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Update No.99/01 on ICRC activities in Sudan

31-03-1999 Operational Update

 General Situation  

The last four months have seen a confirmation of signs of an improving humanitarian situation across southern Sudan compared with 1998. As a result, the ICRC's focus is now on post-emergency and rehabilitation activities. However, the ongoing conflict, with sporadic outbreaks of fighting in the south, in particular in the Upper Nile region, on the eastern border (the Blue Nile region, Kassala, the Red Sea) and in the Nuba area, means that the security environment remains fragile. Moreover, according to the Food and Agriculture Organization (FAO) report from October 1998, the overall picture of predicted record harvests and high stocks of cereals for 1999, particularly in the north, masks the threat of serious cereal deficits at local levels in five states in the south (North Bahr El Gazal, Lakes, Warrap, Jonglei, and Bahr El Jebel). The report further highlights the fact that food aid will probably be required throughout 1999 in different parts of the country, especially for displaced people facing the " hunger gap " from March to September.

Since the beginning of 1999, the ICRC has been focusing its efforts in this crucial period before the next rainy season on a major agricultural rehabilitation programme, which provides seeds and tools for some 60,000 households in the south.

On the political front, the cease-fire, which was extended in the Bahr El Ghazal region for an additional three months on 15 January to ena ble vital humanitarian activities to continue, will expire on 15 April. There is still uncertainty regarding future cease-fire arrangements and the next round of peace talks under the auspices of the Intergovernmental Authority on Development (IGAD) are pencilled to take place at the end of April. In early March, leaders from southern Sudan's main two rival tribes (the Dinkas and Nuers) signed a peace agreement to end clashes that have lasted seven and a half years.

The Bahr el Ghazal region has been relatively stable over the last few months, with the exception of a number of problems linked to the government train passing through the region. Humanitarian organizations were forced to take appropriate safety precautions and to temporarily evacuate their staff from the areas through which the train passed. Since December the region east of Jiech in Central Upper Nile has been seriously affected by tribal fighting, resulting in the displacement of a large number of people towards Jiech itself. In December and January a number of places in Eastern and Western Equatoria were also subject to bombing, including Lokutok, Chukudum, Narus, Ikotos, Kajo Keji and Yei. During January and February, clashes in Western Darfur between Masalit and Arab tribes claimed many lives and about 50 villages were set alight. Displaced people moved to temporarily stay in the state capital Geneina and the situation eventually calmed down at the end of February.

In early December, fighting was reported in the Nuba Mountains, on the Eritrean border and in the Red Sea State, whilst the situation around Kassala remained tense. Tribal clashes occurred around Chukudum in January and in February. There was also a heavy outbreak of fighting around Mankien and Thiek Thou in the Western Upper Nile, leading to an urgent need for the medical evacuation of large numbers of war-wounded. In January and F ebruary, fighting reportedly occurred in the Gammam region in Blue Nile Province between governmental and SPLA troops.

A serious security incident occurred on 18 February in the Bentiu region. Two ICRC delegates and two Sudanese Red Crescent (SRCS) employees were conducting a survey to assess humanitarian needs north of Bentiu. They were accompanied by three government officials when they were captured by the SPLM/A. The two delegates were handed over to the ICRC on 12 March. One SRCS employee managed to escape. However, one of the Red Crescent employees and the three government officials are still being held by the SPLM/A in southern Sudan. The ICRC will endeavour to facilitate the return of the SRCS employee whose release had previously been announced by the SPLM/A, and will pursue all efforts to secure access to the persons still with the SPLA in order to assess their health and living conditions according to usual ICRC procedures. The ICRC hopes that a quick solution will be found for their return. During a meeting held on 22 March in Geneva, the ICRC President C. Sommaruga urged the SPLA leader, Dr. John Garang, to make a gesture by releasing the three government officials still in SPLA hands and to facilitate the return of the SRCS staff member.

The ICRC continues to respond to the prevailing situation in Sudan through its offices in Khartoum, Wau, Yirol, Juba, Bentiu, Nairobi and Lokichokio and currently has some 100 expatriates (including the staff of Lopiding Hospital) and almost 600 national staff in Sudan and Lokichokio working on this operation. In addition, ICRC delegates started work in a new location (Chelkou, Bahr El Ghazal) at the beginning of January.

 ICRC main activities  

Owing to the steadily improving humanitarian situation, the ICRC is now focusing its attention upon post- emergency activities. Since the beginning of the year, the ICRC has been concentrating its efforts on the launch of a large-scale seeds and tools programme to help populations affected by conflict in southern Sudan to re-establish their self-sufficiency, and to reduce their need for direct assistance. A total of 60,000 households are being targeted and each will receive 10kg of seeds and three types of tools. Seeds have been purchased in three different locations, Tambura (280 tonnes), Khartoum (220 tonnes) and Nairobi, Kenya (105 tonnes). Meanwhile, distributions have started in earnest, in an attempt to complete the distributions before the onset of the rainy seasons, so that households are ready for the planting season which starts in April. Distributions have already taken place in Jiech (5,000 households), Chelkou (1,500), Marial Bay (2,000), Aroyo (4,000), Tonj (4,500) and Aguko (1,500). They are also planned for Yirol, Wau and Juba and in the Western Upper Nile region. In total, 52,700 households should be supplied with seeds and tools by the first week of April and possible destinations for the remainder (7,000 households) will be identified thereafter. Harvesting should begin three months later.

Primary health care and water and sanitation programmes are continuing in many areas. In Wau, Juba, Bentiu and Yirol the ICRC is pursuing its longer-term " integrated approach " projects, which aim to improve people's livelihood and help them return to self-sufficiency. Apart from the agricultural rehabilitation programme described above, " integrated approach " projects include non-food assistance, improvements to medical services, the training of local staff and volunteers in community-based health care, and water and sanitation projects. On 6 January 1999 the ICRC launched an " integrated approach " programme in Chelkou (Northern Bahr El Ghazal) basing a permanent team in the area where no other humanitarian organization is currently operational. Their work will concentrate on health, water and sanitation and food security activities with mid- to long-term objectives.    

Distributions of non-food items (blankets, tarpaulins, kitchen sets, soap, mosquito netting, jerry cans, buckets and kangas) to internally displaced people and the most vulnerable have continued over the last three months. With the onset of the fishing season, distributions of fishing material (fishing hooks and twine) have been made to areas of need. 

1999 has also been one of the busiest years for medical evacuations by plane to the ICRC's 560-bed Lopiding surgical hospital in Lokichokio and to the Juba teaching hospital (JTH).    

A large number of UN agencies and NGOs are still active in Sudan (mainly in the south), with the majority working under the umbrella of Operation Life Sudan (OLS). The World Food Programme (WFP) is the lead agency with respect to food distribution. Although the ICRC is not part of the OLS, it maintains close contact with their representatives to prevent duplication or overlapping of humanitarian programmes. It has been in a position to complement the humanitarian work of other organizations, playing a prominent role in the distribution of non-food assistance. Excellent coordination with other humanitarian organizations has been possible in the framework of the ICRC 1999 seeds and tools programme, in particular with UNICEF and WFP and also with World Vision in Tonj.

 The ICRC's response :  

From December to March 1999, the following activities were carried out for :

 Civilians  

 Wau  

The plight of displaced persons in Wau has been greatly improved with the completion of the camp housing more that 12,000 persons on the East bank of the Jur river. In collaboration with SRCS volunteers, distributions of non-food items which began in November 1998 have been completed, providing some 25,900 of the most needy people living in eight districts of Wau with blankets, cooking pots, tea pots, kitchen sets, soap, mosquito netting, kangas, jerry cans, buckets and tarpaulins.

In December a vegetable garden project for 1,200 families on the East Bank and 800 families in town was launched. The programme is being carried out in close cooperation with two agronomists from the Ministry of Agriculture. In March, a non-food distribution (blankets, tarpaulins, kangas, jerry cans and kitchen sets) was made by the SRCS to the leprosy camp in Agok.

The three ICRC dispensaries and health post continue to operate and receive some 1,800 outpatients per week. A health education programme for school children on the East Bank has been started in cooperation with the Ministry of Health and the Ministry of Education based in Warap. The ICRC have donated a generator and emergency dressing material to the military hospital, and 20 beds and fuel for emergency operations have been donated to the civilian hospital. In view of the fact that Wau is located within the African meningitis belt, coordinated efforts are underway with Médecins Sans Frontières (MSF) to enable ICRC dispensaries to respond in the event of an outbreak of the disease. No new suspected cases have been identified to date.

 Juba  

The four ICRC-supported primary health care centres (PHCs) in Juba continue to receive monthly supplies of medical and non-medical items, as well as construction material to rebuild certain facilities or improve existing structures. Between December and March, over 16,100 patients were treated at the PHCs, mainly for malaria, respiratory tract infections, diarrhoea and urinal infections. In mid-March, vaccinations were carried out at the PHCs in Mundri, Yei and Kator against BCG, polio, diphtheria, measles and tetanus. A total of 22,990 students have benefited from the joint ICRC/SRCS health education programme that was initiated following the outbreak of a diarrhoea epidemic in October. A total of nine dispensary kits with medicines were distributed to various health posts around Juba including the prison, Gabat, Malakia, Kajo Keji and Rokon camp for displaced persons during this period.

In December a programme was launched to clean the dirtiest parts of the town in order to improve hygiene conditions. Over 3,000 people were involved in the programme and lessons in hygiene and environmental health formed an integral part. In return, each participant received food for work totalling 48.2 tonnes of food items between the period from December to February.

The SRCS continued to provide daily food distributions (10.5 tonnes of sorghum, pulses and vegetable oil per month) for the JTH, Shaba Children's Hospital and Juba orphanages for a total of 655 beneficiaries. The SRCS, supported by the ICRC, also distributed non-food assistance (mosquito netting, blankets and cleaning tools) to the Juba orphanage. Some 1,400 beneficiaries from the blind and leper populations of Juba were provided with sorghum, pulses, vegetable oil and soap between December and March and the health structures in Mafao/Muguri were also provided with non-food assistance (additional first aid kits, blankets, water containers and soap).

 Bentiu  

The ICRC's emergency response in B entiu had a major impact on the population of the town (18,000 displaced and 9,000 residents). Access to basic health care and clean water drastically reduced the rate of dysentery and other endemic diseases which had been recorded there. A water emergency response unit (ERU) donated by the German Red Cross is supplying over 125,000 litres of clean drinking water per day for the population. A basic health care ERU which was opened in November also serves between 250-300 outpatients per day. A midwife is present in Bentiu, running a mother and child health programme for 50 clients each day and providing traditional birth attendant (TBA) training. At the beginning of February a non-food distribution was carried out for 4,300 vulnerable households in Bentiu.

 Chelkou  

On 6 January 1999 the ICRC launched an " integrated approach " programme in Chelkou (Northern Bahr El Ghazal). The main health problems which have been detected are river blindness, malaria, respiratory infections, intestinal parasites and diarrhoea. Activities in the health sector started immediately, with two delegates involved in the supervision and training of local medical staff and the supplying of material to the PHC. An average of 300 patients are seen each week. In mid-March a polio vaccination campaign was also implemented in Chelkou and surrounding villages for 2,300 children, who also received vitamin A supplements. In the coming weeks TBA training will commence and a new PHC is under construction, planned to open in April, as the present one is in a state of disrepair. 

 Yirol  

The ICRC is continuing its public health care programme in Yirol town and the nearby villages of Niang and Gengeng, carrying out around 800 consultations each week. The main illnesses recorded are guinea worm, river blindness, anaemia, malaria, di arrhoea, respiratory tract infections and tuberculosis. In the Yirol clinic a special programme has been started for leprosy patients. Dressing material and basic medicines have been distributed to the leprosy camp in the town. 

The midwife has successfully completed the third teaching course on traditional birth attendance and a new course was started at the sub-clinic in Nyang. First aid training for selected groups in surrounding villages is ongoing, the aim being to increase the general knowledge on how to stabilize the condition of medical emergencies who are in need of medical evacuation to ICRC surgical facilities.

ICRC water and sanitation engineers continue with the drilling of bore holes in the rural areas of Yirol County situated either in transit paths or areas where they can support the health clinics. Repair work is also being carried out on existing water sources in order to provide or improve access to clean drinking water.

 Other locations  

Seven dispensaries in and around Raja (population: 34,900 including 20,600 displaced people) were supplied with medical kits, following the visit of an ICRC health coordinator and an SRCS representative. Preparations are underway to assist the health posts with materials and training on a regular basis in close cooperation with the local SRCS branch. Polio and meningitis vaccination programmes are also planned.

In order to improve access to clean water for the resident and displaced population, the ICRC completed the drilling of eight bore holes in Marial in January.

Needy populations from Jiech and displaced people from 10 surrounding villages were provided with non-food items (for 3,000 h ouseholds) and fishing material (2,000 households). No humanitarian organizations have visited Jiech in the last two and a half years. ICRC involvement in Jiech has attracted the interest of humanitarian organizations such as WFP, Save the Children UK and CMA who are keen to start a programme in this area.

 Ongoing activities  

 Special care to the war-wounded  

1999 has been one of the busiest years for the ICRC's Lopiding surgical hospital in Lokichokio. From December to March 1999 a total of 567 medical evacuations were carried out to the hospital by plane. Clashes around Mankien in the Upper Nile region in February caused a large number of gunshot wound cases.

At the Juba Teaching hospital (JTH), the ICRC has increased its expatriate staff to 11, mainly working in the hospital's surgical department. The surgical wards and pharmacy both receive regular supplies of medical items and medicines. Meanwhile, repair and construction work on the JTH premises is still going on, to ensure that the war-wounded receive more comprehensive surgical care. This work includes improvements to the water supply, drainage and sewage systems and sanitation facilities.

In mid-February ad hoc medical assistance was also provided to El Geneina hospital (Western Darfur) where 24 wounded patients were treated following intertribal clashes.

 Traditional ICRC activities  

ICRC delegates continue regular visits to persons held by the SPLA in Yei in order to monitor their conditions of detention. Medical supplies, seeds, tools and other non-food assistance have been distributed to the detainees and they are able to exchange Red Cross messages (RCMs) with their families. 

The number of unaccompanied children registered by the ICRC now totals 405, of whom 170 have traceable relatives. Over 60% are able to give names of relatives still alive, and efforts to locate the families and re-establish contact via the RCM network are continuing. The National Council for Child Welfare (Khartoum) has approved the ICRC's request to reunite four children whose relatives were found in Aweil, and the reunion of one of them took place at the end of February.

The service to exchange RCMs between all people separated by the conflict continues. Between December and February a total of 9,323 RCMs were collected and 9,678 distributed on behalf of civilians, while 267 were collected and 171 distributed on behalf of detainees. ICRC tracing staff are active in all regions of the country.

Throughout December more than 365 officers and non-commissioned officers of the Sudanese Armed Forces attended sessions on the law of armed conflict and international humanitarian law (IHL). The ICRC participated in the first Moral Orientation Conference and addressed 1,750 officers at a training session at Jabal Awlia military area.

In the field, efforts have focused towards reaching all main bearers of weapons involved in the conflict in southern Sudan. In January, a four-day course on the law of armed conflict was attended by 31 high ranking SPLA officers in Bahr El Ghazal. Also in January, 233 Sudanese Armed Forces officers, non-commissioned officers and soldiers took part in dissemination sessions in Western Upper Nile and some 180 Unified Police Forces personnel and 750 South Sudan Defence Force (SSDF) combatants attended presentations in Unity State. An additional session was organized in Western Upper Nile for some 20 SSDF commanders and officers. At the end of January a number of dissemination sessions were organized in Wau for both military officers and soldiers, a s well as police forces and officers of the National Sudanese Peace Forces and Security members.

 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. Regular structural support to SRCS branches in Juba, Wau, Raja, Bentiu, Malakal and Kassala continues to be provided by the ICRC.