MSF's expulsion leaves health care vacuum for 100,000 in Kalma Camp, Darfur

On March 4 and 5, the Holland, then France sections of MSF were expelled from Darfur by the Sudanese government.

Lydia Geirsdottir worked as MSF Project Coordinator in Kalma Camp for nine months and has just returned home to Iceland.

She describes how the expulsion will affect the thousands of people living in one of the world's largest internally displaced people's (IDP) camps.

What is Kalma Camp like?

“What is most striking about Kalma is the people’s resilience, their strength and the motto that people seem to have: ”We won’t look back, we only look forward”.

“Kalma Camp covers about six square kilometres, and there are between 90,000 and 100,000 people living there. The houses are made of sticks, plastic sheeting, locally made bricks or whatever people can find to cover the walls. It’s a crowded camp with a lot of huts cramped together.”

What was MSF doing in Kalma Camp?

“We used to call the clinic ‘Paradise’ inside the camp! It’s a really nice set of grass huts and relatively high-roofed, so you can stand up straight inside. We were running a basic healthcare clinic, a women’s health unit, and an outreach department. Last year, we also had a mental health department, but we were instructed by the authorities to shut this down.

“Every day, we saw 200 to 300 patients in the out-patient department and 200 women in the women’s health unit. It was always extremely busy but, as the clinic’s been running since 2004, it was also extremely well organised. And the staff are so well trained that, despite the number of patients going through, it never seemed to feel overly stressful – triaging patients and treating people was a very orderly affair.

“The majority of our staff are Sudanese people who had fled to Kalma Camp and were IDPs themselves living in Kalma. We also had a more medically qualified team commuting from the nearby town of Nyala, made up of international [staff] and Sudanese from other parts of the country; doctors, nurses, nurse consultants and midwives.

“Our medical team would go to the clinic in Kalma Camp every day, leaving Nyala at 8am every morning with about 30 of us in a convoy of landcruisers. We’d have to pass two military checkpoints on the route to Kalma and they determined, on a daily basis, whether MSF was allowed through or not. We would work there all day until about 4 p.m. when the ‘Nyala team’ had to pack up and go back in convoy.

“This is because Kalma is considered a relatively volatile camp and not secure for outsiders to stay overnight inside the camp. In fact, we were only allowed to go to the camp itself, never to the villages in the surrounding area because of the risk of being attacked or cars being stolen.”

What will be the effect of MSF’s expulsion from Kalma Camp?

“I’d say that it’s an absolute and complete disaster. Not only are they expelling MSF but also the only other NGO that was providing healthcare in the camp.

“Our Sudanese staff in Kalma are still there but there are only two MSF-trained medical staff able to treat basic health problems and the supplies will run out quickly. We were treating anything from basic health care issues through to cases of obstructed labour and really serious diseases like chest infections, pneumonia, malaria and meningitis. We used to refer the very complicated cases to the hospital in Nyala, 12 km away, and we would help the patient with the transport to get there. But now I am unsure about how they would make that journey, as it is very dangerous.”

What will be the biggest medical consequence?

Listen to Jena Fernhout, the MSF health advisor for Darfur who has just returned to Amsterdam from Kalma Camp, where she has spent the last two weeks working with the MSF team, getting ready to start a vaccination campaign on Saturday, March 7. Because of the expulsion of the MSF team from Kalma camp, the vaccination campaign did not start.

“Right now, there is a meningitis outbreak in the camp which is a serious medical emergency. Four weeks ago we started to receive the first meningitis patients in our clinic. We did all the standard testing, taking samples of spinal fluid and sending them for laboratory testing at the Ministry of Health. You have to get Ministry of Health confirmation before being allowed to start vaccinating.

“We had started to prepare for a mass vaccination campaign that was going to cover around 80,000 people. The Ministry of Health, however, only confirmed it was meningitis the day before our expulsion. So right now there is no treatment available in the camp, no one to refer patients to the hospital in Nyala, and no mass vaccination. It means that people may die.”

What other concerns do you have for the people of Kalma Camp?

“Although the number of sexual violence and rape patients we saw in the clinic had reduced over time, we were still seeing up to six patients a month. We used to hear from the community that there were more cases than those we saw in the clinic but a lot of women were afraid of coming in. Sexual violence is still happening in Kalma on a regular basis. It happens when women attempt to leave the camp to collect firewood or tend fields in the land around the camp.

“But if people don’t leave the camp to collect firewood or grow crops, then there’s no dinner. One woman told me that if her husband left the camp to collect firewood he would be killed, but if she went, she would only run the risk of being raped. This is life for women in Kalma. It’s a harsh reality.

“Every day we had a woman in a complicated labour or a child born with a life-threatening complication - and every day in the clinic the staff would perform small miracles.

“We didn’t do surgery in the camp, but when necessary we would transfer emergencies to the hospital in Nyala, where we had an MSF doctor following up every case. Now that MSF has gone, women will somehow have to make their own way to the hospital in Nyala, and that’s really dangerous. I fear that, now we’re not there, these women and children will suffer.”