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.     

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.     

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.     

A test of stress theory: relief workers in refugee camps

The purpose of this paper is to apply a stress model drawn from the literature to the relief and social service workers who have been active in refugee camps for a prolonged period of time. Working in difficult environments, social service workers deliver essential services to refugee populations around the world. A model of four work-stress determinants--tasks, management, appreciation and collaboration--was tested on 274 social workers in five regions of the Middle East (Jordan, Lebanon and Syria, as well as the occupied Palestinian territories of the Gaza Strip and the West Bank). Statistical fit indices were adequate but two relationships were statistically insignificant. The collaboration variable was dropped to create a modified model with tasks indirectly and management and appreciation directly affecting work-related stress. The five direct relationships and two indirect relationships of this modified model are consistent with stress theory, and all relationships--direct and indirect--are statistically significant.     

From food aid to livelihoods support: rethinking the role of WFP in eastern Sudan

Despite more than 20 years of distribution of free emergency food in eastern Sudan (38 years in the case of refugees) Global Acute Malnutrition rates are currently the highest in the country. There has been no real improvement in the chronic livelihoods vulnerability that affects people in the region—particularly pastoralists. Food security must be seen from an informed livelihoods perspective. While food aid may still be required as part of transition, WFP must rethink its assistance strategy and advocate for complementarity in the efforts by development actors working across a range of sectors. Alternative models and interventions focused on the rehabilitation of markets and the development of' cargo nets' for the destitute, including cash transfers, must be developed and tested. Land tenure issues should be given particular attention. Food aid will probably remain an important element in the overall response, but its significance relative to other less developed forms of interventions should be reassessed.     

The need to look beyond the production and provision of relief seed: experiences from southern Sudan

Free distribution of seeds in selected areas of southern Sudan has been widespread as a way of increasing food security. Field research in areas targeted for seed relief found that farmer seed systems continue to meet the crop and varietal needs of farmers even following the 1998 famine. Donor investments in seed multiplication of improved sorghum have not been sustained due to a lack of effective demand for the improved seed beyond that created by the relief agencies. The article argues that rather than imposing outside solutions, whether through seed provisioning or seed production enterprises, greater attention needs to be given to building on the strengths of existing farmer systems and designing interventions to alleviate the weaknesses. The case is made to support dynamically the process of farmer experimentation through the informed introduction of new crops and varieties that can potentially reinforce the strength and diversity of local cropping systems.     

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.     

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.     

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.     

Recent trends in the international relief system

Since 1991 the international relief system has been undergoing a process of rapid and fundamental change associated with the end of the Cold War period. The principal changes concern (i) the international community's approach to national sovereignty and the 'right' of armed intervention in support of humanitarian objectives, and (ii) organisatwnal changes aimed at improving the coordination and effectiveness of the response by donor organisations and the United Nations. This paper describes these changes and attempts to place them in the context of earlier trends within the international relief system, notably the enhanced role of non-governmental organisations, which occurred during the 1980s.     

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.