Emergency in Darfur

A humanitarian crisis is raging in the Darfur region of western Sudan. Civilians are suffering torture and death by government-supported militia. Tens of thousands have been killed and over a million people have been driven from their homes. The refugees and those who remain in their villages in Darfur must deal with hunger and disease, lack of water and the absence of sanitation facilities. Seasonal rains hamper access by humanitarian aid organizations, whose assistance is already drastically reduced by limitations imposed by the Sudanese government.

Emergency-Life Support for Civilian War Victims is a non-profit humanitarian organization dedicated to providing assistance to the civilian victims of war, to the wounded and to all those who suffer the consequences of war such as hunger, malnutrition, and a lack of medical care. Emergency promotes a culture of peace and solidarity. It is a private, independent and neutral organization open to all those who share its goals and principles and support its humanitarian activities without any political, ideological, or religious discrimination. In the past several months, Emergency had taken on several field missions in Al Fashir, the historic capital of Darfur. Recently, the organization has decided to begin a new emergency surgery program there.

Dr. Alberto M. Colombi MD MPH is a good will ambassador for Emergency in the US. He recently interviewed Rossella Miccio, coordinator of Emergency’s projects in Sudan, and Dr. Gino Strada, head surgeon and co-founder of Emergency. Following are excerpts from these interviews.

Q: Rossella, tell us about your most recent trip to Darfur.

When we arrived in Al Fashir, we were welcomed by the smile of Najib Al Fatih, one of the two surgeons working at the university hospital of the town, the main referral center for all Northern Darfur. 

Dr. Al Fatih toured us through the various departments of the facility, an intricate maze of buildings erected in a disorderly way around an original core built 70 years ago by the British authorities. “The hospital has 360 beds,” he told us, “but in the last year we often had even two patients per bed. We were not ready to put up with this new current emergency, and we are not ready even now.”

Even to a superficial observer it is clear that the conditions of the hospital leave much to be desired. In the two operating rooms, which cannot work simultaneously for lack of instruments and equipment, the air conditioners are beyond repair. Temperatures are often up the 40 degrees Celsius (104 F) with negative consequences both for the surgical staff and for the sterility of the environment. Empty pharmacies, decaying wards, and hygienic and toilet services are practically nonexistent. A multitude of “co-patients,” relatives and families crowd the inside of the hospital wards and yards with their dowry of pans and kitchen utensils to take care of their own dear ones admitted to the hospital.

All medical services, needless to say, are subject to payment of a fee in honor of the international directives regarding “the economic sustainability of medical procedures.”

A lobotomy costs half the salary of the average worker and in the last year the population of Al Fashir has almost doubled due to the massive displacement of villagers who have lost most of their belongings fleeing from their villages.

It has been about a year and a half now that violence and chaos have stormed through all Darfur. Despite the fact that the intensity of the clashes has somehow decreased after the ceasefire signed by the rebel groups and the government, the exodus from villages to the main towns has not stopped.

Q. What is the situation of the refugees, at least for what you could  see directly?

In Al Fashir alone, there are more than 100,000 IDPs (Internally Displaced Person). About half of them have found a precarious settlement in organized refugee camps supported in various manners by international organizations. The remainder is hosted in the house of relatives or, the less lucky ones have found shelter in makeshift camps on the outskirts of town.  Talking to people, the impression that we derived was that of great confusion.        

The rebels of the Sudan Liberation Army and the Justice and Equality Movement, who in the February of last year -- supported by the internal opposition to the national regime and by some foreign countries -- opened this phase of hostilities against the Khartoum government. They are still recruiting fighters in the villages, independently from tribal affiliations, paying poor, illiterate, hungry farmers to take up a rifle. At the same time, the so-called janjaweed, local bandits prevalently of Arab ethnic origin, seem to have gotten out of control of the central authorities, which have supported them for a long time, financed them and used them to control the rebels, giving way to raids and violence, mostly harming civilian populations.

Q. So, in a confusing situation how do we “take sides?”

For us there is only one side, the side of the victims. It may sound obvious, but once again, even in this case, among much confusion and misinformation, the only certain fact is that common people are paying for the madness of war with their lives and limbs. For this reason we considered our duty to organize our mission in Darfur.  Initially we had provided for re-stocking of the pharmacies of the Al Fashir hospital and of the smaller hospital in Mellit, a small town north of the capital, with medicines and medical consumables for which patients will not have to pay. We demanded and then verified that the medicines we provided were distributed free of charge and on the basis of need. After this initial intervention, we have organized a more onerous one.

We have discussed with the local Health Authorities and agreed with them about the necessity to cooperate, not only to face the emergency due to the recent conflict, but also to improve the general standards of medical services and of surgery in particular.

The right to health is in fact such, only if the available services are accessible to all and are of high quality.

Q. While facing the humanitarian crisis in Darfur I understand that Emergency is striving to build permanent health care capacity. Can you explain how?

In order to guarantee the right to health, Emergency is working to take over the Surgical Department of the University Hospital Al Fashir for civilian victims of war, providing, as our usual practice, a free service accessible to all those in need. At the same time, Emergency is pushing the Ministry of Health to improve the services in the medical part of the hospital.

Q.  Gino, I understand that Emergency has an even bolder vision for a more long-term “peace making” project, in Sudan; what is it?

I think of Emergency’s surgical and rehabilitation centers as practical metaphors where not only we mend the bodies broken by war, but where human relationships are rebuilt based on solidarity rather than violence and money. In this sense “we do not need a war to build a hospital,” we do not need to act only when the number of refugees becomes a humanitarian disaster.

Emergency has therefore declared its intention to build a regional center to provide free cardiac surgery in Karthoum to children of all the neighboring countries, namely: Egypt, Libya, Chad, Central African Republic, Congo, Kenya, Uganda, Ethiopia and Erithrea.

Emergency is confident that increasing cooperation among the peoples of all these countries will contribute to promote “people to people” friendly relations in the region.   High infant mortality rates in the region due to valvular disease as consequence of rheumatic fever is one of the rationales; the choice of Karthoum is due to the central position of Sudan that shares borders with all those countries, and where similar facilities are scarce or non-existent and the need is similarly high.

Q. Emergency is not new at building surgical centers in the middle of war providing care to civilians in spite of opposing warring parties. Wouldn’t such a project, though, be perceived as a favor to a despicable regime?

Nowadays wars have Variables and Constants. Dictators and regimes are the variable part: friendly dictators of yesterday become the enemies of today to be substituted by other regimes that will become the foes of tomorrow. The victims, mainly civilians, women, children are the constant; they pay with life, disability, misery, poverty, their basic rights denied, including their right to a decent existence, health and education tramped on.  For us there is only one side, the side of the victims: the worse the regime, the more help they need.

Besides, we ought to stop thinking of delivering third world quality health care to third world countries; they already have plenty of that. Let us think, instead, of using fundamental    human rights, as our compass and rationale; if we do that then it is easier to see that children in Sudan Egypt, Libya, Chad, Central African Republic, Congo, Kenya, Uganda, Ethiopia and Erithrea have the same right to high standard surgical care as our children, independently from the dictators and regimes of the moment.

While it is true that the current regime of Sudan (and not only of Sudan) spends less to cure its citizens than to kill them, this cannot become an excuse for inaction or for withholding “people to people” interventions.

A free care, high quality standard, Heart Surgery center for the children of Sudan, Egypt, Libya, Chad, Central African Republic, Congo, Kenya, Uganda, Ethiopia and Erithrea, becomes the metaphor of equality in rights and dignity, the only foundation for building peace...

Q. What do you expect from sharing this vision?

We expect a great response from the American public to this project, not just in terms of funds but in terms of volunteering surgical and medical personnel on a rotational basis, in terms of helping in the formation and education of a cadre of local surgical and medical and nursing staff, in terms of donation of medical equipment, etc, because while in our countries we suffer of overcapacity in those countries there is lack of essentials, because we all know that either rights are everyone’s or are just privileges...because peace can be built only on reciprocal respect rather than mutual annihilation... In this way, Emergency intends to begin in Sudan, too, a practical path of peace that through the practice of fundamental human rights and the respect for the dignity of each individual, helps to re-build human relationships, the only true resource to overcome the non humanity of war.

Sidebar

Originally an autonomous sultanate, “the great Darfur” was annexed to Sudan at the beginning of the past century by the British rulers and then recently dismembered into three “states,” the Northern, Southern and Western Darfur. Right after the annexation, a policy was introduced encouraging the inflow of nomadic tribes. Prevalently of Arab origin and used to animal herding, the nomadic tribes often clash with the settler tribes of African origin who are used to farmlands of a desert nature.

Al Fashir is the historical capital of Darfur, “the land of the Fur,” a vast western region of Sudan bordering with Chad and Libya.

Photos from Emergency's field mission in Darfur taken by Rossella Miccio.