As the number of international health-care providers is decreasing amid continuous insecurity and lack of funding, the people in Darfur face further deterioration of already limited health care.
The World Health Organization (WHO) says the early recovery phase will require US$ 150 million over the next 2-3 years to ensure the provision of basic health and nutrition services to 3.4 million people
“We have been here for the past five years, seeing on average 240 patients per day. We were trying to make life easier for displaced people in Zamzam,” says Abdurahman Zakaria, project officer of Mercy Malaysia, a nongovernmental organization (NGO) running a clinic in Zamzam Camp in North Darfur.
Zamzam Camp was set up in 2004 near the regional capital El Fasher to receive the thousands of people fleeing the violence that broke in 2003 in Darfur, in the western region of Sudan.
As other camps have recently stopped receiving new arrivals and the conflict persists, Zamzam’s population has rapidly grown to more than 150 000 people. Last year another 20.000 displaced people arrived and many more are expected as the fighting in Jebel Amir area, west of El Fasher, enters its fourth month.
Lack of funding is causing a significant decrease in health facilities as NGOs are being forced to withdraw their vital services.
“We have to close the clinic in June as our grant requests were not successful. We are sad as we don’t know if there will be anyone to take over the clinic and its 34 staff,” adds Mr Zakaria. This is the only clinic open during the night and it is unlikely that any other health facility would be able to provide night services that are vital for deliveries and complications during pregnancy.
Mercy Malaysia is the latest example of the continuing trend. In North Darfur, home to 2.1 million people, the number of health NGOs has halved since 2009. Now there are only three international health agencies operating there.
For camp residents this is a worrying development. “We are seeing humanitarian health organizations leaving the camp and there is no clear indication who will take over,” says Abdallah Idriss Awad, one of the community leaders in Zamzam. “At the same time more people are coming and needs are only getting bigger”
Sudanese NGOs are willing to step in but their financial capacity and training levels cannot match those of the large international agencies. They often lack experience and expertise to work in complex settings.
“The withdrawal of Mercy Malaysia will put lot of pressure on us with increased caseload in our clinics,” says Mahjub Omar, manager of Humanitarian Aid and Development (HAD), a WHO-supported national NGO that runs two clinics in the camp. “We need more funding and training to be able to fill the gaps,” he says.
Hospitals struggle with limited resources
At El Fasher Teaching Hospital, the lack of resources is clearly visible by its overcrowded wards and congested waiting areas. Built in 1948, the hospital does not have the capacity to service the current population of the town, swelled by the influx of displaced people. A project of establishing a new general hospital in new premises could take another decade if the construction continues at the current pace.
“When I came here in 2009 with my ill son, I received medications for free,” says Haleema Abbaker, mother of three living in Zamzam camp. Referred to the hospital again for her daughter who has fever and vomiting, she found that this time she needs to pay US$ 10 a day for medicines. “My family cannot afford the treatment and we are forced to borrow the money,” she says.
Since 2006, WHO has been financially supporting running costs for five hospitals in North Darfur and medical supplies, ensuring that displaced persons had access to medicines for free. The funding stopped in 2010 and the impact was strongly felt in these hospitals.
“Financing from the Ministry of Health covers only the salaries. Without outside financial support, we can no longer ensure provision of basic medical supplies such as surgical equipment,” says Dr Khaled Siddeg, Curative Medicine Director at the State Ministry of Health. “This funding was also used to pay for electricity and maintenance costs. We are struggling to keep going and our patients are paying the price.”
Another serious issue in North Darfur is the significant inequities in the geographic distribution of health facilities. Many rural areas are underserved by the health system and lack health facilities, which are clustered in towns and cities.
To address this problem the Ministry of Health has established the Health Academy, aiming to train some 500 health workers from rural parts of North Darfur in professions such as nursing, midwifery and community health workers. However, the Ministry of Health can provide only 40% of funds for this initiative so its future is uncertain.
International funding appeal
“Our biggest challenge is the gap in access to primary health-care services for the population and this has been exacerbated by the withdrawal of international health agencies,” says Dr Munir Matar, Emergency Health Action Coordinator at North Darfur State Ministry of Health. “We have a 5-year plan to expand primary health-care services to all regions but without a substantial increase in funding it will not be possible to build new health centres and to respond to disease outbreaks”
The primary health-care services in Darfur are characterized by low coverage, limited accessibility and inadequate provision of essential services. Most of the primary health-care facilities lack the minimum required medical equipment and adequate infrastructure. Darfur has a low workforce density of health professionals with only 0.4 health workers per 1000 population compared to the WHO benchmark of 2.3 workers per 1000 population.
At the International Donor Conference for Darfur held in Doha in April, WHO and the Ministry of Health of Sudan presented the Darfur Early Recovery Strategy for Health and Nutrition, calling for US$ 150 million over the next 2-3 years to ensure the provision of basic health and nutrition services.
Rehabilitating existing health facilities, increasing the number of trained health professionals and improving supply systems are key priorities in this region of the Sudan with some of the world’s poorest health indicators. An additional US$ 105 million is needed to sustain health and nutrition coverage over the next 15 years, including improved surveillance and rebuilding the health system.
In the meantime, with no lasting peace in sight, Darfur and its people will have to rely on existing resources and hope for stronger international support.