WHO calls for Sudan humanitarian assistance

Intensified and urgent action is needed in the Greater Darfur Region of western Sudan to address one of the most severe humanitarian emergencies today. Given the current situation, the humanitarian crisis will last several months.

• Current estimates are that more than 1.2 million persons are affected by the conflict, and among them more than 750,000 are internally displaced. People are gathering around urban areas seeking security, water, shelter, sanitation and health care - all of which are insufficient.
• Outbreaks of measles, a deadly disease particularly for children, have been recorded, and with the onset of the rainy season, malaria outbreaks and acute diarrhoea is a real threat.
• In one Internally Displaced Persons Camp, WHO found a Daily Children Mortality Rate of 6.7 x 10.000 - many times the higher than normal rate.
• Malnutrition has also been recorded as a severe problem, in an area which has normally survived on subsistence farming and nomadic herding.
• With widespread reporting of rape, women's reproductive and sexual, as well as mental health is severely at risk.
• Besides these major threats and war-injuries, it is common, easily preventable and curable conditions, such as diarrhoeas, respiratory, eye and skin infections, that contribute disproportionately to the suffering of the people.

• The Greater Darfur Region covers one fifth of Sudan’s surface. It is an area the size of France, where about 6.7 million people (20% of Sudan’s population) live. Darfur is a poor and underdeveloped region, where the maternal and infant mortality rates are the highest in Sudan. The people of Darfur live of subsistence agriculture and nomadic animal herding.

• Since early 2003 the conflict has affected more than one million people. By April 2004 approx. 750,000 people are internally displaced, and gathered around towns where water is scarce, shelter and sanitation are precarious, health facilities are understaffed and medical supplies insufficient to meet the increased demand. Outside of the towns, only sparse health units can cater for a small proportion of the needs. The assessments conducted between October 2003 and March 2004 by WHO with partners revealed the low coverage and quality of health services rendered to the people, difficult access to health facilities and services, high levels of malnutrition and the increased risks for outbreaks of communicable diseases.

• Constraints in delivering humanitarian relief include the weak capacities of local health authorities, the small number of implementing partners and the inaccessibility of large parts of the region. With the rainy season starting in few weeks, agencies now must gear up their operational capacity, to reduce the risk of at least one million people suffering -and many dying - from avoidable conditions such as measles, malaria, diarrhoea, respiratory infections, and malnutrition in a climate of fear and violence.

WHO is an integral part of the UN response to the Greater Darfur Crisis: the Organization seconded a public health officer to the OCHA team, and deployed three health public staff in support of the coordination hubs established by OCHA in El Fashir, Nyala and Geneina (the capitals of North, South and West Darfur, respectively). WHO is also strengthening its presence in Chad to assist UNCHR and the NGO partners in the response to the influx of Darfur refugees there.

Overall, WHO supports authorities, UNICEF, ICRC and NGOs in mitigating the impact of the conflict on health of the affected people through an appropriate, timely and coordinated response to basic health needs by:

1. Ensuring that health needs of the affected population are continuously assessed, tackled and monitored in a coordinated manner
2. Strengthening communicable disease control and response to outbreaks by a comprehensive network of surveillance and operational capacity
3. Implementing simple and appropriate measures of environmental health.
4. Collaborating with all partners at improving the access to quality primary health care services for all war-affected population
5. Strengthening the referral system for emergency care at secondary and tertiary level (war injuries, surgery, and emergency obstetric care)

WHO is already using its own resources to implement activities that are relevant to these objectives. Now the Organization needs additional donor support to consolidate and expand them. WHO needs for six months ( April to September 2004) an amount of US$ 5.4 million provided the situation does not get worse.

From its three sub-offices sited in the humanitarian coordination hubs of El Fashir, Nyala and Geneina, WHO will a) ensure that health needs are identified, monitored and properly addressed, by working to b) reduce the risks related to communicable diseases, especially of outbreaks, c) reduce the risks due to poor water supply and sanitation, c) reduce the risks related to poor access to, and poor quality of primary health care, and d) ensure that a proper referral system is in place for secondary level care, especially for reproductive health emergencies and physical and psychological traumas.

• Provide in-service training to local hospital administrators
• Make available equipment and refurbishing facilities for emergency obstetrics, paediatrics, and trauma surgery.
• Provide reagents and supplies to strengthen blood screening for HIV, hepatitis and syphilis in hospitals
• Provide one new ambulance for each rural hospital (eight ambulances)
• Cover the costs of the return and/or the deployment of new additional national staff
• Contribute to running costs, in-patients alimentation, support of co-patients (e.g. accompanying mothers).

• Water and basic sanitation in particular in IDPs camps
• Delivery and provision of primary health care services
• Establishment and rehabilitation of health facilities in localities and remote areas
• Provision of medical supplies and equipment at primary, secondary and tertiary levels
• Provision of immunization with emphasis on measles and meningitis in well organized campaigns
• Tackling the malnutrition problems and food security measures to be taken urgently..

• Common, easily preventable and curable conditions, such as diarrhoeas, respiratory, eye and skin infections, contribute disproportionately to the suffering of the people. Local health delivery services are weak and under tremendous pressure. Outside the towns, only a few health units cover the sparsely populated area.

• There is an acute shortage in health facilities, health personnel and supportive services in the three states; Hospitals and health centres are concentrated in the capital cities of Darfur. For example, in North Darfur 42% and 56% of the hospital and health centres (HC) are located in Elfashir. The number of hospitals is as follows: 12 in the north, 4 in the west and 10 in the south. The supportive services such as blood banks, advanced diagnostic equipment, ultra sound and laboratories are only available in the capitals. The scarcity of health trained personnel at all levels and specialties is even worse;  In Eljeneina, it is believed that only 60 out of 176 dispensaries listed in the State would be actually working, only nine HC out of 11 (and five of them in the Capital) and only three hospitals out of seven.

• Malaria, pneumonia and diarrhoea are the major diseases leading to hospital admission as well as malnutrition. The other leading diseases are respiratory infections, amoebic dysentery and bronchitis;

• Maternal mortality rate in Darfur is 524 per 100 000 births, infant mortality is very high; 116-1000 for males and 96/1000 for females compared to the national average of 68/1000;

• Water is scarce in the three states and diseases resulting from low basic sanitation and lack of water are responsible for many leading diseases.