Doctoring In Darfur
"I am currently working as medical team leader in Garsilla in South Darfur. We have an international MSF team of 19 people in Garsilla and dozens of Sudanese staff working on three main activities: nutrition, health, and water and sanitation. I look after the medical side of things and my role is to manage the international medical team and help us keep focused on the reasons that we are there.
Garsilla used to be a town of about 5000 people, but now the town has grown to six times the size with 25,000 displaced people in the town who have fled violence over the past year and a half. Many have lost everything – their homes and all of their belongings.
The initial wave of displaced people who came to Garsilla were absorbed by relatives and host families in the town, but the more recent arrivals are living in makeshift camps on the outskirts of town. They are still afraid of going anywhere. Being in a very vulnerable situation and living in poor conditions, they get sicker faster.
What we are trying to do in Garsilla is to deliver quality basic healthcare to everyone, both residents and displaced people. There is a ministry of health system in place in Garsilla, but we are trying to help increase its capacity as the health needs of the displaced are greater than the system can handle. The MSF team is focusing most on reducing death and illness due to the infectious diseases that most affect people living without adequate food or hygiene conditions. We pay special attention to children under five as they are especially vulnerable to dying from diarrhea, chest infections, and malaria. We are also focusing on pregnant women and trying to improve their health before they give birth in the hopes that they will deliver a healthy child. We can't do everything in an emergency like this so we focus on the real killers, like malaria, pneumonia, and meningitis.
We have been lucky and not had any noteworthy disease breakouts. We have seen a fair amount of diarrhea and Hepatitis E due to the poor sanitary conditions in the town. We have also seen a number of cases of acute flaccid paralysis, which raised the possibility of polio. This is especially significant since Sudan had largely eradicated polio in the entire country before this year and there are only about 500 cases of polio reported in the entire world each year. As we can't confirm polio in Garsilla, we can just treat the patient and alert the Ministry of Health and the World Health Organization (WHO). Sudan was polio free until some suspected cases popped up in June along the border with Chad. The violence has disrupted the normal vaccination coverage in the region. We also have an early warning system in place for diseases like meningitis and cholera so that we can stop them quickly – but so far we have been lucky and not seen outbreaks of either disease. MSF is also running a primary health clinic in Garsilla where we see roughly 8000 patients a month and support the in-patient capacity.
In addition to communicable diseases, the next priority for MSF has been nutrition – luckily the situation is stabilizing and new admissions to our feeding centers have decreased since MSF first arrived. But, we are still treating 150 children in our therapeutic feeding center (TFC) and another 800 in our supplementary feeding center (SFC).
After disease and nutrition control, our next priorities in Garsilla have been improving the shelter and water and sanitation situation. We've done lot of work on repairing water pumps in the town so that people can have clean water and we hope this has helped to reduce the risk of a major outbreak of cholera or other disease.
Garsilla is really a forgotten corner of Darfur. There was no other aid organization working there in March when MSF arrived, so we are encouraged that others are coming in now as there is still a great deal to do.
The big question on everyone's minds now is when are people going to be able to go home. The situation in Garsilla is calm, but it is an uneasy calm as no one knows what the future will bring. It looks like people are going to be stuck where they are for now, as they will only go home when they feel safe – and they certainly don't feel that way yet. You have people managing in a fashion, but they are completely dependent on outside aid and will be for many months at least as they were not able to plant their fields this year.
People are managing to survive on their own coping mechanisms. They have adjusted to living as displaced, but it is not satisfactory, and not something that they can do forever. It's like adjusting to living in a tent on your front lawn – you can do it, but not for that long. What kind of life will they be able to lead if they are never able to go home?"