Darfur: a tale of two children
The security situation in Darfur in western Sudan remains extremely precarious with civilians still at risk of indiscriminate attacks. Even children are not spared the violence that has shown signs of further deterioration in recent weeks.
In mid-November, 12 year-old Mohammed Abdulkarim was shot in the thigh. After five days of emergency treatment in Zalingei hospital, an ICRC surgeon sewed-up the wound and told Mohammed's family he would soon be ready to go home.
In contrast is another 12 year-old boy, Mohammed Bakhat. Shot in the hip in April and initially treated by ICRC surgeons at Nyala hospital in Southern Darfur, his injuries and subsequent infections have left him bedridden.Dr Hassan Nasreddine, an ICRC surgeon who has been working at Zalingei hospital, knows that to recover, Mohammed Bakhat needs a year of specialised medical care – care that is unavailable in western Sudan's Darfur province. The plight of the bedridden boy has touched him deeply.
" I have a soft spot for this little boy, " he says, describing how Bakhat first arrived in Zalingei hospital, suffering from acute malnutrition and depression.
In Zalingei, the hospital staff have encouraged him to eat and nursed him through many operations. But Bakhat is still frail and declines his father's offerings of fresh meat and milk.
The tale of the two Mohammed's illustrates the huge difference gunshot wounds can have in terms of their severity. It also shows that Zalingei hospital is able to treat victims from both communities affected by Darfur's devastating conflict.
Abdulkarim is from Darfur's largest African tribe, the Fur, while Bakhat is from the province's Arab minority but they lie in the same hospital.
Dr Mohammed Idris is a Sudanese doctor at Zalingei. Himself a Fur, he says treating Arab patients is in line both with medical ethics and with the ICRC's policy of impartiality. Recently, it was Dr Idris who cleaned Bakhat's injuries in the hospital's operating theatre.
" We have a good collaboration with the doctors and the hospital, " says Dr Nasreddine. " I feel people are motivated and there's a willingness to learn. "
Not all Zalingei's patients are war or weapon-wounded – 25 people were treated for gunshot injuries in October, and 18 in November, but many more emergency operations were carried out to save lives endangered by untreated a ppendicitis or strangled hernias.
Recent ICRC policy has attached a new focus in conflict zones not just on surgery but on more generalised medical care.
" The idea is to go from a traditional surgical approach…to supporting the whole hospital, " says Frederic Stauffer, the ICRC's regional medical doctor based in Kenya.
This means that the ICRC is renovating the operating theatre in Zalingei hospital, and also taking over the children's ward of the hospital in January. A surgical team will remain, but other ICRC staff work at the hospital too, providing medical care and support.Though the Sudanese government runs the hospital, lack of adequate state funding means the patients here would receive inadequate care without the involvement of humanitarian organisations.
But Mohammed Bakhat c annot go home to his nomadic family. The severity of his injuries means he may remain an invalid for life. His father, Bakhat Amara sits outside the small, dark ward where his son lies, fanning a fire to make tea and appealing to outsiders for help to move his son to a hospital abroad.
It is a request that presents Dr Nasreddine with a dilemma - whether or not to ask for a transfer to a hospital not abroad, but in the Sudanese capital of Khartoum, and whether this would actually make a difference.
ICRC surgeons initially saved a life, but in this badly injured little boy, Dr Nasreddine knows he has found a painful reminder of the limits of his intervention.