|
Name: Ismaiel, Wigdan
Home country: Sudan
Research country: Sudan-Denmark
Project period: 2000-2004
Title
Humanitarian Aid for the Internally Displaced People in Sudan: adequacy and efficiency
Abstract
IDP are among the most vulnerable and neglected groups including in the Sudan, where conflicts have been ignored since 1950`s. High rates of morbidity and mortality due to preventable diseases point to the need for prompt attention and concerted efforts to find better ways of response.
Data about health problems among IDP are scarce and fragmented. Fund allocated for IDP are smaller when compared to that provided to refugees.
The purpose of the present study was to evaluate the adequacy and efficiency of humanitarian aid for IDP.
The justification for the present study comprise both aspects: to collect and assess data on health and disease, to see if the health situation is truly insufficient, particularly in groups traditionally considered vulnerable, namely under-five children, and at the same time to train local residents to help supplying the need for humanitarian aid eventually identified.
The field work was conducted between 1999 and 2001. The methods of collecting data were mainly by interview, observation, clinical examination, and Mantoux testing.
Ethical clearance was performed from different authorities. Communal and written informed consents were obtained from the community leaders and individuals.
Field clinic was established during surveys offering drugs and laboratory tests freely.
Before starting the fieldwork, two training programmes (in research methodology& prevention of communicable diseases) were run for a team from the Institute of Endemic Diseases and participants from the local community of the camp.
The study was an in-depth assessment to identify needs by analyzing the health situation in Elsalam camp, Sudan. The information gathered included most steps recommended by international accepted guidelines concerning the IDP assessment issue; that included census and mapping for the area, demographic, information on communicable diseases, nutrition and environmental conditions. To avoid bias and inaccurate data, different techniques were used for data collection; questionnaires were filled at both health facility level and community level. The basic needs for populations affected were also assessed e.g. water, sanitation, shelter and nutrition. Since under five children are considered among the most affected group in poor communities especially in camps, interviews, clinical and observational studies were undertaken in particular in children under five years of age and their care-takers child’s illnesses are mainly due to preventable diseases and might easily reflect any deficiencies in the health services. Vaccination coverage and efficacy were assessed using different techniques; checking the vaccination card, examining for BCG scars, checking for measles epidemics in the health centers and applying Mantoux test for apparently healthy under five children.
Elsalam camp was established in 1992. The study population is originally from Western and Southern Sudan (mainly Nuba and Dinka tribes).
High attendance rate for antenatal care, high percentage of vaccination coverage, high attendance rate of children in schools and good knowledge of mothers about their children illnesses were found. Most females were illiterate and unemployment was high in both sexes.
The majority of households were not far from health facilities in the camp. However, there was no transport system in any health facilities. Drugs and food provision was not constant.
Water supply system was well established with sufficient points of distribution. The majority of population in Elsalam camp used Jerry cans to collect water and for storage; but still there were high prevalence of diarrhoeal diseases, 16% and 20% in the pre- and post-seasonal surveys, respectively, which might indicate contamination with water born microbes from point of water collection till usage. Females were responsible for collection of water in 95% of households. Distribution points were at a walking distance from 85% of households.
The majority used pit latrines for disposal of human excreta and the number of latrines was adequate, but disposal of human excreta were observed outside and around the houses.
In the camp eight working health facilities were available and it was sufficient according to the standard
Intervention programmes were generally well organized between different NGO`s facilities and included malaria control, DOTS against tuberculosis, maternal and child health, vaccination and nutritional programs. The health provision at the level of primary health care level was acceptable, although some gaps were identified.
The main causes of child illnesses were gastroenteritis, respiratory tract infection, malaria, conjunctivitis and urinary tract infection. The prevalence of malaria was not high and this was proved parasitologically.
Two cross-sectional studies, pre- and post rainy season, showed that although 180/755 and 167/761 of the children under five were malnourished in the pre- and post-rainy season surveys, respectively, about 75% of children were adequately nourished Hemoglobin level in the two surveys showed a significant improvement in the post-seasonal survey .This may indicate the intervention by our investigating team (provision of treatment against malaria, helminthes infection and anemia) and also by provision of supplementary and therapeutic feeding that had been deficient during the period of January-April as mentioned by a local annual report
Although the camp was multitribal, in the observation period from December 1999 to November 2001 people seemed to live peacefully together without major problems and with good cultural and religious tolerance. This may be partly explained by: high security system in the camp which prevent fighting; it is a chronic camp and the community is getting used to live together though each tribe living in different quarter with a relatively comfortable
The majority of households were not far from health facilities in the camp. However, there was no transport system in any health facilities. Drugs and food provision was not constant, and this may be reflected in the relatively high prevalence of anemia and night blindness even among older children and adults.
Vaccination coverage was high. The BCG evaluation showed that there was a high BCG scar rate which was indicative of good coverage, viable vaccine and an efficient cold chain. However, there was a high percentage of negative Mantoux results despite the high scar rate; re-vaccination may be indicated.
The main problem of this camp is that it was changing to a chronic long term camp which may on one side help the population to adapt to local conditions, yet in isolation from the surrounding community. Evidently, the health problems are now different from that of the acute, emergency, situation. Developmental and integration programmes may be one solution but is not always possible because of current political situation and lack of acceptability by the local community. Another solution is repatriation which was tried several times in the camp and failed, mainly due to insecurity in place of origin and the attraction to displaced people to live in big cities. .
For proper health services in the camp ambulance services is mandatory for transportation of emergencies to referral centres; but no major imbalances in access to health were identified in most of the studies, nor alarming emerging infections, though HIV was not systematically tested for – which would have been desirable, but not easily acceptable.
Those most in need may be those IDP who either squatting in a variety of planned and unplanned areas around Khartoum or other areas of Sudan or may be those in more acute camps, whether IDP in Sudan or Sudanese as refugees outside (in Chad presently). “Chronic” camps for IDP – at least in the Khartoum area – may be more effective and serve most populations more equitably than sometimes claimed in undocumented writing – and as hypothesized before the present study was undertaken. Therefore, our ideas of how bad IDP chronic camps are – at least in Khartoum area, have to be revised.
It is recommended that academic institutions should be involved with donor organizations, local health authorities and qualified members of the affected population to conduct this type of surveillance.
As a general recommendation, it will be desirable to implement developmental measures for the whole community including reduction of poverty e.g. by economic growth via agriculture and/or industrial spheres. Reduction of poverty also means making link between emergencies and development by reduction of vulnerability.
Peace could be the final solution for those long-term endangered groups, though their vulnerability appeared to be considerably lower than in the acute phase of emergency, like the one presently taking place in Western Sudan.Supervisor(s)
Ib C. Bygbjerg, Department of International Health, Institute of Public Health, University of Copenhagen
Freddy Karup Pederson, Eltahir A. G. Khalil and Ahmed Mohamed El Hassan
Correspondence
Dr Wigdan Ismaiel
Hamad Medical Corporation
Womens Hospital
Doha, Qatar
P.O. Box 3050
|
|
