No end in sight to violence and suffering in Sudan

Sudan continued to be wracked by two major humanitarian emergencies in 2008 - the crisis in Darfur and the consequences of decades of civil war in the south.

Darfur remained the site of the largest humanitarian aid operation in the world, with more than 80 organisations and 15,000 aid workers - including 2,000 MSF staff - providing assistance in a region where one-third of the population has been displaced by conflict.
But despite international efforts, five years into the Darfur crisis, hundreds of thousands of people remain cut off from aid. Thousands more are at risk of losing assistance as a result of unstable frontlines, shifting alliances among armed factions, targeted attacks on aid workers, and increasing government restrictions on the provision of humanitarian assistance. Eleven aid workers were killed in Darfur this year and 189 abducted, according to the UN. MSF was also the victim of attacks and lootings in the region.

Improving public health indicators mask the sad fact that for most people in Darfur, their security situation deteriorated significantly in 2008.  In February, a brutal raid in West Darfur's northern corridor area was a cruel reminder of the early days of the conflict, as bombings, attack helicopters, and ground troops returned in force. Villages were burned and emptied, affecting about 50,000 people.

Many people seek refuge in Darfur's vast camps for internally displaced persons, but there is little safety in numbers. In Kalma camp, home to more than 90,000 people, a MSF teams treated 65 patients suffering from gunshot wounds after fighting broke out within the camp. More than half of those admitted were women and children. Fighting between rebel and government troops throughout the year has left thousands displaced and cut off from assistance.

In southern Sudan, the UN estimates that 1.2 million people have returned home after 20 years of civil war. Those returning have found their home regions practically devoid of infrastructure, services, or health care.  And even with a peace agreement the regional tensions continue to be explosive. In February 2008, after an extremely violent attack near the town of Abyei, thousands of people fled to camps in northern Bahr-el-Ghazal State and an estimated 10,000 fled into the bush. In May, fighting virtually destroyed Abyei, displacing another 60,000 people. Right after the clashes, 140 war wounded were treated by MSF teams. Approximately 300 malnourished children under 5 were admitted into a therapeutic feeding program. In December, new fighting broke out causing further displacement.

Throughout 2008, MSF's 1,500 field staff in southern Sudan provided medical services in a region where, in addition to the ongoing violent attacks, malnutrition is prevalent; maternal mortality rates remain among the highest in the world; tuberculosis and kala azar are ongoing problems; and large-scale outbreaks of meningitis, measles, cholera, and malaria are relentless. In the midst of all of this, humanitarian aid was conspicuously lacking, with some major donors having redirected their funds and the number of humanitarian agencies reducing due to a lack of resources. With census results not yet released, there is a risk that elections in 2009 may be delayed and that violence may will again flare up in the region.