Weak care system remains at Darfur's Camp Kalma

"But we still see children dying. Last week three, the week before six. The problem is that a very malnourished child is often very sick as well and easily gets chest infections or diarrhoea."

A one hour drive along the Khartum-Nyala railroad track takes the MSF convoy to Kalma, a camp stretched over four kms - which doubled in size during the month of July. Today Kalma camp is home to 80,000 displaced and every day new people continue to settle on its outskirts.

There are thousands of small shelters here, covered with plastic sheeting, or anything their inhabitants could lay their hands on,that dot the landscape with no particular pattern or structure. They are separated here and there by large pools of water from where people had to move once the rains started pouring.

The first two cars stop at Feeding Center Number 2, near the entrance of the camp, where a long queue of women with their malnourished children is waiting to collect their family ration of 45kgs of sorghum and four liters of oil. The next two cars stop at the MSF primary health care clinic. The other landcruisers and the bus continue through the mud, puddles and market to Feeding Center Number 1.

The relatively peaceful appearance in and outside the feeding center should fool noone. People are still hungry, children are still dying, and families live in abysmal conditions.

Upon arrival, everyone hurries to their jobs. An increasing number of mothers are coming to the daycare with their malnourished children.

"If a child's weight-for-height ratio is below 70% the child is severely malnourished and we admit it in our therapeutic feeding center where we keep them and their mothers throughout the day," explained Frauke, a doctor who started working here three weeks ago.

"We have two phases. In phase one we ask the mothers to feed their children a low-fat milk four times a day to stabilize the child's body. After a few days we increase the input of calories with a richer milk. If the child is well - can eat by itself, finishes all the meals and has no oedema - we send it to home-based care. The child receives special food for one week and comes for a weekly check-up.

"But we still see children dying," Frauke continued. "Last week three, the week before six. The problem is that a very malnourished child is often very sick as well and easily gets chest infections or diarrhoea.

"Aisha, who came in a couple of days of ago, was a sad case. Her mother saw her husband die and Aisha didn't receive any food for 21 days. She was one year old and weighed only four kg. Her weight for height ratio was 57%, which is very borderline. She was extremely dehydrated and had pneumonia too. She was too weak to drink or even suck, so we tried to feed her by naso-gastric tube and kept her in 24-hour care. Every two hours we gave her some milk, but in the end we couldn't save her."

In other regions of Darfur, the number of severely malnourished children is decreasing in MSF feeding centers, mainly thanks to the general food distributions. In Kalma, however, there is still an increase which cannot be explained by the fast growth of the camp alone. Food distribution is still patchy, there is confusion on how to get registered, and many mothers arrive in the feeding centers when their children are already in a critical state.

The infrastructure in Kalma camp is not yet what it should it be and new arrivals or women, who are without their husbands, often have difficulty getting registered for the general food distributions. People living close to the aid organisation flags are the best off, but on the edges of the camp you see no latrines and little plastic sheeting.

Epidemiologist Ya Ching confirmed that "living conditions in a camp are rougher than in other locations where people are better integrated in the host communities. Kalma is often not the first stop for the displaced. They fled to other places first, but continued to Kalma, which they consider to be safer. On the move they lost many of their resources, cattle or money which served to pay their way through. So they arrive here in a quite vulnerable state already."

Seven liters of potable water per day is what people are receiving on average in Kalma camp. But 15 liters is a minimum in an emergency. For the over-stretched sanitation needs, 70 people are supposed to share one latrine. Lack of hygiene and drinking water makes vulnerable people even more prone to illnesses such as diarrhoea and the recent outbreak of hepathitis E. There is no cure for hepathitis E which is particularly dangerous for pregnant woman in their third trimester, killing one in five.

The dire suituation with water and sanitation is why MSF has already rehabilitated 40 existing wells and constructed 15 new ones, installed or repaired water pumps and set up 90 water collection points in its programs in West and South Darfur alone. At each point MSF employs two persons to chlorinate the water that people come and fetch with buckets and jerry cans.

MSF also distributes soap through the feeding centers and each community health worker takes bars of soap on her house visits through the camp.

"Especially in places with a high incidence of diarrhoea and Hepatitis E, like Garsilla and Kalma, we have to increase the amount of chlorinated water," explained MSF water and sanitation expert Jan. "People defecate in open places and in the wadi's [dried river beds which fill very quickly fill with water when it rains] from which they collect water for drinking or they take it from contaminated wells. People don't use their firewood or charcoal to boil water. They drink from the same pot and eat from the same dish. So it is important that they have access to safe water and wash their hands regularly."

Even though living conditions are far from perfect in Kalma and the emerging settlements nearby, people are not considering going anywhere. At home their crops are ripening on the ever greener fields, but it is very unlikely that they will be back to harvest a month or two from now.

People mention that, at night, after aid organisations have left the camp "things happen": men are beaten, registration and ration cards confiscated, jerry cans pierced... But they prefer this home than to risk being attacked again and losing even more husbands, wives, children or neighbours.

MSF started assisting refugees in Chad in September 2003 and has worked in Darfur since November 2003. Today, more than 180 international staff and approximately 2,000 Sudanese staff are providing health care and nutritional support in 26 locations in North, West and South Darfur. More than 10,000 malnourished children are being treated in MSF feeding centers and over a thousand medical consultations are conducted each day.