First epidemiological study to assess the impact of the civil war in Darfur

The first epidemiological study to assess the impact of the civil war in the Darfur region of Sudan is published online by THE LANCET today (Friday 1 October 2004). The study quantifies the high death rates both before and after civilians became internally displaced and sought refuge in other communities and displacement camps.

More than a million people have become internally displaced as a result of the recent violence in Darfur, Sudan. An epidemiological study of the effect of armed incursions on mortality in Darfur was needed to provide a basis for appropriate assistance to internally displaced people. Between April and June this year Evelyn Depoortere (Epicentre, Paris, France) and colleagues did surveys among over 215,000 internally displaced people in four sites of West Darfur to compare death rates in the region before and after displacement.

Before displacement (either to refugee camps or to other communities), death rates were between 6 and 9·5 deaths per day per 10,000 people; violence accounted for around 70-90% of deaths, most of which were among men. Death rates decreased, but remained high, after arrival in displacement sites (the highest reported death rate being 5·6 deaths per day per 10,000 people in the region of El Geneina). Death rates at all sites were three to ten times the expected rates in sub-Saharan populations, indicating an emergency situation.

Dr Depoortere comments: "This study, which was done in a difficult setting, provides epidemiological evidence of this conflict's effect on civilians, confirming the serious nature of the crisis, and reinforcing findings from other war contexts."

Bradley Woodruff and Reinhard Kaiser (US Centers for disease control and Prevention, Atlanta, USA) conclude in an accompanying commentary: "Depoortere and colleagues provide another illustration that, even under conditions of insecurity and moving populations, rigorous epidemiological methods can provide essential data to document potential violations of international humanitarian law. Such documentation can be used to hold responsible parties accountable for their actions. Although the rate of violence-related mortality in many situations usually decreases after people arrive in camps, the challenge remains to prevent further violence against the population and to provide sufficient humanitarian aid to prevent excess mortality due to communicable diseases and malnutrition".