MSF report: Nutritional status of the population

Many displaced people demonstrate greatest concern and anger over food shortages and the destruction of their food stocks. People claim they will be attacked if they return to their fields. There was almost no planting in May and so even if there were good rains there will be virtually no harvest in many conflict effected areas in November this year.

Food aid does not cover all the needs to fill this gap. The displaced and host populations had to wait nine months after their arrival until the first food aid was distributed. When MSF first arrived in Darfur, the number of people (especially the children) close to starvation was staggering. For instance, on the first day the MSF therapeutic feeding centre in Kalma opened, 112 children were admitted.

Erratic general food distributions started in February 2004 but became more regular20 only in May-September 2004 - and then only in the main camps along major roads and around large towns. The food distributions to date have not completely addressed the high levels of mortality among starving children, but have for now prevented a looming famine. However, the distributions still only cover half of the assessed needs of the displaced population21.

Many areas are still unassessed and pockets of displaced are still not receiving food, mainly in the rebel-controlled areas. People cannot buy food because their belongings have been stolen, they have no income and food prices have increased. Many populations in Darfur have been reduced to full dependency on aid. The numbers dependent on food aid are only likely to increase next year with the failure of the November harvest.

"We are depending so much on the food rations distributed by the organisations. We have no source of income, as there is no work available in Deleig. The only option is to collect wood and to sell it in the market. But it becomes too dangerous only 1 or 2 kms far from Deleig." Female IDP, 24, Deleig (West Darfur)

"I have two children and I don't have anything to eat at home. My husband was killed last February (2004) and I have no other relatives here. I have no wood and no money to build a shelter so I live at somebody's place. I can't go outside to get some wood because one of my children is sick [severely malnourished child admitted in MSF feeding centre]. I'm also very hungry." Female IDP, 19, Kalma camp (South Darfur)

Although the nutritional crisis in the major sites in West Darfur has been stabilised after May 2004, it remains very fragile for host and displaced populations. Any interruption of assistance would result in an immediate and drastic deterioration of their nutritional status.

In the camps in South Darfur, the situation is still cause for particular concern, as shown by the table below.

Table 1: Malnutrition rates (W/H Z-Scores), South Darfur, September 2004

Locations Kalma Kass Muhajaria
Severe acute malnutrition 3.3% 1.9% 0.9%
Global acute malnutrition 23.6% 14.1% 10.7%

Based on MSF statistics22, malnutrition is reported to be the second cause of death, after diarrhoeal diseases. Different nutritional surveys highlight that malnutrition is the direct result of lack of food shortages and not due to environmental factors.

In early July 2004, when Kalma camp received a major population influx, the number of new admissions of children under 5 in the feeding centres grew exponentially. Among the new admissions, almost 40% of children were from displaced families who had arrived very recently in the camp (less than two weeks before)23.

But the majority of children newly admitted remained among children already in the camps for some months. This situation is a worrying indicator of the critical nutritional conditions of both the new arrivals and those who have been longer in the camp.

Some women explained that the delivery of food relieves them from going outside the towns and therefore they are less exposed to beatings and rapes. Food distributions and therapeutic nutritional support cover some of the immediate needs of the population. According to the UN, still 49% of the food needs are uncovered.24 The displaced are either exposed to risk or confined in a state of semi-starvation - dependent on international food aid.

Health status of the population

Mass displacement and food shortages have a serious impact on the health status of the population. The very precarious living conditions of the displaced have favoured the development and spread of preventable diseases.

The main reported causes of deaths are diarrhoeal diseases, respiratory infections and malaria. Almost 45% of MSF consultations are for diarrhoeal diseases and acute respiratory infections, while malaria cases, particularly acute during the rainy season, represent the third main disease seen during consultations.

The high incidences of all three diseases can be traced to people's lack of adequate shelter and appalling water and sanitation conditions in the camps.

Table 2: Crude mortality rates - South Darfur, September 2004

Location Kalma camp
7 months recall period   Kass
4 months recall period   Muhajaria
7 months recall period  
  All ages < 5 All ages < 5 All ages < 5
Per 10,000 per day 1.6
(2.0*) 2.9 (3.5*) 3.2 5.9 1.2
(2.3*) 0.7 (1.0*)
* 30 days recall period

The crude mortality rates remain above the emergency thresholds, which are one per 10,000 per day for all ages and two per 10,000 per day for children under 5.

Table 3: Reported causes of death - South Darfur, September 2004

Location Kalma camp
7 months recall period   Kass
4 months recall period   Muhajaria
7 months recall period  
  All ages < 5 All ages < 5 All ages < 5
Diarrhoea 24.6% 34.9% 25.3% 33.3% 11.5% 21.7%
Measles 17.6% 33.7% - - 4.5% 26.1%
Other illnesses 28.9% 27.7% 54.4% 63.3% 34.0% 52.2%
Violence 28.3% 3.6% 18.0% 3.3% 46.2%
Among > 18 : 81% 0

Mortality rates are alarming. In Kalma camp (66,000 people25), in South Darfur, the retrospective mortality survey from September 2004 showed that in the past seven months, approximately 2,500 people have died, of which 1,100 were children under 5. In other words, around 20 children have been dying every day in the past seven months. These figures are far above the emergency thresholds.

Estimates over August do not show any appreciable improvement, despite increased access to health resources in Kalma camp (due to lack of food and water and new influxes of severely affected people).

Measles has been a major killer of malnourished children in the past months. UNICEF supported the Ministry of Health to vaccinate - but coverage was so low that the epidemics continued with disastrous effect. MSF has repeatedly asked to carry out measles vaccination campaigns but the Ministry would not allow NGOs to vaccinate as they claimed they had already done the job.