Update No. 98/04 on ICRC activities in Sudan
17-09-1998 Operational Update
The last two weeks have seen a slight stabilization in population movements in southern Sudan. There has been a decrease in arrivals of newly displaced in the emergency " pockets " of the Bahr El Ghazal region in towns such as Wau and Tonj, compared to the first half of August which saw a peak in the movements of the displaced. At the same time, mortality rates appear to have improved but, nevertheless, remain abnormally high. Despite this drop in population movements and mortality rates, the crisis continues. There are still thousands of displaced people in urgent need of humanitarian assistance. Many internally displaced are still too weak to make use of dry-food rations. Thus the provision of shelter and other essential non-food items remains a high priority. In the worst-affected pockets of the Bahr El Gahzal, the emergency is far from over.
Rains are now a regular occurrence across most of southern Sudan which is causing logistical difficulties as some airstrips are inaccessible for days at a time. The ongoing rains are also putting countless malnourished displaced people at further risk from hypothermia, pneumonia, malaria and other illnesses.
Another area of concern is northern and eastern Sudan where there has been severe flooding in the last week. In Kassala, the Gash River broke its banks and flooded western parts of the city. In the Damer region, north of Khartoum, Artoli island and the town of Dongolo have been flooded.
Owing to the gravity of the humanitarian situation, the ICRC continues to respond to the crisis through its offices in Khartoum, Wau, Tonj, Juba, Yirol, Nairobi and Lokichokio. The ICRC currently has over 80 expatriates and almost 500 national staff in Sudan and Lokichokio working in this operation.
ICRC main concerns and general strategy
There are a large number of NGOs already present in Sudan (mainly in the south). The World Food Programme (WFP) operates a large fleet of aircraft and focuses on dry-food distributions. ICRC activities aim to complement existing humanitarian assistance without duplicating WFP general food distributions and the Operation Lifeline Sudan's support to NGOs. With this in mind, the ICRC continues to:
• Organize feeding programmes for children and adults. Wet-feeding is the selected form of assistance as this enables delegates to monitor and follow up individual cases, ensure that correct nutritional value is provided and target those who are in real need.
• Provide non-food materials to internally displaced persons (IDPs). This is being done either through the ICRC's own distribution structures, for example in Tonj, and/or by making use of existing NGO systems, such as in Agiep and Panthou.
• Establish integrated approach projects which include non-food assistance, improvements in medical services, the training of local staff and volunteers in community-based health and the rehabilitation of water and sanitation projects.
ICRC emergency response in the Bahr El Ghazal region
In May, June and July there was a massive influx of IDPs and returnees to Wau but since the second half of August there has been a dramatic decrease in these movements. An average of 30-60 people are currently registered as new-comers on a daily basis. According to the ICRC's estimation, Wau has a total population (returnees, IDPs and residents) of 100,000 of which some 30-40% are displaced. The last few weeks have also seen a reduction in mortality rates. However, the number of deaths (approximately 30 per day) remains high. This is partly due to the poor physical condition of recent arrivals and of those displaced who have been in the town for a number of weeks.
For the malnourished
Since June the Sudanese Red Crescent Society (SRCS), with the ICRC's support has been running a therapeutic feeding centre where 27 SRCS volunteers feed some 800 under five and 500 adolescents and adults. Between 15-22 August the ICRC has opened three supplementary feeding kitchens which are currently catering to 1,500 beneficiaries on a daily basis (total capacity: 4,500 beneficiaries). These four structures provide approximately 18,000 meals per week.
The ICRC is convinced that only some of the cases of severe malnutrition are seen at the feeding centres. That is why in mid-August it established a mobile clinic which visits the places where the IDPs are gathered and carries out some 75-100 consultations per day. Most
patients are single parents, their children and the elderly, whom the ICRC tries to convince to go to the hospital or a feeding centre.
For the sick and wounded
Each ICRC feeding centre has two general medical technicians running primary health care units. The main illnesses treated are malaria, conjunctivitis, respiratory tract infections and diarrhoea. Tuberculosis has also been identified as a major problem which exacerbates the general condition of some of those who are severely malnourished.
The ICRC has provided 100 cholera beds for the Wau hospital and has also made ad hoc donations of medicines. It is also supporting a SRCS medical dispensary which provides about 300 consultations per week in addition to carrying out anti-parasite campaigns.
For the population
Non-food assistance has been made available to 57,000 people in Wau.
The ICRC is installing a pump and water filter at the main reservoir in Wau. This will dramatically increase the amount and quality of water being pumped from the Jur River. At the same time, the water will be filtered and then chlorinated.
Following the ICRC's assessment of the situation in Tonj (a village which under normal circumstances has 600 inhabitants but currently houses between 8,000 to 12,000), which was carried out from 27-31 July, around half of the population was identified as being severely malnourished and in need of immediate care. Those who have migrated to the town from rural areas were all identified as being malnourished to one degree or another. Malnutrition appeared in all age groups and all sexes but was predominant amongst you ng children and nursing mothers. The ICRC categorized this situation as an emergency owing to the alarmingly high levels of malnutrition.
For the malnourished
The ICRC's overall objective in Tonj has been to reduce mortality resulting from starvation. In response to the desperate situation here, the ICRC is currently running one wet-feeding centre and three kitchens.
There are currently 2,500 beneficiaries in the four centres. Each of them receives two meals a day made up of maize flour, beans, oil and salt amounting to approximately 2,500 calories. Upon registration each beneficiary receives deworming tablets, bactrium and vitamin A. In order to monitor the impact of the feeding programme, each child is re-measured on a weekly basis and adults every two weeks. Although the situation is still worrying, a marked improvement in the nutritional status of the population has been observed since the beginning of the ICRC's feeding programme in Tonj in August. However, severely malnourished people, some of whom hardly have the energy to walk, continue to arrive in Tonj every day.
The main source of water for those in the rural area surrounding Tonj is the river. In the town there are three handpumps, only two of which are in full working order. A short-term sanitation programme is being established by the ICRC with a view to improving this situation. The focus will be placed on ensuring emergency water supplies for the feeding centre and kitchens, as well as basic sanitation work.
For the displaced people
In the coming weeks the ICRC will carry out a non-food distribution consisting of blankets, tarpaulins, jerrycans, kitchen sets, mosquito netting, soap and fishing equipment to some 3,500 families in Tonj. At the moment, the IDPs in Tonj have very little or even nothing in the form of shelter and with the continuing rain this poses a further risk to their health status.
Agiep and Panthou
Agiep, a small village to the north of Wau, was faced with a massive influx of IDPs at the beginning of the year. Over the following months the situation in Agiep deteriorated rapidly as the village became home to some 20,000 new arrivals.
For the malnourished
At the end of August the ICRC carried out a non-food distribution of 6,000 blankets and 3,000 tarpaulins for the beneficiaries of a feeding programme run by a NGO. The lack of access to shelter for this vulnerable population created an increased health risk, as many did not have the strength to build shelter with mud and straw. In addition, the ICRC has provided 39 tonnes of high energy biscuits (BP5) as a life-saving measure to complement the food given in the feeding centres.
An ICRC relief administrator is currently in Panthou preparing for the distribution of 3,000 blankets for 7,000 beneficiaries of a feeding programme run by a NGO. A total of 6 tonnes of BP5 has already been provided by the ICRC for this programme.
ICRC plans for the short and medium-term
Not all parts of southern Sudan have been so severely affected by the current crisis. In such areas the ICRC has adopted a longer-term, " integrated approach " aimed at assisting communities to move towards self-sufficiency. The projects focus on providing clean drinking water and sani tation facilities, assistance to medical dispensaries and primary health care clinics, as well as seeds or fishing hooks and nets at appropriate times of the year.
Yirol is a town which has suffered the effects of ongoing fighting between 1985 and 1988 resulting in the destruction of buildings, houses and water pumps. The ICRC began rehabilitation work on the former hospital so that it can be used as a primary health care centre (including mother and child care). On average 60-80 consultations are carried out each day. The most common treatments are against malaria, respiratory tract infections and water-borne disease. An ICRC specialist (nurse/midwife) is working with traditional midwives and launching a programme of pre- and post-natal mother and child health care.
A number of the town's water sources has been sabotaged during the fighting in recent years. Water and sanitation activities started on 13 July in Yirol. Of the 43 water points assessed, only one provided acceptably clean water while 23 were beyond redemption. The one fully functioning well provided clean water for the local population of 7,000. The ICRC aims to provide at least one source of clean water for every 1,000 residents.
Special care to war-wounded
An ongoing concern for the ICRC is the fate of the war-wounded. In Juba, access to proper medical care has been difficult owing to the lack of support by the national health authorities, as well as the direct consequences of the war. The ICRC has begun work on the rehabilitation of both the dispensary and the 500-bed hospital in Juba in order to provide more comprehensive surgical care to the general public and to extend that care to the war-wounded. By the end of August a six-person surgical team and a laboratory technician had arrived in the town. The surgical team jo ined the three ICRC expatriates and 32 Sudanese staff already working in Juba. They have been delivering medical supplies to the Juba hospital and food to hospital patients and staff (regular supplies for 500 persons), as well as other assistance to flood victims (175 households) and vulnerable groups such as IDPs, orphans, lepers and the blind in Juba and the surrounding area (some 920 people). The food distributions are carried out with the support of the local Red Crescent branch The ICRC is also supporting four primary health care centres through the provision of construction materials and medicines.
The ICRC continues to carry out medical evacuations to its 560-bed Lopiding surgical hospital in Lokichokio. In the first week of September the hospital was treating some 350 patients.
Continual conflict in the east
In recent months most of the world's attention has been focused on the devastating situation in the south of Sudan. However, in the north-east of the country another humanitarian crisis has been unfolding. At the end of March there were some 34,000 displaced people around the town of Kassala, taking refuge in makeshift camps. By the end of July renewed fighting had caused an influx of a further 25,000 people. Those who had no relatives in the area are settled in six camps. Many of the most recent arrivals are living in huts constructed of branches and vines and covered with bits of cloth and rags in an attempt to protect their families against the elements.
Since the beginning of July the ICRC has provided a total of 8,000 blankets and 2,000 tarpaulins to provide shelter for IDPs in Kassala. These items are distributed by the SRCS in the camps. Following the recent fl ooding of the Gash River, emergency assistance has been provided to 200 families who have been forced out of their homes. A total of 10,000 sandbags have also been given to assist flood victims.
The SRCS operates a hospital and three clinics serving refugees from Eritrea and the Sudanese IDPs and provides them with support and material assistance.
On 29 August, with the agreement of both the Sudan People's Liberation Army (SPLA) and the government, the ICRC organized the return of 77 former detainees released by the SPLA in Yei.
Earlier in August ICRC delegates carried out the second visit in two months to detainees held by the SPLA in relation to the conflict. Food, non-food and medical assistance has been provided to the detainees. The ICRC maintains its offer to visit people held by the government in relation to the conflict.
The tracing agency in Sudan handles an average of 2,000 Red Cross messages a month. Some originate in refugee camps in surrounding countries, others from displaced people within Sudan, while the remainder are sent by people detained in relation to the conflict. ICRC tracing staff are active in all regions of the country including Kordofan, Darfur, the Nuba mountains, southern Sudan, Khartoum and Kassala.
The ICRC is also active in Sudan in disseminating the principles of international humanitarian law, particularly the treatment of non-combatants. ICRC representatives recently took part in a seven-hour roundtable discussion with senior military officers with the aim of incorporating humanitarian law into the training programme of the Sudanese armed forces.
Cooperation with the Sudanese Red Crescent Society
Local branches of the National Society have played a major role in all aspects of the ICRC's work in the government-controlled areas of Sudan. The ICRC has been providing regular financial and logistical support to all five SRCS branches in southern Sudan, and ad hoc support to the Kassala branch.