MSF in Khartoum: The heat is on

© Ton Koene Click image for full size In fact, the rainy season has now pretty much arrived. It brings with it acute aid transportation problems, worsening sanitation conditions and the growing threat of cholera, malaria and respiratory infections. During an emergency coordination meeting on yet another sweltering Khartoum afternoon, the words of Dan Sermand, MSF head of mission in Sudan, pretty much sum up the situation: "For the coming weeks, the sky is not looking blue, it is looking grey. In fact it is looking very dark." The troubling forecast is not news to the MSF Khartoum team working frantically to get crucial medical aid to the people of Darfur. Some of the staff have been in the Sudanese capital since January, struggling with numerous hurdles through the 50-degree mid-day heat, wading through endless paperwork, coping with a myriad of logistical difficulties, participating in countless co-ordination meetings. They know full well that, despite the fact that more aid organisations are finally starting to mobilise in Darfur, despite the measures recently pledged by the UN and the Sudanese government, despite growing international awareness of the crisis, things are likely to get harder rather than easier over future months. "The rainy season is coming," is the phrase echoing repeatedly around Khartoum, at UN meetings, in press reports, during NGO gatherings. In fact, the rainy season has now pretty much arrived. It brings with it acute aid transportation problems, worsening sanitation conditions and the growing threat of cholera, malaria and respiratory infections. "The town of Kebkabyia in North Darfur State used to have a population of about 15,000 residents," says Nathalie Civet, MSF Medical Coordinator, who has been working on the Darfur emergency since January. "In April there were 45,000 more people living there, all of them displaced from their homes and villages. There are now about 68,000 extra people in this small town, many of them living in appalling conditions. Way too many of them are dying from common diseases - illnesses which can be easily and cheaply treated such as diarrhoea, respiratory infections and malaria. "With so many people living cramped together with poor sanitation and water facilities, we are very nervous about an outbreak of water-borne diseases such as cholera and shigella. It would be disastrous in these circumstances. © Ton Koene Click image for full size "Our goal in Kebkabyia is extremely simple: to get the mortality rate down as quickly as possible by treating respiratory infections, diarrhoea and malaria correctly and urgently vaccinating newly arrived children against measles." "We are also worried about the potential for measles, since we believe that many of the displaced children who continue to arrive have never been given a measles vaccination. Measles is very unlikely to be fatal for a well-fed, otherwise healthy child. But for malnourished children already suffering from other chronic diseases it can easily kill, especially the very young. "Our goal in Kebkabyia is extremely simple: to get the mortality rate down as quickly as possible by treating respiratory infections, diarrhoea and malaria correctly and urgently vaccinating newly arrived children against measles." Straightforward as the goal sounds, the team are battling against a host of difficulties to achieve it. First you have to get the right medicines to the right place. Although some of the official restrictions for transporting medicines and clearing customs have recently been eased, for the team it can seem as if as soon as they make it over one hurdle, another is set up in its place. New directives on drugs and health being issued continually by various different health authorities mean a gruelling bureaucratic headache for Nathalie. Even when you have the right drugs in place, you need to find trained medical personnel to administer them correctly. In Kebkabyia, many of the staff that used to work in the hospital fled the town because of fighting. Of the few medical staff remaining, most have received scarce training, even in the very basics such as how to use a thermometer. With low salaries and high insecurity, they also have little motivation to work. "We are now sending Sudanese doctors, nurses and Ministry of Health teachers from Khartoum to Darfur in order to train the local staff in Kebkabyia and make sure that everybody stays focused on the emergency priorities," says Nathalie. "Before MSF arrived, the hospital was treating a small number of people with chronic illnesses. This makes absolutely no sense in a crisis situation, when you have people dying outside the doors from diseases which could be treated easily." Problems ranging from the serious to the bizarre will continue to evolve and be solved. Many problems are the types of things that could easily be sorted out in a developed country, such as keeping medicines at the right temperature, become infinitely more complicated in places such as Khartoum, where the electricity supply cuts out regularly and the generator sometimes goes on the blink. Luckily the MSF Khartoum team are in high spirits. But the cry of "Malesh!" ("Bad luck!") is going to be heard echoing around the office for a good while longer yet.