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Human Mortality In Darfur: What Is Unspoken, And What This Silence Means

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Human Mortality In Darfur: What Is Unspoken, And What This Silence Means

Post by Mazy on Sun Sep 08 2013, 13:55

This should help explain the difference in the numbers that we have been getting. Also this is a long report, Eric Reeves is usually in-depth and gives accurate information.

Human Mortality In Darfur: What Is Unspoken, And What This Silence Means
By Eric Reeves,

September 7, 2013 – For more than five years the UN has offered no new figures on mortality in Darfur, no estimate of the number of lives lost to violence and its consequences in the decade-long conflict. The last figure officially promulgated was 300,000, a crude calculation by then head of UN humanitarian operations John Holmes (April 2008), based on no new data or revised methodology: it was simply an extrapolation from the previous UN figure of 200,000, which had been established with some rigor by the UN’s World Health Organization (WHO) in 2004 and 2005. But as a senior UN official explained to me at the time of the WHO study, there would be no further mortality studies in Darfur: Khartoum had threatened those collecting data and had made clear its intense hostility to any further analysis of the number of dead. This in part explains why Holmes was driven to the crude extrapolation he offered in 2008.

Data continued to accumulate, however, although even this had ceased by July 2010 with the publication of a report from “Darfurian Voices” (“Darfurian Voices: Documenting Darfurian Refugees’ Views on Issues of Peace, Justice, and Reconciliation” (July 2010). On the basis of this survey and all previous data, as well as an important but deeply flawed account from researchers at the Center for Research on the Epidemiology of Disasters (CRED) (January 2010), I published in August 2010 a lengthy analysis that concluded approximately 500,000 people had died from all war-related causes in Darfur and eastern Chad from February 2003 through July 2010 (see [url=(http://www.sudanreeves.org/?p=2269).](http://www.sudanreeves.org/?p=2269). [/url]There have been no subsequent data of significance, or critiques of my methodology, that I am aware of.

But it is now September 2013—more than three years later—and still we have no revision of the UN estimate for the number of people who have died as a result of the Darfur conflict. Holmes’ casual estimate continues to be the one cited most often by news organizations. Moreover, we have no data bearing on Global Acute Malnutrition for Darfur as a whole or other global indicators of morbidity. But we know people have continued to die—and in large numbers, if not at the rate of the earlier years of the genocide. How can total mortality remain an unaddressed issue? The answer remains Khartoum’s intimidation of the UN and thereby the international nongovernmental (humanitarian) organizations (INGOs) in Darfur, which dare not get ahead of the UN in releasing data and reports on mortality and morbidity. This is shocking UN capitulation to a regime that has always insisted that “10,000″ people in total have died in the Darfur conflict. This capitulation has always been implicitly justified in the name of continued access, but the continuous expulsion, harassment, and obstruction of INGOs makes clear that Khartoum will not hesitate to remove even the most essential humanitarian resources if its demands are not met. The recent experience of the UN’s own High Commission for Refugees (UNHCR) is all too revealing:

The Sudan government has expelled 20 members of staff of the Office of the United Nations High Commissioner for Refugees (UNHCR), “compromising the ability of the refugee agency to effectively undertake its work in Darfur.” Agency spokesperson Melissa Fleming confirmed at a UN briefing in Geneva on Tuesday that “of the 37 UNHCR international staff based in Darfur, only 17 currently have valid permits to continue their work.” Fleming confirmed: “Permits in the other 20 cases have not been renewed, despite extended follow-up by UNHCR with the relevant government authorities, forcing us to scale down our operations. “This has particularly affected our work in North Darfur. None of our international staff based in El Fasher have been granted permits to return, with the last remaining staff having been asked to leave at short notice in early July. The result is that for over a month, UNHCR has been unable to effectively undertake protection and assistance activities for displaced persons in North Darfur,” Fleming said. (Radio Dabanga, Darfur relief operations hampered as 20 UNHCR staff expelled [Geneva/El Fasher], August 6, 2013) (all emphases in all quotes have been added)

At the same time, violence against humanitarians has increased, and assaults on the resources of these intrepid organizations have increased even more rapidly. The most significant moment in recent history was the overrunning of Kutum town and Kassab displaced persons camp in North Darfur in August 2012 (see my detailed account, based on an eyewitness report by a relief work, at [You must be registered and logged in to see this link.] Though not as significant as Khartoum’s expulsion of thirteen major INGOs in March 2009, the attacks signaled a breach that has led to a large number of significant assaults on relief workers and ruthless destruction of their supplies and property:

[1] “MSF headquarters in North Darfur plundered and looted”
The Darfur headquarters of Doctors Without Borders/Médecins Sans Frontières (MSF) in Tawila, North Darfur, was allegedly violently raided and looted “by pro-government militiamen” on Saturday morning. Witnesses told Radio Dabanga that the militiamen opened fire on the compound with rifles, machine guns and grenades. “There were about 20 security guards in the compound at the time, but they could not prevent the militiamen from taking computers, mobile phones, medical supplies, and a vehicle belonging to the NGO.” Sources say that troops from the Sudanese army, supported by elements of the Central Reserve Forces (known as Abu Tira), intervened and drove the attackers off. (Radio Dabanga [Tawila, North Darfur], September 1, 2013)

[2] “Red Cross workers abducted in [formerly West] Darfur”
Eight members of staff of the International Committee of the Red Cross, including the organisation’s director for Nertiti locality in Central Darfur, were allegedly abducted “by pro-government militiamen” on the road from Nertiti to state capital Zalingei on Monday morning. A witness told Radio Dabanga that “two Red Cross vehicles carrying a total of eight people were stopped by militiamen at about 10[am] in the Hila Beeda area” and taken “to an unknown location.” He could not confirm the full names of all the abductees, but said that they include the Red Cross director for Nertiti locality Abubakar Mohamed Saleh, the drivers of two vehicles Habib Hamza and Salah and Red Cross workers Antar, Adam Ibrahim, Abdul Rahim Agen, Ahmed, and another whose name has not yet been established. (Radio Dabanga [Zalingei, West Darfur], August 26, 2013)

[3] “Second attack on NGO’s North Darfur HQ this week”
The headquarters of the medical NGO Médecins Sans Frontières/Doctors Without Borders (MSF) in Tawila was reportedly attacked on Tuesday, the second such attack on the compound in less than two days. A witness told Radio Dabanga that two militiamen opened fire on the headquarters at 11pm, seriously injuring two guards. However, the source said that the security situation has prevented Adam Hamid Ahmed and Adam Issa Said from being transferred to hospital in state capital El Fasher. The gunmen allegedly made off with a vehicle belonging to the NGO. As previously reported by Radio Dabanga, on Saturday, after threatening the security guards at gunpoint, militiamen managed to enter the building and took “computers, mobile phones, medical supplies, and a vehicle belonging to the NGO,” a source recounted. (Radio Dabanga [Tawila, North Darfur], September 5, 2013)

[4] Masked gang plunder NGO’s office in South Darfur
Six masked gunmen reportedly robbed the office of the American Refugee Committee (ARC) in the vicinity of the airport of Nyala, capital of South Darfur, at 2am on Saturday. Witnesses told Radio Dabanga that the gang forced two guards to open the doors of the building at gunpoint. The gang then allegedly stole all of the international charity group’s computers, laptops, electronic equipment, and whatever else they could find of value…. (Radio Dabanga [Nyala], August 25, 2013)

The consequences of these assaults on humanitarians have been immediate: this week MSF shut down its critical Tawila clinic, leaving large numbers of people without health or medical resources:

“Darfur’s Tawila Faces Health Care Crisis As Clinic Closes”—Sheikh
More than 1,000 patients, including 200 pregnant women, 500 children, and 300 seniors in Rwanda, Daly and Argo camps in Tawila locality, North Darfur, reportedly have no access to health care due to the closure of the camps’ clinic. A sheikh told Radio Dabanga that the clinic run by Médecins Sans Frontières/ Doctors Without Borders (MSF) closed when the NGO apparently moved its operations to state capital El Fasher on Tuesday. “Now, about 1,000 people a day, who suffer from malaria, diarrhoea, malnutrition, and other diseases are helpless,” he said.

“We have contacted UNAMID to ask for medical supplies. They say that they do not have any but will raise the matter with higher authorities.” The sheikh demanded that the health authorities and humanitarian organisations expedite the rescue of patients especially those pregnant women who are approaching full term. He also appealed to MSF to return and re-open the clinic. As reported previously by Radio Dabanga, the unstable security situation in Darfur has prompted many humanitarian relief NGOs to reduce their operations within the camps for the displaced. (Radio Dabanga [Tawila], September 5, 2013)

Moreover, the callousness of the regime’s notorious “Humanitarian Aid Commission” (HAC) should also be noted here, even in these life-and-death circumstances:

“South Darfur sheikhs accuse HAC workers of stealing, selling relief food”
Sheikhs of the camps for the displaced in Girayda locality in South Darfur have met with the local security authorities as part of an investigation into alleged theft of food by government staff. One of the sheiks told Radio Dabanga that the sheiks went to the security offices on Thursday to charge and investigate staff of the Humanitarian Aid Commission (HAC). The sheikhs allege that HAC staff have stolen food—supplied to them by the World Food Programme (WFP) and destined for distribution to the displaced—and sold it in the markets.

“The security authorities deny that the HAC staff have stolen the food,” the sheikh said, who further alleged: “Elements of the security forces have demanded SDG40,000 ($9,000) from each sheikh for ‘transport costs.’” He said they justified levying the charge because the direct road from state capital Nyala to Girayda is often blocked due to the security situation, so supplies must be delivered via a roundabout route. Still in Girayda, an activist told Radio Dabanga that 30 camps are facing an acute shortage of food. He said that no food was distributed to the displaced from April to June…. “Many are on the brink of starvation,” he said. (Radio Dabanga [Girayda, South Darfur], August 30, 2013)

Not all who work for HAC are corrupt, and some—especially those working in their region of origin—will speak truth s that few wish to hear:

The Commissioner of Humanitarian Aid for Girayda locality in South Darfur, El Tayeb Suleiman, has acknowledged that more than 129,000 displaced persons in the locality are facing “a shortage of food and real suffering.” Suleiman told Radio Dabanga that the displaced have not received any food rations since July, and have been sharing what little they have left. He warned that “a humanitarian disaster might occur in the locality, because the population have not been able to farm their lands this year due to security instability,” referring to the deaths of more than 16 farmers in attacks.

The commissioner also confirmed that the World Food Programme (WFP) required the displaced to provide a barrel of petrol for each of the 23 trucks that must transport the food. This has been echoed by reports from the Girayda displaced. The commissioner demanded the state authorities “put pressure on the WFP to compel the drivers to deliver the food to the displaced.” (Radio Dabanga [Girayda, South Darfur], September 5, 2013)

One hopes the allegation that WFP employees are extorting fuel from displaced persons in order to carry out the urgent task of moving food will be fully investigated.

Throughout Darfur, some 3 million people remain in need of humanitarian assistance; this is half Darfur’s pre-war population. And yet via HAC and other means, the Khartoum regime is speaking openly about reducing the international humanitarian presence in Darfur:

New measures proposed by the Khartoum government to control the activities of international humanitarian groups, including UN agencies in Sudan, will only permit national organisations to work in the field of rights in the country. In a statement via the state news agency SUNA, Interior Minister Ibrahim Mahmoud Hamid said that the new rules were agreed upon at a meeting on Wednesday between President Omar Al Bashir, and the Ministers of the Interior, Justice, Foreign Affairs, as well as the Director of the security apparatus. Hamid: “The meeting put forward detailed procedures for the work of foreign humanitarian groups in the capital Khartoum and the regions, ensuring that it is in line with government policies and strategy.” (Radio Dabanga [Khartoum], citing SUNA, August 22, 2013)

The still immense international humanitarian capacity will be replaced by extraordinarily limited “national” and Arab organizations and resources; all human rights reporting will be prohibited (as it already is). This is quite simply a method of genocidal destruction by other means.

Are there any data?
It is certainly not difficult to see why humanitarian organizations—enjoying no meaningful political backing, either at the UN Security Council or even from the U.S., the EU, or the African Union—feel they must not get ahead of the UN agencies in speaking about issues such as mortality, or publishing data and reports that would make clear the full scale of the rapidly expanding humanitarian crisis. This makes UN silence on so many critical issues all the more culpable and—as we are seeing—ultimately destructive of the vast humanitarian operation that once worked fairly effectively, given the overwhelming needs of the people of Darfur and the logistical challenges in reaching them.

But recent reports from the camps, largely by way of Radio Dabanga, offer data suggesting that the Crude Mortality Rates (CMR) for both adults and children under five (U5) are well in excess of the emergency range. CMR measures the number of deaths per 10,000 of population per day; in Darfur, the CMR had historically been in the range of 0.3, according to UNICEF, below the rates for sub-Saharan Africa, which range from 0.5 to 0.9. The emergency CMR threshold for adults is usually considered to be 1.00 and above; for children under five, it is 2.0 and above. At various points in the conflict the CMR for Darfur and specific regions within Darfur has been astonishingly high, sometimes 7.0, 8.0, and even higher. Use of a CMR is the most revealing way of establishing total mortality, if an accurate CMR can be established and the size of the affected population can be reasonably estimated.

For example, in 2004 – 2005 the UN’s World Health Organization was able to sample displaced populations in camps sufficiently well to reach some significant conclusions about Darfur’s CMR. The UN figure of 180,000 deaths (from disease and malnutrition, though—notably—not from violence) in March 2005 (and a subsequent figure that year of 200,000) represents a simple multiplication by 18 months of the monthly mortality rate that emerged from the UN World Health Organization mortality study published in September 2004, with a corresponding October 2004 analysis, “Morality Projections for Darfur.” The mortality study and “Mortality Projections” followed a WHO survey of accessible camps in Darfur; it yielded for August 2004 a mortality rate of “2.6 per 10,000 per day, with a worst and best case range of 1.6 to 3.2″ (UN World Health Organization, “Mortality Projections for Darfur,” October 15, 2004, by Dr. David Nabarro, Director-General, Health Action in Crises at [You must be registered and logged in to see this link.] There was very good reason to expect that the CMR would have been higher at camps that were “inaccessible.” (For a more detailed analysis of these early mortality estimates, and a chronology of WHO’s work, see [You must be registered and logged in to see this link.]

More recently, at Yida refugee camp in Unity State, South Sudan—where many tens of thousands of people from the Nuba Mountains have fled Khartoum’s indiscriminate violence—MSF was able to establish early in the crisis, on the basis of a camp census, the CMR. This in turn, applied to the total camp population, tells us how many people are dying every day as a consequence of having to flee the regime’s new war on civilians:

[W]e were able to discover quickly that the crude mortality rate was 1.8 per 10,000 per day and the under-five mortality rate was 2.8 per 10,000 per day. Both rates were well above the emergency threshold, defining this as a severe situation. Almost 3 children were dying in the camp every day and 65% of deaths were due to diarrhoea. (MSF epidemiology report on Yida refugee camp, August 2012)

It should also be noted, particularly in reading the reports from the Famine Early Warning Systems Network (FEWS NET), that the CMR of a given camp or area is very closely related statistically to the rates of Global Acute Malnutrition (GAM). This makes obvious sense: those weakened by malnutrition are much more likely to die from diseases that well-fed adults and young children would be able to shake off.

A CMR is useful, however, only if we have a credible denominator—the number of people for whom the CMR is relevant. Khartoum has made it impossible to establish a useful denominator by intimidating the UN and INGOs. But the regime cannot prevent shocking reports from the camps, and accounts of the number of deaths daily, late in this year’s rainy season. Still, reports on the size of various camp populations are highly contradictory and continually changing—often dramatically—especially with the massive displacements of the past year. Without a reliable denominator for the various camp populations, it is impossible to arrive at an accurate CMR and thus establish the number of people who are dying every day, and what the total mortality for the period August 2010 to the present might be. The figure is certainly in the tens of thousands, though no more precise estimate is possible.

But if we at least bear in mind the requirements for mortality assessment, the reports from Radio Dabanga included below will suggest why an estimate of even “tens of thousands” may well be conservative, and perhaps very soon untenably so. Certainly without at least a statistical framework, an identifiable methodological ambition, the many numbers with which we have been presented by Radio Dabanga, from reliable sources on the ground, are largely opaque in implication, even as there can be no doubt that something terrible is happening to the Darfur populations.

It is important to remember that the UN’s World Health Organization mortality studies of 2004 – 2005 did not include violent mortality, or mortality outside the accessible camps. It was thus highly circumscribed in implication about total mortality, especially since various organizations reported that violence was clearly the major cause of death in the early years of the genocide. And yet it was the WHO figure of 200,000 non-violent deaths, based on a significantly limited mortality assessment, that served as the basis for the April 2008 estimate by John Holmes of 300,000 deaths. Key studies of violent mortality in Darfur—by the Coalition for International Justice (August/September 2004) and “Darfurian Voices” (July 2010)—have never been included in any UN estimate of mortality.

It is, in short, important to remember that there are many ways to die in Darfur that relate directly to the nature of conflict as Khartoum has chosen to wage it. Aerial bombardment has been particularly destructive of civilian lives and livelihoods (see forthcoming update to [You must be registered and logged in to see this link.] and significant civilian casualties in eastern Jebel Marra in particular have been reported on a very regular basis for years:

• “At least seven dead in Darfur air raid”: herdsman
At least seven people, including four children, are reported to have died in renewed air raids, allegedly by the Sudanese air force, in Darfur’s East Jebel Marra on Thursday. Several witnesses fleeing the area told Radio Dabanga that the vicinities of Kined, Silo, Shangil Tobay, as well as the villages of Kunjara, Sharaf, Tirbo, and Vanaga were affected. They said that three Antonov aircraft and two MiG jets pounded those areas from 8am until 1pm on Thursday. They said that they saw “many dead and wounded among the population, as well as a number of livestock killed.” They could not quote exact number, however, as “people were fleeing for their lives in all directions.” A herdsman who spoke to Radio Dabanga said that while they were watering their livestock at the wells of the Abuzaid agricultural project, a strike killed seven people and wounded five others. “The dead included four children….” (Radio Dabanga [eastern Jebel Marra], September 5, 2013)

• “Air raid [UXO]” kills four children in Darfur’s East Jebel Marra
Four children were reportedly killed on Friday in the Dubbo Al Omda area in Darfur’s East Jebel Marra when a bomb dropped during an alleged Sudanese Air Force raid on Thursday, exploded while they were watering their camels. Witnesses told Radio Dabanga that Antonov aircraft bombed the area on Thursday. They said that Samani Yaqoub Saleh (9), Bahradin Musa Sakin (12), Hawa Haroun Musa (Cool, and Omar Ajap Mohamed (15) died when one of the unexploded bombs went off. The explosion also killed 37 camels. As previously reported by Radio Dabanga, at least seven people, including four children, are reported to have died in renewed air raids, allegedly by the Sudanese air force, in Darfur’s East Jebel Marra on Thursday. (Radio Dabanga [east Jebel Marra], September 6, 2013)
• “Two Darfuris killed in on-going East Jebel Marra airstrikes”

Bombings allegedly carried out by the Sudanese Air Force continued on Friday in East Jebel Marra leaving at least two people dead and several others injured, local sources fleeing the strikes say. As a result of the “heavy bombardments, targeting mainly the North Darfur village of Dubbo al Omda and surroundings,” houses and farms caught on fire and livestock were killed. (Radio Dabanga [eastern Jebel Marra], August 23, 2013)

• “Village destroyed, civilians dead and injured in Darfur air raid”: villagers
An “intense air bombardment,” allegedly by the Sudanese Air Force, reportedly caused an unknown number of casualties and completely destroyed the village of Abu Tega in North Darfur on Tuesday. A villager fleeing the area told Radio Dabanga that from 12pm till 1pm, two Antonov aircraft strafed the area to the east and west of the main highway that connects El Fasher and Nyala, capitals of North and South Darfur. Areas east, north and west of Marshang locality in South Darfur were also reportedly targeted. Witnesses counted a total of 25 bombs that were dropped. “The village of Abu Tega to the west of Shangil Tobay was completely burned and the population fled in all directions.” The source said while he was sure that there were “many dead and injured,” he could not yet account for the human casualties due to their dispersal. (Radio Dabanga [Shangil Tobay, North Darfur], August 20, 2013)

Assaults on camps and displaced persons have become more frequent, more brazen, and more violent—often taking the form of brutal extortion schemes:

A group of “pro government militiamen” are allegedly threatening to torch Moro camp in Sirba locality, unless the displaced pay compensation for a dead cow. A sheikh from the camp told Radio Dabanga that on Tuesday, the militiamen demanded SDG1,600 ($365) compensation for the cow. “The gunmen have given us 24 hours to pay the compensation. If we do not, they have threatened to set the camp on fire,” the sheikh said. “When we threatened to report them to the police and the Sirba Commissioner, they said that they do not recognise any authority—that they are the authority here.” (Militiamen threaten to torch Darfur camp: Sheikh, Radio Dabanga [Moro camp], September 3, 2013)

[See also my analysis of Darfur insecurity and the growing number of such extortionate threats and attacks, August 28, 2013]

The trauma of rape is also a source of significant mortality, and youth is no protection against the most barbaric of assaults (Radio Dabanga [Kutum], August 23, 2013):

“12-year-old gang raped in North Darfur”
A group of militants alleged[ly] armed by the government are said to have raped a 12-year old girl near Kassab camp, in North Darfur, where she lives. An activist at the camp of Kutum locality, said the militiamen, riding horses and camels, took the girl at gunpoint and raped her alternately “from 10am until 8pm.” A group of displaced men, supported by elements of the Sudan Armed Forces, chased the alleged perpetrators who managed to repel the group. The victim was transferred on Friday morning from the crime scene to a hospital in Kutum where she remains in “deplorable condition,” the source told Radio Dabanga.
[You must be registered and logged in to see this image.]
The girl in this photograph (not identified by any source I have seen) is not the victim, nor would I publish it if it were; but it is sometimes useful to look into such a beautiful if anonymous face and imagine how her life would be changed forever by this brutal crime, for which there is near total impunity in Darfur. It is also quite uncertain whether a girl this age can survive such a massive trauma, physical and emotional; for many gang-rape victims, often further victimized by other forms of violence, have died over the years during which there have been many tens of thousands of rapes, a very large percentage of them rapes and gang-rapes of girls.

Displacement itself can be fatal, and many hundreds of thousands of people have been displaced in the past year—and more than 1 million since the UN/African Union protection force, UNAMID, took up its mandate in January 2008 (see “Taking Human Displacement in Darfur Seriously,” [You must be registered and logged in to see this link.] Assaults on camps and non-Arab farmlands by militia either linked to the Khartoum regime or granted implicit immunity from accountability have increased sharply (see Events in Darfur Rapidly Spiraling Out of Control as Security Continues to Collapse, August 29, 2013;[url= [You must be registered and logged in to see this link.] [You must be registered and logged in to see this link.] And military violence, including Arab inter-tribal fighting, has also sharply escalated with dire consequences for civilians (Bloody tribal clashes leave “hundreds dead, many wounded” in [formerly South] Darfur, Radio Dabanga [ed Daein, South Darfur], August 11, 2013):

Violent clashes that erupted between the Riezegat and Ma’alia tribes in East Darfur on Saturday and Sunday have reportedly left “hundreds dead and many wounded” on both sides. Tensions between the tribes began to rise when Ma’alia members allegedly stole several cattle belonging to the Riezegat, and when a Ma’alia merchant, Hashin Houmeida, nicknamed Al Libi, was allegedly killed by Riezegat tribesmen. These events prompted a high-level security delegation, as well as Sudanese army troops, to be dispatched to state capital Ed Daein on Thursday. The combat zones included Kilikil Abu Salam on Saturday, spreading to Al Muhalgarat, Dar Es Salam, Al Sahab, Mijelid, and Angabo by Sunday. Witnesses have been reporting to Radio Dabanga that “loud explosions and small arms fire could be heard from Saturday afternoon until Sunday evening….

But in a year of heavy rains and floods throughout Sudan, what we have seen most threateningly since July is a dramatic upsurge in morbidity and death from disease and malnutrition in Darfur. What is assembled here, with as much suggestive data as possible from the past two months, are reports from camp leaders about the rate at which people are dying for lack of food, clean water, sanitation, and primary medical care. In a notable change in reporting, these omdas, sheikhs, and local medical directors are increasingly using a “deaths per day per camp” metric. Thus if we can estimate the size of the camp and extrapolate a rough approximation to the prevailing CMR, we may generate a statistically significant figure for total deaths. Khartoum can prevent the global assembly and analysis of data; the regime cannot halt the reporting of Radio Dabanga, which is giving voice to many hundreds of thousands in the camps and many more who are displaced elsewhere in Darfur, giving us an ever clearer picture of a CMR that cannot yet be calculated.

Commentary here (in italics) is minimal, though some context is needed in a few instances. The connection to the massive reduction in delivery of food and medicine is the central theme in virtually all these reports; here, then, it must be borne in mind how much Khartoum has done to impede humanitarian delivery, the entry into Darfur of humanitarian workers, the assault on humanitarian resources by both the regime security forces and its militia proxies, and the general atmosphere of insecurity and intimidation that has been deliberately created, if not always under full control. The examples here—all from the past two months—appear in reverse chronological order:

• “Infant mortality rates risen to five a day in Darfur camp”: Sheikh
Lack of adequate health care and proper nutrition for the children of Darfuris, especially the displaced, has seen the infant mortality rate rise throughout the region, according to multiple reports reaching Radio Dabanga. In Attash camp near Nyala, capital of South Darfur, four to five children are dying of diarrhoea and malnutrition every day. Sheikh Abdul Karim Abkar told Radio Dabanga that “the mortality rate at Attash camp has risen significantly from the end of August into the first week of September.” (Radio Dabanga [Nyala/Um Dafur], September 3, 2013)

• Malnutrition kills 10 children in [Formerly West] Darfur
A total of 10 displaced children died from malnutrition in Nierteti hospital last week, a sheikh has told Radio Dabanga. The Sheikh lamented the high mortality and disease rate among the children, which he attributed to a lack of food, medicine and health care…. and demanded that humanitarian organisations address the supply of food and medicine to the children of displaced people. The sheikh appealed to humanitarian organisations to provide tents and tarpaulins to the affected people, who he said are living in the open without food or shelter. (Radio Dabanga [West Darfur], September 2, 2013)

• Measles kills two displaced people in [formerly South] Darfur
Measles reportedly claimed the lives of two people in Abu Karinka locality in [South] Darfur on Wednesday, where 25,000 displaced are living in harsh circumstances. Speaking from Abu Karinka, one of the displaced told Radio Dabanga that secondary school student Tariq Ali and a woman, whose name was not immediately available, have died. “They were both positively diagnosed with measles.” The source pointed out that “the number of displaced in the locality following the recent clashes between the Ma’alia and Rizeigat tribes has now risen to 25,000. (Radio Dabanga [West Darfur/South Darfur] (August 29, 2013)

Measles is a highly contagious disease, and often fatal among children, especially children in poor health or malnourished. The fact that measles deaths have been reported in other camps suggests that the vaccination program for this disease has left many holes in coverage.

• Youths try to bridge pools as flies, mosquitoes plague South Darfur camp
The displaced residents of Dreige camp near Nyala, capital of South Darfur, fear “a health disaster” due to the breeding of flies and mosquitoes in pools of stagnant water left after the seasonal rains. The youth representative explained to Radio Dabanga that the youths of the camp have tried to bridge the pools. He said they are hoping from assistance from the Scottish team of the humanitarian NGO Mercy Corps. “They have promised to bring us some sand, but have not delivered it yet,” he said. He also appealed to those humanitarian organisations working in the field of health to intervene by spraying the pools. These pools of stagnant water now reportedly occur in and around many of the camps for displaced people in Darfur. (Radio Dabanga [Dreige Camp near Nyala, South Darfur], August 29, 2013)
August is the heaviest month of rains during Darfur’s long rainy season; September is traditionally the second rainiest month. The danger from stagnant water will remain long after the dry season begins in October, and fly-borne and mosquito-borne diseases will plague people in the camps long after the pools have dried. Malaria will be the main killer, but kala azar is an even more deadly disease and much more difficult to treat.

• “Four children die each day in South Darfur capital”: medical director
Medical sources at Nyala hospital in the capital of South Darfur have revealed that the mortality rate in the children’s department has risen to four cases a day. In an interview in Sudan’s Al Sahafa newspaper, the medical director Dr Zuhal Sharaf Al Din has confirmed that his department receives 150 cases daily, 90 of which are due to malnutrition. Dr Al Din notes that there are no more than 14 beds available, which often requires four children to be put in one bed. He also complained of frequent power failures. “These cause many deaths due to children not being able to receive oxygen in a timely manner.” (Radio Dabanga [Nyala], August 28, 2013)

• “Still no health relief for West Darfur poisoning victims”: Sheikh
The leaders of Murnei camp for the displaced in West Darfur complained on Tuesday that the victims of a mass food-poisoning incident “have not received proper medical care for the fifth day running.” As reported by Radio Dabanga on Sunday, sheiks said that 275 people were stricken with vomiting and acute diarrhoea after eating contaminated grain. Some of those were in “critical condition.” By Monday, reports reached our station that 13 have died, including three children and four women. Large numbers of livestock also perished. One of sheikhs of the camp told Radio Dabanga that people were forced to remove sick relatives from the camp’s health centre, as there was no treatment available there. (Radio Dabanga [Murnei, West Darfur], August 27, 2013)

Khartoum has often in the past delayed food on arrival in Sudan at Port Sudan, giving contamination more time to work its way through a food supply.

• Four children die of disease in [formerly West] Darfur
Four children reportedly died at Nertiti hospital in Central Darfur on Monday, “as a result of diarrhoea, fever, vomiting and severe lack of health care.” A woman activist reported to Radio Dabanga the death of the four children, including a girl named Marwa Mohamed Adam, is attributable to an outbreak of malaria, diarrhoea, and malnutrition among children of the camp…. The displaced Jabalain camp near Garsila in [formerly West] Darfur have complained of an outbreak of paralysis among the adults of the camp. (Radio Dabanga [Nertiti], August 21, 2013)

• MSF Survey: “Gunfire main cause of death for those fleeing Darfur”
The majority of people who died while fleeing [formerly West] Darfur [for eastern Chad] earlier in the year perished as a result of violence, and mostly by gunfire, according to a retrospective mortality survey released on Tuesday by the international medical humanitarian organisation Doctors Without Borders/Médecins Sans Frontières (MSF). “Between January and May 2013, tens of thousands of Darfuri refugees and Chadians fled Darfur and sought refuge in the Tissi area of neighbouring Chad. The survey, carried out by MSF’s
epidemiological research division, Epicentre, reveals that 119 of the 194 deaths (61 percent) reported by family members were caused by violence. 111 people, or 93 per cent, died from gunshot wounds linked to specific episodes of violence preceding the two major waves of displacement, one in early February and one in early April. The people shot to death died in Darfur. Survivors reported mass shootings and the burning and looting of villages, the report states. “This survey confirms that violence in Darfur is indeed the major cause of mortality,” said Delphine Chedorge, MSF emergency coordinator. (Radio Dabanga [Paris/New York], August 7, 2013)

It was MSF that first established, early in the genocide, that the predominant cause of death in Darfur was violence; this has changed over the years, but such reports as these are ominous in the extreme:

• Measles kills four children in El Salam camp, South Darfur
Four children have died of measles in El Salam camp for the displaced near Nyala, capital of South Darfur, and there are threats the camp “might have to be dismantled.” Speaking to Radio Dabanga on Friday, Sheikh Mahjoub Adam Tabaldiya attributed the children’s deaths a lack of medicine, health care and a food shortage at the camp. Sheikh Tabaldiya reiterated that “the displaced are going through very difficult humanitarian and health circumstances, especially children, women and the elderly.” He warned that “the camp might be dismantled from lack of food, medicine and due to organisations’ stoppage of food provision to displaced people.” (Radio Dabanga [El Salam camp, near Nyala, South Darfur], July 22, 2013)

• Quarterly death toll of 47 children and 18 pregnant women in Kalma camp
During the second quarter of 2013, the spread of diarrhoea, vomiting and malnutrition among the displaced of Kalma camp near Nyala, capital of South Darfur, has claimed the lives of at least 47 children and 18 pregnant women. Sheikh Bakhit Hamid, speaking to Radio Dabanga from Centre Eight of the camp, said that “the general situation of the newly displaced in terms of health and nutrition as very bad.”

The problem of food has become worse, especially after relief organisations suspended their activities following the recent violence in South Darfur…. Hamid also highlighted the emergence of 15 cases of swelling in the legs and in the spinal cord among the elderly. “They have had not been examined by doctors to find the cause of the disease, but we are sure it’s due to the breeding of flies,” he said. “10,000 displaced people have to share just 100 family latrines, so the children often relieve themselves in the open, which does not help.” Hamid expressed the hope that relief organisations will resume their work as soon as possible to relieve the pressure on the displaced. (Radio Dabanga [Kalma Camp], July 18, 2013)

100 family latrines for 10,000 displaced people ensures the massive reproduction of disease-carrying flies.

• “High mortality rate, fever” among displaced of Marshang, South Darfur
The displaced residents of camp Marshang in South Darfur have complained of the high mortality rate among the elderly of the camp, as well as the spread of skin diseases, diarrhoea, and fever among children. The sheikh of the camp told Radio Dabanga that the mortality rates among the elderly is increasing as a result of malnutrition and the lack of medicines. He said that the deteriorating health of the environment and persistent pools of standing water left by the heavy seasonal rains are promoting the spread of diseases such as malaria and skin disorders.

“There has been a complete halt to any humanitarian relief organisations inside the camp, which amounts to a major disaster for the displaced,” the sheikh said. “Their situation is tragic.” He appealed to the international humanitarian organisations to provide the basic needs of plastic sheeting, tents and medicines to the displaced so that they can face the rainy season. (Radio Dabanga [Marshang, also Mershing, South Darfur], July 10, 2013)

• Acute diarrhoea outbreak among South Darfur displaced
Reports from Kalma camp for displaced persons near Nyala, capital of South Darfur, say that cases of acute diarrhoea are on the increase among residents of the camp. Dr Abdulkarim Abdullah, a physician at one of the camp’s clinics, says that at least 250 people visit the clinics each day complaining of acute diarrhoea. “Another cause for concern is vomiting and malnutrition among the children; all a result of the deteriorating sanitary environment and a lack of medicines,” he lamented. “This is aggravated by the influx of displaced persons and the rainfall at the camp. Antibiotics just can’t treat them anymore.” Dr Abdullah criticised the international organisations and the Ministry of Health for not providing medicines. “The health situation is far worse than it was, for example, in 2003 when the organisations operating in the area managed to supply medicines. However, the current organisations are poorer and incapable of providing drugs.” The doctor appealed to the international community to expedite the provision of medicine to the displaced. (Radio Dabanga [Kalma camp], July 5, 2013)

Conditions in Darfur become more deadly by the day, with no evidence of increased humanitarian capacity; rather, there is every sign that conditions will continue to deteriorate, with substantial increases in morbidity and mortality.

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