An overview of MSF projects throughout the Darfur region of Sudan.
Since the beginning of the Darfur conflict, the population of the town of Zalingei has swelled to over 115,000 with the influx of 95,000 displaced. MSF focuses on surgical care in the main town hospital. In 2006, MSF undertook 2,761 paediatric, 1,787 maternal, 932 general medicine and 1,826 surgical admissions. MSF has constructed a hospital and health centre in the vast displaced camp of Mornay which is home for 75,000 displaced and 5,000 residents. In 2006, MSF carried out nearly 69,000 consultations and 2,245 hospitalisations. There were 617 children admitted into the nutritional centre. MSF has worked in Niertiti, an area in the foothills of the Jebel Mara, with an original population 3,000 in addition to the 30,000 displaced. Teams have been running a small hospital since March 2004 as well as mobile medical clinics, although the latter have been put on hold due to a number of security incidents. 2,491 hospitalisations and 53,395 consultations were carried out during 2006. In the Jebel Mara itself, MSF runs a health centre in Kutrum, which has been a rebel-controlled area since March 2006. There were 16,362 consultations carried out in the first six months of 2006. While the project was evacuated on September 14, from November teams began to return from the nearby base of Niertiti. In Habilah, a camp near to the border with Chad, which houses over 22,000 displaced and a 7,000 resident population, MSF runs a medical clinic with 30-bed inpatient ward. This includes therapeutic feeding for severely malnourished children and ante-natal care and delivery. An average of 35 deliveries occurs each month in our health center. Outreach workers assist with health education and referrals. In 2006, 25,000 consultations were done in the OPD and 750 patients were hospitalized. Mobile clinics which provided medical care for mostly nomadic populations have been stopped, once again due to increasing insecurity. In this particularly difficult context, we are trying to reach populations located north of El Geneina, who are receiving little if any assistance. This is the case for a four-person team based in Seleia, in the north of the West Darfur province, home to 20,000 people, and around which fighting has been on-going. The team is setting up a surgical facility to treat the wounded; a capacity to answer to emergency obstetric cases and is giving support to the health centre. A mobile clinic is being put into place. Access to medical care and emergency support is a constant problem for populations faced with on-going violence. Fighting to north of El Geneina led to the displacement of several thousand people in December, 5,000 of whom arrived in the nearby Aradamata and Dorti camps. In Aradamata camp on the outskirts of town, MSF has set up a medical mobile unit to screen new arrivals, and more than 500 people were treated in less than a week and non-food items were distributed to displaced 750 families. Displaced continue to arrive in small groups, mostly at night due to the risk of attacks on the roads and there are many reports of acts of violence perpetrated against villagers. An exploratory mission recently went to Tanjeke, 30km north of El Geneina, where the displaced had talked of families being stranded because of insecurity. A security incident on the way back has confirmed roads were not safe enough to take them regularly. As of now we have not been able to bring further assistance to this population. In El Geneina, the provincial capital of West Darfur, MSF supports the emergency and surgery ward of the general hospital, with medicine, medical material and technical support such as the management of the pharmacy and of hygiene. North Darfur Severe security incidents had led MSF to evacuate its international team out of Serif Umra in July 2006. Medical activities towards a population of 55,000 (mostly displaced) in the dispensary have had to be run by national staff alone. In the town of Kebkabyia, just over 150 kilometres to the west of the provincial capital El Fasher, MSF is running three dispensaries and providing support to the Ministry of Health hospital for the clinical management of the cases referred. The program serves a population of approximately 75,000 - mostly displaced who have sought refuge in the city. Outreach support from Kebkabyia continues to the town of Kaguro in the rebel-held Jebel Si. The project was placed on stand-by in August 2006 after a number of security incidents. After an initial assessment in February, the team has once again been able to start work in this area, which has been a battlefield between the SLA and the Sudanese government since the start of the conflict in 2003. The project focuses on bringing medical care to civilian population who been cut off from assistance for a number of months due increasing insecurity and conflict in the area. To the south and east of Kebkabyia district, mobile clinics have also been launched recently in order to allow provision of basic healthcare to a marginalized and neglected population of Arab nomads. The simplistic description of a conflict pitting Arabs killers against Africans has translated into many nomadic Arab communities being denied assistance, even when they have fled violence, such as in this area. Severe security incidents had led MSF to evacuate its international team out of Serif Umra in July 2006. Medical activities towards a population of 55,000 (mostly displaced) in the dispensary have had to be run by national staff alone. Since March 2007, supervision has restarted on a weekly basis from our international team based in El Fashir. A total of 4,000 out-patient consultations are performed on a monthly basis while patients in need of secondary health care are transferred to the hospital in Zalingei In June 2006, MSF began work in clinics in Killin and a month later in Gorni to assist displaced persons. However the project was evacuated for security reasons in late July, when an MSF convoy was attacked on the only access road to the area. Since then, the clinic, located in the north of the Jebel Mara, has been run primarily by Sudanese staff alone. MSF is still evaluating the possibility of re-establishing a permanent presence in the area. In Shangil Tobaya, MSF provides healthcare services for the displaced people living in the Shangil and Shadat camps, as well as in Shangil Tobaya village. Every month an average of 3,700 consultations are carried out and 110 patients are hospitalized. Around 50 children are treated in the nutritional program every month. After several incidents in December and January, the team was withdrawn to El Fashir and since then it has been operating on an in-and-out strategy. Negotiations for access are on-going to re-open a full program in the coming weeks. The clinic is currently run by Sudanese staff with an international team assisting once or twice a week to carry out consultations (an average of 150 per day). Assessments have also been undertaken recently among pockets of newly displaced people in North Darfur. South Darfur As the conflict has split the population along ethnic lines, the situation is complex and remains highly volatile. MSF offers surgical care and runs inpatient and outpatient departments and a lab, as well as providing reproductive health services with antenatal, postnatal and family planning assistance. Treatment of survivors of sexual violence is available. With a population of over 90,000 people, Kalma is one of the largest camps for displaced persons in Darfur. Since May 2004, MSF has been offering a range of health services in the camp and surrounding area. MSF is focusing on mother and child care and running a women's health center with 450 to 500 consultations per week. The center provides ante- and post-natal care, as well as delivery assistance for high-risk pregnancies and referrals for obstetric emergencies. Family planning is also available. MSF is one of three agencies providing full treatment for survivors of sexual gender-based violence. A mental health program addresses the profound psychosocial stress and trauma experienced by the population as a result of current living conditions and uncertainty, as well as past conflict related psychological trauma. Psychosocial care is given through private counseling session, workshops and support groups. In Shariya, a government enclave where originally around 27,000 people were living, ethnic tensions precipitated by the conflict, led to almost 50 per cent of the population fleeing from the town. The remaining population is isolated and has little or no access to health care. Two days a week MSF supports the clinic of the Sudanese Ministry of Health in Shariya. In addition MSF provides ante and post-natal services, and therapeutic feeding during the hunger season. Regular mobile clinics provide the only direct humanitarian care to a fluctuating group of 400 to 1,500 displaced trapped on the outskirts of the town who have no access to the clinic. A weekly mobile clinic provides basic health care services to Khazan Jadid, a government held town of 40,000 currently dealing with similar conflict related tensions. Mobile teams are also regularly assessing and respond with health care for displaced rural communities. Muhajariya is a major rebel-held town in South Darfur with a population of approximately 47,000, including displaced from the surrounding area. After a period of relative calm, open combat broke out in the town and the surrounding areas in October 2006, resulting in new displacement of an estimated 50,000 people. As the conflict has split the population along ethnic lines, the situation is complex and remains highly volatile. MSF offers surgical care and runs inpatient and outpatient departments and a lab, as well as providing reproductive health services with antenatal, postnatal and family planning assistance. Treatment of survivors of sexual violence is available. Because the nutritional situation is still fragile, therapeutic and supplementary feeding remain integrated in the basic health care. Community outreach programs and mobile clinics complement these activities. MSF teams also provide water to displaced persons in IDP settlements around Muhajariya. Currently, MSF provides basic health care services once a week to the towns of Labado and Angabo, and is assessing and responding to health needs in other settlements. Sileah is a government held town in south Darfur, with a population of 6,000. MSF responded when 14,000 IDPs from and around Muhajariya sought refuge in the town in November 2006. Plastic sheeting and blankets were distributed to new arrivals. MSF offers outpatient services, vaccinates children between six months and five years old, monitors malnutrition and is running a home based feeding program. In addition MSF is supporting the provision of water and sanitation to the IDPs. In Um Dukhun, in West Darfur near the border of Chad and CAR, MSF offers emergency surgery, basic health care, ante- and post-natal care, lab services, as well as treatment for survivors of sexual violence. Therapeutic and supplementary feeding assistance is provided during peaks of malnutrition. In May and June 2006, the team responded to the needs of the 12,000 new arrivals who crossed the border from Chad due to clashes and attacks in their villages. Programmes are complemented by community outreach and referrals.