PHA-Exchange> Darfur Part 2

[Claudio]

About one third of the patients in the camp clinics demonstrate somatic complaints that are aggravated by psychological and social stress. Since medical NGOs mainly have the mandate to treat emergency medical cases and acute infectious diseases, chronic diseases can only be addressed symptomatically. Although the World Health Organisation and Ministry of Health are pushing for strategies to address diseases like HIV, TB and mental disorders, the lack of financial and political will to address diseases that are rooted in social disruption leave these programs on standby for the moment. In humanitarian emergencies, funds are allocated for a period of one year and rapid progress must be made. Hence vertical programs addressing health issues are in the majority. Malaria, diarrhoea and malnutrition are reduced by providing antimalarials, ORS and enriched food. Health messages are given to the population about the necessity of using impregnated bednets, proper hygiene and breastfeeding the infants. To be fair, all these programs are necessary in the humanitarian work, but all too often they are not embedded in a broader strategy that addresses root causes of disease. The displacement and impossibility to economically maintain a family's livelihood itself increases by tenfold the relative risk on poor health status and mortality.[1]



Is it surprising that IDPs sell the bednets they were given on the market? What about health messages about hygiene when people are crowded into a camp? From a clinical and public health approach we treat symptomatically. We cannot cure, but alleviate symptoms. Many lives have been saved, but the community and social nucleus itself is destroyed. 

 

What is the alternative? In medicine, diseases can be prevented, and if they occur can be prevented from worsening. In public health, the goal is to prevent outbreaks of communicable diseases such as meningitis and cholera. To prevent a humanitarian emergency may be more difficult, but possible. In Eastern Africa, fragile balances exist (or have already been disrupted) between communities and interests groups about natural and political resources. The Democratic Republic of Congo, with all its mineral resources, has suffered gravely in recent years. The Central African Republic and Chad face crises as governments might topple. Ethiopia and Kenya, with their varied ethnic tribes, are constantly at risk of famine. Somalia is still inflamed and devastated by an ethno-religious conflict. And Sudan, with its 20 years of war in the South, continues to be the country with the largest internal displaced population on Earth. Because major political and economic structures can be analysed, but are almost impossible to alter, international assistance must focus on individual communities. This assistance must be humble in character and rely on the knowledge and character of the community. In general they are the ones who know best how to organise the resources. Communities must be supported in claiming their right to health as part of a larger human rights approach, holding the duty bearers accountable for the violated and neglected health determinants[ii] 

 

In the meantime, the international community must keep analysing, discussing and lobbying on the effects that WTO agreements, oil, mineral and water exploitation, weapons trade have on regions and environments. A widening gap will grow between the globalised haves and the have-nots who are left behind. More and more people risk tumbling over into this last group. Will we let it happen on our watch?

 

 Dr Remco van de Pas

                                                                                         Darfur & The Netherlands, July 2006
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