10 minutes during my visit to the Abuzar camp, set up in an El Genina school, I identified eight children suffering from severe malnutrition. I quickly referred them to the hospital. Then, word-of-mouth led families to bring their children to us on their own. At that point, our priority was to increase the hospital capacity. We set up two 80-square meter tents and several smaller ones, but also built two buildings, giving us 100 additional hospital beds. We very quickly had 80 hospitalised children.

When our colleagues from MSF's epidemiology unit came out to do a survey, they estimated that there were between 500 and 1,000 severely malnourished children. To treat the children without hospitalising them systematically, we set up outpatient feeding centres, as we have done elsewhere in Darfur. The principle is simple. Twice a week, the children come to the therapeutic feeding centre (TFC). They are weighed and measured, nutritional aides confirm that they are eating the peanut butter (a therapeutic nutrient) distributed to them, they all see a medical assistant, and the most troubling cases are seen by a doctor, who may decide to hospitalise them. Otherwise, they remain at home, taking a ration of peanut butter with them until their next visit. In addition, we distribute a family survival ration to each child who comes for a medical visit.

There are not enough general food or relief items distributed to the displaced people and it is difficult for them to go beyond the camp to try and find any. The women do leave in search of wood for cooking or additional food, but the violence is ongoing. Pro-government militias still control the outskirts of the camps and most of the rapes and violence occur during the day.

Violence is clearly always present, but it is difficult to quantify. Every week, when we see patients in Mornay, we see a dozen victims of violence, including two or three female rape victims and women with marks from whippings or blows to the ankle from a club. But we know for certain that not all the victims come to us.