Concern and confusion following teams’ expulsion from Darfur

Twenty-eight international aid workers arrived recently in Paris and Amsterdam after the French and Dutch sections of Médecins Sans Frontières were expelled from northern Sudan. These two sections represented half of the MSF staff working in Darfur. They are all worried about the future of those with whom, and for whom, they worked over weeks or months and they wonder why they had to stop this essential medical aid.

“I just don’t understand,” says Eric JEUNOT, who served as MSF’s program manager in Zalingei, western Darfur, for seven months. “I can’t believe that this is really happening.” Since December 2003, MSF had been providing medical aid in this city of 130,000, whose population includes 100,000 displaced persons. “I can hardly believe it. I can see the dozens of patients who came to the clinic in the displaced persons’ camp at Hassa Hissa every day. Now when they arrive, the door will be closed. We also had two nutritional clinics for severely malnourished children. And we provided free care in the hospital departments where we worked – patients could be now required to pay, which is particularly worrying as they don’t have much money. And that’s not including the medical staff, who will no longer receive bonuses from us. They could be less motivated to continue working in the hospital.”

The problems are already visible. Pauline BUSSON, formerly MSF’s program manager in Niertiti, received a call for help from the team’s local staff members. “They said, ‘We don't have any more food to feed the hospitalized patients. We can't pay to transport patients to Zalingei who need surgery or a cesarean section or to send patients with meningitis to Niertiti right away.’ What could I say? There’s nothing I can do!  So I told them to go see the local authorities. It’s their responsibility now. MSF can’t help them now.” MSF’s programs covered the health care needs of approximately 80,000 people in and around Niertiti. Following the expulsion, only one doctor and four nurses remain to meet those needs. The team was preparing to conduct an emergency meningitis vaccination campaign in response to the current epidemic.

In the Kalma camp, vaccinations were to begin on Saturday, March 7 as meningitis has broken out in this camp of 90,000 displaced persons. “It’s a complete disaster,” says Lydia GEIRSDOTTIR, who spent nine months there coordinating Médecins Sans Frontières’ projects in the camp. “People with meningitis will not receive treatment and there will be no more referrals to the Nyala hospital or vaccination campaigns. That means people could die.”

"Getting into a helicopter knowing you are leaving tens of thousands of people behind with no healthcare is heartbreaking. It was probably the hardest thing I have ever had to do," says Vanessa CRAMOND, a nurse who worked in the hospital in Muhajariya for the past nine months. Muhajariya is a large town in south Darfur where MSF ran a hospital and provided care to around 70,000 people from the town and surrounding areas. "In January we had to evacuate a lot of the staff for 6 weeks because of insecurity in the area and had only been back in Muharajiya for two weeks when the expulsion took place. When we left, we were seeing between 100 and 150 outpatients a day and increasing numbers of malnourished children - we saw 21 new admissions of children with severe acute malnutrition in 1 week when we normally admitted 3 to 4 new cases in one month. These people we were assisting have now been left with nobody to treat even the most basic of their medical needs."

In a region where more than one-third of the population is displaced, humanitarian aid had kept mortality levels stable overall – until now.  “In spite of all the problems, the situation wasn’t catastrophic,” explains Emanuela BERTOLI, MSF’s medical coordinator. “In the hospitals and clinics where we worked – either alone or in cooperation with Ministry of Health teams – the mortality rate was below 4%, which is better than that in many hospitals in other African countries. We managed to maintain a good level of medical quality for a population exposed to many forms of violence and epidemics. And beyond medical care and MSF, the entire humanitarian operation in Darfur – the largest in the world – made it possible to avoid excess mortality overall. So of course we are all very worried now.”

The announcement of the expulsion, after the teams had already evacuated, has also created a sense of frustration. Eric Jeunot left Zalingei a week ago, on March 3. “The Sudanese authorities asked international staff to evacuate Zalingei, as well as several other towns, saying that they could no longer guarantee our safety. Neither I nor any of the 11 other members of my team who had to leave were worried. We had notified the local authorities that we wanted to stay to make sure that essential medical staff remained.” But forced to comply with the decision, the team evacuated to Khartoum. “Our concern at that time was how long we would be away,” Eric says. “We were sure that we’d be back but we worried that we wouldn't be able to return for several days -- two weeks at the most.” However, after the International Court of Justice announced the arrest warrant issued against Sudanese president Omar Al-Bashir, Eric learned that the evacuation had become an expulsion. “I couldn’t go see the patients to tell them why we were leaving them,” he says with regret. “I couldn’t speak directly with the 120 people who worked with us – some for as many as five years – and lay them off, and I couldn’t tell the director of the hospital that relied on Médecins Sans Frontières that we had to stop working immediately. I feel like I abandoned people to whom I had made a commitment. At the local level, everything was working well. We had great cooperation. This doesn’t make any sense.”