Darfur: providing care on both sides of the front line
10-04-2008 Feature
In a volatile environment such as Darfur, where travelling by road is often dangerous, access to health care is difficult for all communities, whether sedentary or nomadic. At the foot of the Jebel Marra mountains, the ICRC is supporting clinics in areas controlled by rebels and government forces alike. Report by Valérie Petitpierre, ICRC delegate based in Zalingei.
The sun was still low on the horizon when the first patients appeared in the doorway of the primary-health-care centre in Gorne. Adam Jibril is a nurse. Having arrived at work early to organize his paperwork from the day before, he was now ready to see his first patient.
Meanwhile, the pharmacist was ch ecking her stock and was already lining up boxes of the most commonly requested drugs on her desk. Even though the clinic is open non-stop until the middle of the afternoon, most patients and their families prefer to come before the hottest time of day and before their daily chores take over.
The village of Gorne is situated in a government-controlled area, at the bottom of the Jebel Marra range in West Darfur. The Jebel Marra is considered by some to be the heart of Fur territory and is the stronghold of a faction of the Sudan Liberation Army (SLA), one of the main groups opposing the Khartoum government.
The village’s strategic position at the crossroads between the three Darfuri states and its fertile lands make it a spot coveted by all. While the slopes and peaks of the Jebel Marra have remained exclusively in the hands of the Fur people, the surrounding plains are now populated by farming communities and pastoralist nomads.
Uneasy coexistence
As in the neighbouring villages of Dabenga and Waranga, the relationship between sedentary farmers and pastoralist nomads in Gorne is strained, and security is a major concern for everyone. Since 2006, the ICRC has tried to visit Gorne as regularly as possible – organizing vaccination campaigns, for example – and it recently decided to go one step further and support the village’s small clinic.
An ICRC team has therefore been visiting the clinic once a month since October 2007 to deliver drugs and advise the local personnel: a nurse, a pharmacist, a midwife and a cleaner. The organization has also supplied cement to reinforce the structure of the building and pays part of the medical staff’s salaries.
The clinic mainly serves the village of Gorne and the four nomad camps surrounding it, approximately 12,000 people in total. The most common complaints are diarrhoea, dysentery, painful joints, chest infections, stomach infections (due to the poor quality of the food and water), conjunctivitis (due to the dust and the flies), and coughs.
Nomads are especially susceptible to urinary-tract infections and also to migraines because they spend long periods in the sun. They have less access to water and so their symptoms are often aggravated by dehydration.
Regular skirmishes
- In 2007, around 252,000 people living in rural areas had access to primary health care thanks to the six clinics supported by the ICRC in Darfur. Over 111,000 consultations took place and over 72,000 doses of vaccines were administered.
- Of those consultations, more than 15,000 were antenatal or postnatal.
- Mobile medical teams also visit villages in remote areas to provide the population with basic preventive and curative care, including vitamin A and iodine supplements.
- The ICRC helps the Ministry of Health carry out vaccination campaigns in areas that are inaccessible to government officials. It took part in the immunization of over 46,000 children under five against polio.
On the southern slopes of the Jebel Marra, the ICRC supports another health-care centre in the village of Golol, which has been in SLA hands since the start of the conflict. Around 15,000 people, all from the Fur tribe, live in the village or in the immediate vicinity. Golol is only seven or eight kilometres from the small town of Thur, which is in a government-controlled area. The front line is close by, and the region, which has seen some serious clashes in the past, is still regularly the stage for skirmishes between rebels and soldiers of the Sudanese army.
Since the beginning of the war, the population of Golol has significantly increased with the arrival of the displaced. The local clinic employs seven people who give up to 70 consultations a day, mostly to women and ch ildren and often for cases of diarrhoea or malaria. Since the beginning of 2006, as in Gorne, the ICRC has been delivering drugs to Golol once a month and contributing to the salaries of the medical staff. This year the organization is also planning to extend the existing building to create three more consulting rooms.
Finally, the ICRC focuses on preventing illness through better public hygiene and makes every effort to broaden the skills of the staff. In contrast to the inhabitants of Gorne, who can travel to towns in the government-controlled area if they become seriously ill, Golol residents cannot risk crossing the front line, particularly if they are men of military age. This small clinic is therefore their only chance to get treatment.
The risk of highway robbery
Back to Gorne. Halima Shama was born and grew up here. Her three children had all fallen ill. She explained to the doctor that her elder daughter, Aisha, who was five years old, had digestive problems and her four-month old baby, Uthman, had a urinary-tract infection. Her younger daughter, Hawa, had not slept all night long due to a severe fever.
After sounding the chests of his three young patients, the doctor was able to reassure their mother and gave her some tablets in a small plastic bag, with precise instructions. Halima looked relieved: her three children should be smiling again soon. As she left the clinic, she met the ICRC team and told them that three months ago, she would have had to travel to Nertiti to get her children treated. The journey by public transport would have taken over half a day there and back and would have cost around US$ 5 – not to mention the risk of being robbed by gunmen en route.
" The road isn’t saf e, and we can’t afford the bus fare, " she explained. Hussein Adam Uthman, the village sheikh, added: " A few months ago, local people had to go all the way to Nertiti, or even further, to Zalingei or Nyala, spending more than five hours on the road so that they could receive adequate treatment. With the ICRC’s help, the clinic now has a supply of essential drugs.”