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.     

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 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.     

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.     

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.     

Training of expatriate refugee health workers: Principles and practices

Abstract—This paper describes in detail the separate components of an ideal expatriate refugee health worker training course. Emphasis is given to organizational aspects of such courses.     

Sub-regional integration in Sudan: the key to food security and recovery

The signing of the Comprehensive Peace Agreement (CPA) in Sudan has created a new opportunity for peace. Approaches to food security must now be reoriented based on the agro-ecological diversity in Sudan. WFP is in a unique position to catalyse an approach to food security that meets immediate needs and contributes to long-term recovery, in collaboration with the Government of National Unity (GNU) and the Government of South Sudan (GOSS). Aggregate food production in Sudan has increased in the past decade. At sub-regional levels, however, many areas remain food insecure. Major research must be undertaken to identify optimum levels of food production and barriers to access to food at sub-regional levels as a first step towards linking deficit areas with areas of surplus. Initiatives must also be undertaken to facilitate increased integration between sub-regions. Increased sub-regional linkages could ensure more efficient delivery of food in the short term as well as recovery and economic growth in the long term.     

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.     

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.     

Accelerating progress on salt iodisation in Sudan: time for action

This paper uses a public health approach to examine briefly: (a) the progress of universal salt iodisation (USI) in Sudan; (b) the roles of the main actors involved; and (c) the main issues around accelerating USI. The literature, especially that coming from the UN agencies, is analysed and experiences from the recently revitalised USI programme, and related relevant meetings, are distilled. In Sudan the prevalence of goitre is 22 per cent. It is assumed that productivity among the people affected is reduced by 5–25 per cent. Little apparent progress has been made with USI. The Government of Sudan, UN multilateral agencies, international consultative groups, bilateral agencies, global and national non-governmental organisations and, increasingly, the private sector must work together to find innovative approaches to increase awareness of the broader social, public health and nutritional contexts, and to advocate for increased national nd international funding.     

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.     

Accelerating progress on salt iodisation in Sudan: time for action

This paper uses a public health approach to examine briefly: (a) the progress of universal salt iodisation (USI) in Sudan; (b) the roles of the main actors involved; and (c) the main issues around accelerating USI. The literature, especially that coming from the UN agencies, is analysed and experiences from the recently revitalised USI programme, and related relevant meetings, are distilled. In Sudan the prevalence of goitre is 22 per cent. It is assumed that productivity among the people affected is reduced by 5-25 per cent. Little apparent progress has been made with USI. The Government of Sudan, UN multilateral agencies, international consultative groups, bilateral agencies, global and national non-governmental organisations and, increasingly, the private sector must work together to find innovative approaches to increase awareness of the broader social, public health and nutritional contexts, and to advocate for increased national nd international funding.