An Ethiopian refugee village in Sudan: the question of employment

Abstract— There are some 460,000 Eritrean and Tigrean political refugees in Sudan. The numbers have increased dramatically since the mid-1970s, and as yet there are no convincing signs of peace which would allow the prospect of a speedy return home. Sudan is thus faced with one of the Third World's largest populations of long term refugees, and the capacity of the economy to absorb such numbers into its labour force is an acute and potentially violent issue. Discussion and planning has been hindered by a lack of specific information on the proportion of refugees who are of urban or rural origin and the proportion of those who might undertake skilled or unskilled employment. The following report of a census and survey of a refugee village in eastern Sudan offers some insight into the problem and suggests steps towards its solution.     

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.     

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.     

Cholera in Sudan: An account of an epidemic in a refugee camp in eastern Sudan, May-June 1985

In 1985 cholera has been a serious problem in the horn of Africa, particularly affecting the many famine victims and refugees in that region. In this paper the history of cholera in Africa is briefly summarized, as is the background to the current refugee situation in eastern Sudan. A cholera epidemic involving 1,175 cases in two adjacent refugee camps in eastern Sudan is described. In this epidemic there were thirteen inpatient deaths and thirty-eight known home deaths from cholera. The management of the epidemic is described in detail. Overall an average of 8 1. of intravenous fluid was used per case, a higher figure than was anticipated, probably because of the unexpected degree of vomiting and the shortage of trained nursing staff.
The relationship between cholera and malnutrition is explored and hypochlorhydria is suggested as the main reason for the increased susceptibility to cholera among malnourished populations. It was observed that severely malnourished adults and children appeared to nave less severe diarrhoea with their cholera, presumably because of reduced mucosal surface area and poor enterocyte function. Finally possible means of aborting cholera epidemics are discussed.     

An Examination of the 1990-91 Famine in Sudan

Shortly before and during the harvest of 1990, a series of warnings were issued by concerned international and UN agencies that Sudan would experience a very poor harvest followed by an acute food shortage over the period 1990-91. The 1990 harvest was estimated to be similar to that obtained in 1984. After the very poor harvest in 1984, Sudan experienced a major famine during which deaths may have numbered in the hundreds of thousands. There were fears that this experience might be repeated in 1990 - 91. By the time of the subsequent 1991 harvest, it was clear to all that a severe food crisis had been experienced. There were severe shortages of water and food and very high malnutrition rates of children were noted by UNICEF across a wide range of areas. Despite these adverse indications, starvation deaths were probably numbered in thousands, rather than hundreds of thousands. Famine mortality, which may include deaths from famine associated disease, was similarly low. The initial predictions, it now seems, may have over-estimated famine mortality almost one hundred times. Several potential explanations of the over-estimate are examined. These include prediction errors, government and donor responses to the drought such as food aid and immunization, and traditional community and household level coping strategies in times of food shortage.     

From emergency to social security in Sudan - part I: the problem

This is the first part of a two-part article which stresses the need to move away from short term emergency measures to a more general system of social security. A weakness in much of the thinking on food security in Sudan is its conception of a normally self-provisioning peasantry which is pushed into distress only as a consequence of exceptional external conditions. Food catastrophes are therefore seen as, essentially, temporary phenomena requiring emergency interventions. This article proposes a different view: that the commercial development of Sudan has engendered a crisis of subsistence synonymous with the collapse of indigenous support systems, the spread of absolute poverty and the erosion of the country's resource base. In the North this situation has come about through economic means and in the South through war. The spread of absolute poverty and the resulting vicious struggle for scarce resources cannot, however, be separated from the decay in governance. Part I of the article attempts to establish the interconnections between these elements and thereby to indicate the problems which a system of social security would have to overcome. Part II will examine the institutional consequences of the crisis, namely the imposition of a donor-led system of social security.     

Practical evaluation of a pilot immunization campaign against typhoid Fever in a cambodian refugee cAMP

An epidemic outbreak of typhoid fever in the largest refugee camp of the besieged capital of Phom-Penh, Cambodia; the concomitant lack of personal and public hygiene and the availability of a locally manufactured Tetanus-Typhoid-Paratyphoid vaccine, prompted us to test the practicability of a mass immunization campaign by carrying out a trial in the smaller, well delineated refugee camp of Pochentong. Attendances by adults as well as children throughout the three or four inoculation rounds showed a steady decline with only 30 (20%) of the people completing the course. The general initial acceptance by the people on the other hand was good, due to a comprehensive service (information, health education and individual care of patients). It is concluded from these results that multi-injection immunization campaigns against typhoid-paratyphoid are a waste of money in a war-torn situation with an unstable population.     

An outbreak of scurvy in Somali refugee camps*

Between June and October 1982, an outbreak of scurvy occurred in the refugee camps of Somalia. An epidemiologic investigation eventually detected more than 2,000 cases. The outbreak came at a time when the relief programme had been well established and the general health status of the refugees had otherwise stabilized. We report on 72 of the cases. Joint pain of the lower extremities and gingivitis were prominent features in the majority. Hemorrhagic phenomena were not observed and no deaths occurred. The outbreak primarily affected the poorer refugees who were unable to purchase locally available Vitamin C-containing foods. This outbreak demonstrates the vulnerability of a large population of displaced persons who are dependent on imported relief supplies for survival.     

Evaluative research in a refugee cAMP: the effectiveness of community health workers in khao I dang holding center, Thailand

An evaluation of Khmer refugee public health services found a strong cultural preference for older females as Community Health Workers (CHWs), in contrast to the young males employed. Class conflicts were identified between educated, upper-class CHWs and the uneducated camp majority. Poor community acceptance of the CHWs impaired their effectiveness, and was attributed to age, sex and socioeconomic barriers. Based on these evaluation findings, the refugee health program was restructured to include a preponderance of female workers. A repeat survey demonstrated enhanced program effectiveness following this change.
Selection of refugee health workers should be based on intrinsic community roles, taking age, sex, socioeconomic and other group distinctions into account. Additional research is needed on the adaptation of community health principles to the refugee context.     

A comparison of health provision and status in ban napho refugee cAMP and nakhon phanom province, northeastern Thailand

Health care provision and health status in Ban Napho Refugee Camp is compared with that of the surrounding Nakhon Phanom Province for the year 1988. Records for the period 1984–88 were also examined to compare trends in health status. Personal experience of health services in the Camp and visits made to local schools and health facilities were also used in the comparison. Although direct comparison was difficult (because of the mobile nature of the camp population and problems to do with the interpretation of statistics), it was found that health care for refugees was more comprehensive, at a primary level, than for the Thai population of the surrounding Province. Access to primary health care facilities in the Camp was, moreover, easier and free of charge. This may explain the higher use of health facilities in the Camp but, despite this, health and nutritional status appeared to be worse in the Camp than in the Province. Possible reasons for the difference in reported health status and the use of facilities are discussed.     

Restocking refugee pastoralists in the horn of Africa

Repeated and lingering famine in the Horn of Africa has produced enormous pastoralist refugee populations in a region where livestock production is a major form of land use. Permanently settling destitute pastoralists has a record of failure. It can disrupt host land-uses, causing social and ecological problems, and prevent the utilization of very large grazing areas where pastoralism may be the only ecologically and economically sustainable land-use. Herd reconstitution should be considered an option in relief and rehabilitation programmes for pastoralists. This paper examines a design where the most proven and immediate way of sustaining stockless pastoralists – farming – can be used to facilitate restocking objectives. Using data gathered in Somalia, estimates of livestock carrying capacity are linked with forage resources, land area, livestock units, and the frequency of good, average, and poor (drought) water years, to explore the possibilities for incorporating restocking into refugee rehabilitation efforts.     

From Emergency to Social Security in Sudan - Part II: The Donor Response

In the first part of this article I examined the crisis of subsistence in Sudan resulting from the commercial development of the North and the war in the South. An attempt was also made to relate the deepening impoverishment that this represents to a decay in governance. There is a tendency amongst donor and government officials, which is reflected in the literature, to regard the unfolding crisis as the transitory result of exceptional circumstances rather than as irreversible and therefore warranting a major revaluation of policy. As a consequence, social security and emergency planning has generally been of an emergency type. In this, the final part of the article, I examine the donor response in more detail. In particular, I argue that the decay of governance is so extensive that a donor-led system of social security has been imposed on Sudan. This system has a number of characteristics, the most important of which is that it exists in the absence of the political renewal and democratisation that would be necessary for the technical solutions it advocates to be implemented. The result is that donor-led security, which is typical of the Horn of Africa, proceeds in a relation of antagonism to the sovereign power, a situation which significantly reduces the efficiency of the measures undertaken.     

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.     

Ecological stress and political coercion in the Sudan

This article outlines the impact of state intervention on ecological relations in the Sudan. The establishment of large-scale mechanised agricultural schemes; population and livestock concentration around water sources; and the evolution of large urban centres with high demands for firewood and charcoal have all contributed to ecological degradation. These effects have been coupled with the use of coercive measures to displace traditional farmers and pastoralists from their lands in favour of large-scale farming schemes. The objectives of government policy have suffered a double retreat – from development to crisis management and from crisis management to the bare maintenance of compliance and order. The inability of the state to intervene on behalf of the victims of drought and famine has led to the use of coercion as the only means to legitimise its hold on power.     

The future of food security in the Three Areas of Sudan

Currently, the pace of recovery in the 'Three Areas' is moving faster than the implementation of the Comprehensive Peace Agreement (CPA). This gap is leading to greater imbalances in income, unsustainable urbanization, overexploitation of the environment and resource based conflict. Unless regulated, the likely result will be chronic poverty and an undermining of the success of the CPA. Agencies must be mindful of how they provide assistance so that they support the CPA. The analysis of food security should take place in the context of a larger political, social and economic analysis of the emerging situation. The least developed areas should be prioritised and interventions should provide benefits to the full range of socioeconomic groups. WFP must identify its role in the wider and integrated response. It should support the emerging peace process and the key reforms. If WFP chooses to consolidate its activities, it will require capable strategic partners. If it chooses to invest more in building the capacity of government and community structures, it must improve its skill base and field presence