Mortality and Malnutrition Among Populations Living in South Darfur, Sudan

IN EARLY 2003, 2 REBEL MOVEments (the Sudanese Liberation Army and the Justice and Equality Movement) launched an insurgency against the rule of Khartoum and the government of Sudan, and Janjaweed tribal militias have responded with decisive counteroffensives. Militia attacks have been blamed by refugees and internally displaced persons (IDPs) for indiscriminate killings, rape, abduction, cattle and property looting, and razing of villages. More than 1.5 million people (25% of the population of the region) are now scattered in 127 encampments in Darfur and 15 in neighboring Chad. Humanitarian assistance arrived late, having been limited initially by severe government restrictions and low institutional donor interest; and also by insecurity, which is ongoing. Médecins Sans Frontières (MSF) began work in West Darfur in December 2003, and operations in South Darfur, including feeding centers and primary care clinics, opened in May 2004 and have been centered on 3 sites (FIGURE 1). Kass is a busy market town where 50 000 IDPs arrived mainly in November 2003 and now live both within the compounds of the 30 000 residents and in distinct encampments in school grounds and waste areas. Kalma, which in January 2004 was a small village on the main railway line running east of the regional capital Nyala, is the largest single IDP settlement in South Darfur and in August 2004 had 66 000 inhabitants; it Author Affiliations: Epicentre, Paris, France (Drs Sanderson and Brown, and Mr Grandesso); Médecins Sans Frontières, Amsterdam, the Netherlands (Ms Kruijt and Mr Koene); and Department of Infection, Charing Cross Hospital, London, England (Dr Sanderson). Corresponding Author: Frances Sanderson, MD, PhD, Department of Infection, Charing Cross Hospital, London W6 8RF, England (frances.sanderson@imperial .ac.uk). Context Mass violence against civilians in the west of Sudan has resulted in the displacement of more than 1.5 million people (25% of the population of the Darfur region). Most of these people are camped in 142 settlements. There has been increasing international concern about the health status of the displaced population.