Sudan: Humanitarian aid in the balance

  • International staff: 78
  • National staff: 1,200 Sudan has been embroiled in civil war since 1955. Despite a ceasefire in the early 1970s, the war - with roots in the economic, religious and social differences between the country's north and south - has continued. This has been devastating for the Sudanese people, and challenging for the humanitarian community trying to provide them with relief. In late 1999 and early 2000, the rebel Sudanese People's Liberation Movement (SPLM), which controls most of the southern part of the country, pushed for a memorandum of understanding (MOU) to be signed by its humanitarian wing (the Sudan Relief and Rehabilitation Association) and NGOs. All NGOs were expected to sign, whether or not they were part of the UN aid umbrella Operation Lifeline Sudan (or OLS, in place as an aid coordinating mechanism since 1989). The agreement was thought to be a possible step toward more SPLM control over NGO projects, which put all NGOs working in SPLM-held territories in a difficult dilemma: either sign the agreement by the March 1st deadline and open the door to this possibility, or do not sign and be expelled. Some NGOs working in SPLM-held territory decided against signing and were forced to evacuate their missions. Most MSF teams signed, in order to remain operational in the area to respond quickly to medical or nutritional needs. This decision allowed MSF to stay close to the population as long as possible - continuing to struggle for access to the people but prepared to leave should access or a means of working be denied. Because of the specific situation and the SPLM's local control, one MSF team determined that they would no longer be able to carry out their work under the MOU. As a result, they decided not to sign and left southern Sudan, at least temporarily. In another development, the sole remaining MSF team working within Operation Lifeline Sudan withdrew in August 2000, after judging that the OLS had lost its capacity to negotiate unconditional access for humanitarian aid. MSF has continued to call on all parties to protect civilians throughout the country. In the province of Equatoria, in the south, repeated government bombing of civilian populations - and the hospital where MSF works - forced MSF to protest publicly in February 2000. Projects seek to help civilians in north and south Against this struggle to maintain access to the population and a humanitarian space in which to work, MSF continues to bring direct medical care to people on all sides of the conflict. MSF projects are scattered all over southern Sudan: from Bahr el Ghazal, the Lakes Region and Western Equatoria, to the Upper Nile, Eastern Equatoria and Jonglei. Its missions in the south are varied - nutrition support at feeding centers, primary care, water supply, hygiene promotion, vaccinations, mother and child health care, and surgical intervention. MSF also works at the civilian hospital in the government-held garrison town of Wau. Long-term projects in the north are just as diverse. Near Khartoum, MSF provides primary care and feeding programs at three camps for displaced people. In Meiram, a clinic treats both the displaced and the area's residents, providing vaccinations, general consultations, and prenatal care. During the rainy season, MSF distributes protein rations to needy residents and displaced people. Responding to Crises The organization also responds to crises as they occur. For instance, the town of Akobo, on the Ethiopian border, experienced particularly high rates of meningitis in early 2000. MSF responded quickly with patient care, vaccinations and epidemiological surveillance. Immediately after the meningitis outbreak came sudden and severe nutritional problems in Akobo. MSF's emergency teams were mobilized again, this time for therapeutic and supplementary feedings and measles vaccinations. Crises occurred in the north as well: The month of May saw tens of thousands of Eritrean refugees flee the war between Ethiopia and Eritrea, which resumed in May 2000. Refugees arrived en masse in and around Kassala, on the Eritrean border, and MSF was quick to respond to the crisis. Intensification of the fighting in summer 2000 prompted MSF to temporarily evacuate some of its staff from the region of Bahr el Ghazal. Ongoing fight against disease MSF projects fighting kala azar, sleeping sickness, and malaria have reached thousands of people at risk for or suffering from these diseases. Kala azar clinics in Qasaab and Um El Kher help combat this potentially fatal illness. Spread by the sandfly, the disease leads to an enlarged spleen, internal bleeding and eventually death. However, through analyses done at MSF's labs in Qasaab and Um El Kher, kala azar can be diagnosed quickly and treated in time. MSF began a new sleeping sickness program in Kajo Keji county in early 2000. The disease is treatable, but the treatment itself can be lethal: Between three and ten percent of those treated with Melarsoprol, used during the later stages of sleeping sickness, die from the medicine and not the disease. In Meiram, MSF is putting a special emphasis on fighting malaria, endemic in many parts of Sudan and a particular problem in this area. Malnutrition Getting enough to eat is a struggle for many Sudanese. Many MSF programs have an ongoing nutrition component. Therapeutic and supplementary feeding centers are sometimes set up for just a few months to address periodic food shortages or peaks in chronic malnutrition. MSF has been working in Sudan since the late 1970s.