A blazing sun beat down on the city of Nyala, in southern Darfur. In the shelter of a warehouse, Adil timidly tested his new prosthesis with the aid of parallel bars. Beside him, two other patients were doing the same thing. Together with four other amputees, the three of them had arrived in this limb-fitting centre seven days ago to receive treatment.

Over the past three years, many people have been wounded in the Darfur conflict. According to Pierre Gratzl, the ICRC's medical coordinator in Sudan, "people who have been shot in the arm or leg must sometimes wait weeks before they can be treated, and the only way to save their lives is to amputate the infected limb before gangrene sets in."

The Nyala centre is one of six limb-fitting centres in the country. "We support facilities that already exist, provide them with supplies and equipment and train local staff so that something will remain after we leave the country," said Dr Gratzl. The ICRC also covers transport and treatment costs.

An often difficult journey

"Some people must travel several hundred kilometres to get here," said ICRC orthotist/prosthetist Achille Otou-Essono, a Cameroonian who has been imparting his knowledge to the centre's two Sudanese technicians for the past four months.

It is difficult to drive across Darfur. Good tracks are rare and insecurity is rampant. Abdul, a patient at the centre, said that it had taken him three days to get here because the truck he was riding in had broken down twice along the way. Men usually travel in groups, using public transport to get from one place to another. Women and children go by plane, which reassures their families.

More than 500 amputees have come to Nyala since the centre opened. The ICRC also supports the national centre in Khartoum and another centre in Juba, to the south. To ensure that these centres can be taken over some day, 14 students are currently being trained in an ICRC-supported school for orthopaedic technicians in the capital. Three Sudanese have recently been sent to Tanzania for training.

When patients arrive at the centre, first they are installed in the dormitory. The following day, the orthotists/prosthetists conduct an evaluation. "This is often a delicate moment. The patients are apprehensive, especially when amputation is unavoidable," Achille Otou-Essono explained. In such cases it is important to show great tact.

Happy to be walking again

When treatment is possible, amputees spend two weeks on average at the centre. Prints are taken so that prostheses or orthoses can be made to measure out of polypropylene, a technology developed by the ICRC. Once the devices are ready, patients can learn their first exercises and begin to practice them in a room especially fitted out for the purpose.

In the physical rehabilitation room, Ibrahim and Adil patiently performed their exercises. First patients learn how to walk between parallel bars, then they must go up a slight slope and finally they must walk across a shallow pit filled with sand and rocks. "They have to get used to rugged terrain since most of them live in villages that only have dirt tracks," said Mohamed, an orthopaedic technician who learned his profession four years ago at an ICRC training course in Khartoum.

The centre is open to all war-wounded people. To enhance mutual understanding and respect between patients and staff, who often come from different areas and belong to different tribes, the ICRC holds awareness-raising sessions on the humanitarian values of the Red Cross and Red Crescent.

Adil would soon be going back home to his family. Although the first few days had been difficult, he was making progress and gradually regaining his mobility. "I am happy that I am beginning to walk again like other people," he said. It is an arduous task to teach an amputee to walk with a prosthesis, but the centre's orthotists/prosthetists are amply rewarded when they see the first smile on their patient's face.