Mortality and morbidity in refugee camps in eastern Sudan: 1985-90

Civil war has disrupted life in Ethiopia since the 1960s and many people have sought refuge in Eastern Sudan, particularly during the famine emergency of 1984–85. UNHCR has provided the main financial support for the refugee programme, but began scaling down operations in 1990. Nearly 300,000 refugees still live in camps and benefit from food and health programmes. Health services are co-ordinated by the Sudanese Refugee Health Unit which operates a centralised health and nutrition surveillance system with the co-operation of the NGOs responsible for health care in the camps. A revision of the monthly reporting system and the establishment of a computer database in 1990 provided an opportunity to review the situation in the camps over the five years since the emergency. Child death rates for example, appear to have been reduced to levels below those expected in rural Africa. Patterns of mortality, morbidity, and nutritional status are outlined here and point to the general effectiveness of the health care programme. The surveillance system can, however, be used to identify those camps which have persistent problems, while monthly comparisons with the situation in previous years can provide early warning of deteriorating conditions.     

II Murahaleen Raids on the Dinka, 1985-89

Successive Sudanese governments have used proxy forces, so-called militias, as an integral part of their war with the rebel Sudan People's Liberation Army (SPLA). The Rizeiqat and Misseriya of South Darfur and South Kordofan created armed bands, known as Murahaleen, in order to raid cattle from the Dinka to their south. Massive raids have depopulated swathes of territory south of the Bahr al-Arab, killing tens of thousands of people and leading to the destruction and displacement of unknown numbers of others. Famine in western Sudan fuelled the early raids, but the scale of the devastation wrought from 1985 onwards was the result of government complicity and assistance. More recently, since the coming to power of the current military government in Khartoum in June 1989, the relationship between the army and the Murahleen has been formalized through the creation of Popular Defence Forces.     

Famine, gold and guns: the suri of southwestern ethiopia, 1985-91

Over the past few years, the Suri have lived through a deep ecological and social crisis without substantial external aid from either the Ethiopian government or international aid agencies. They have experienced drought, cattle disease and an increasing level of violent conflict with their neighbours, leading to the severe disruption of their traditional agro-pastoral subsistence system and settlement pattern. Through migration, the exploitation of gold resources and investment in automatic weapons, however, they have managed virtually a full recovery of their economy and society.     

National organizations and famine early warning the case of mali(1)

In the Sahelian countries of West Africa, the problems of drought and famine are sufficiently long term to justify the existence of permanent food security agencies. Yet donors are reluctant to fund these agencies when there is not a crisis, forcing poor countries to use their own resources for food security and famine early warning efforts. To make more effective use of limited resources and since the data needs for effective famine early warning are similar to those for basic rural development, information systems to provide data simultaneously for development projects and famine early warning should be developed and supported. In Mali, one of the larger and poorer countries of the West African Sahel, basic information systems which gather a range of appropriate data already exist, but there need to be improvements in the quality of design and the timeliness of analysis to make the information more useful for either development or famine early warning.     

Malnutrition and Poverty in the Early Stages of Famine: North Darfur, 1988–90

In this article we report findings on the relationship between malnutrition and poverty during a period of acute food insecurity in Darfur, Sudan. Children of rich and poor families were equally likely to be malnourished, which is explained in terms of people's responses to the threat of famine. This finding has important implications for targeting interventions in the early stages of famine. Appropriate interventions at the early stages of famine are livelihood and income support to the most vulnerable. The entitlement theory of famine causation assumes that the poor are most vulnerable, and become malnourished and die during famines. In this article we show that this assumption does not hold. Even though poverty is the root cause of malnutrition, it does not follow that anthropometric status can be used to target individual poor families, or even that targeting the poor is appropriate in famine situations.     

Medical supplies management in the cholera epidemic in Somalia 1985

In March/April 1985 a cholera epidemic of explosive speed affected a population of 45,000 newly arrived refugees in the town of Hargeysa in the North-West region of Somalia. Seven hundred and sixty one people were killed by the disease within ten days. Great efforts were made on regional, national and international levels in order to reduce mortality and to control the spread of the disease, and large amounts of relief supplies were immediately flown into the country from various aid organizations and governments. This paper describes the supplies management during the operation, with an emphasis on the mobilization of supplies from abroad and from the capital into the emergency area. Recommendations are offered for the organization of medical supplies during cholera outbreaks. The author worked during the epidemic as co-ordinating secretary for relief supplies in Mogadishu.     

Practical experience with the management of a cholera outbreak in a refugee cAMP in eastern Sudan, 1985

From May to November 1985 most refugee camps in Eastern Sudan were affected by cholera. This article summarizes the experience from the refugee camp Wad Sherife with the emphasis on the practical aspects of management of cholera in a refugee context. Paramedical personnel from the refugee community were used to a great extent both in curative and preventive measures. The home visitors played an important role in the early detection of the cases and in trying to prevent the spread of cholera in the camp. A total of 1793 cases were admitted during a three month period. The results show a case fatality rate of 1.8%. A significantly higher number of women were affected in the age group 15–44. As seen in other refugee camps in Eastern Sudan, there was a relatively high intravenous fluid consumption with an average of about 6 litres in adults.     

Selective feeding programmes in Ethiopia and East Sudan–1985/1986

A survey of thirty-four feeding programmes in Ethiopia and East Sudan was undertaken. Wie differences were found between the two countries and also within Ethiopia. Irrelugar general ration distribution was commonplace in Ethiopia, thus placing an extra strain on selective feeding programmes. The principal admission criteria to Selected Feeding Programmes (SFPs) were weight for height categories. The cut-off stages of the emergency. Useful compasirions between programmes were hampered by such differences, as well as by the different methods of reporting data.
The types of food usd in programmes depended on availability and included high energyu drinks, poridges, take-home pre-mixes and sometimes indigenous foods. A large number of foods e.g. cornedbedef, chicken paté, noodles, da4tes etc. Some added interesting variety and added nutritional value to the diet, while others caused more problems than they solved due to their low acceptability, inappropriate packaging, limited accompanying information and complex an costly preparation. The imlementation of food dination policies by donors and consignees regarding appropriate foodstuffs and their recommended use was considered to be the major solution to this problem.     

Entitlements and the Wollo Famine of 1982–1985

The traglic recent events in Ethiopia and other parts of Africa have again foccussed attention on the different anaytical approaches to the problems iof famine. Perhaps the most important analytical contribution to this field has been Sen's "entitlements approach." One of the case studies Sen used to articulate this approach was of the 1972–1973 famine in Wollo Province, Ethiopia. This article provides a provisional assessment of the famine process in the Wollo during 1982–1985 to set against the analysis by Sen of the earlier famine. Some striking contrasts are revealed.     

Health Assessment of the 1985 Flood Disaster in Puerto Rico

In Puerto Rico, during October 1985, tropical storm Isabel caused widespread flooding, landslides, and collapsing of bridges. A maximum of 180 persons died, including an estimated 127 at a landslide where the majority (78%) of deaths resulted from traumatic injury. Approximately 3,000 homes were damaged with 4,400 persons temporarily displaced into 44 shelters. A shelter surveillance system was established to monitor 19 acute and chronic conditions in 28 shelters during a 5-week period. Trend analysis trends of selected reportable communicable diseases in the general community revealed no changes attributable to the disaster in the 12 most severely affected municipalities. In these municipalities, the number of persons using the scheduled outpatient clinics after the disaster decreased significantly, but the mean daily number of emergency room visits did not show significant change. Analysis of surveillance data showed that no infectious disease outbreaks had occurred in the shelters. The post-impact health consequences resulting from this widespread flooding were minimal. Even so, disease surveillance remains essential for efficacious resource allocation and prevention strategies.     

The United nations and disaster relief in the sahel, 1973-75

This research is part of an extensive study entitled 'International Disaster Response: The Sahelian Experience', which was made possible by a grant number 1711–520147 of the U.S. Agency for International Development and the U.S. Department of State. The opinions expressed are solely the responsibility of the researcher and do not necessarily represent the views of the organizations studied or the sponsoring institutions.     

Rainfall and flooding in the Guayas river basin and its effects on the incidence of malaria 1982–1985

Inasmuch as health is at cross purposes with illness, suffering, disability and death, it is clear that all measures that are adopted with foresight to reduce the repercussions of natural disasters have consequences for health     

The resilience of households to famine in el fasher, Sudan, 1982-89

This paper examines issues related to famine resilience and describes the results of a survey of households who migrated from famine affected rural communities in Northern Darfur to the provincial capital, El Fasher, in western Sudan. It reveals that asset wealth did not enhance household resilience to famine; rather, the data indicate that households who reportedly practiced more numerous survival strategies before migrating to El Fasher were on the whole able to stay longer in their villages before migrating. The data also suggest that some households might have been better able to endure the deteriorating rural conditions by participating in intra-communal practices of sharing resources. An additional issue influencing the timing of migration to El Fasher is previous familiarity with the economic opportunities in the provincial capital.     

Operational value of anthropometric surveillance in famine early warning and relief: wollo region, ethiopia, 1987-88

In this article I examine the operational implications of the findings reported in 'Entitlements, Coping Mechanisms and Indicators of Access to Food: Wollo Region, Ethiopia, 1987–88' (Kelly, 1992). The usefulness of anthropometric and other indicators for early warning and relief planning in Wollo is assessed by comparing the findings of Save the Children Fund's nutritional surveillance programme with those of the Early Warning and Planning Service of the Ethiopian government's Relief and Rehabilitation Commission. Case studies are used to illustrate the value of anthropometric and other indicators for targeting relief food and monitoring its effects. The costs of monitoring various indicators are then considered, and the cost of the Save the Children Fund programme is compared with that of other programmes. It is argued that in Wollo, anthropometric surveillance is a cost-effective means of improving early warning, planning, targeting and monitoring.