In background information, the authors write mass violence against civilians in the west of Sudan started in 2003 and has continued. "More than 1.5 million people (25 percent of the population of the region) are now scattered in 127 encampments in Darfur and 15 in neighboring Chad," the authors note. "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 n May 2004 and have been centered on 3 sites." The three sites are Kass, Kalma, and Muhajiria, South Darfur.
Francesco Grandesso, M.Sc., and colleagues from Médecins Sans Frontières, analyzed the results of surveys conducted in August and September 2004 in the three sites among 137,000 internally displaced persons to assess health and nutritional status for the relief efforts in those area. At each site, general household status, number of deaths among adults and children, and nutritional and vaccination status of children aged 6 months to almost 5 years were assessed. A questionnaire detailing access to food and basic services was administered to a subset of households (n= 210 in each site).
"Two hundred seventeen deaths were reported over the previous 121 days in Kass; and in Kalma and Muhajiria, there were 30 and 36 deaths over the 30 days prior to the survey," the authors found. "The crude mortality (death) rates at all 3 sites were considerably higher than the 1 per 10,000 per day that is recognized internationally as defining an emergency situation and 4 to 6 times the expected rate in sub-Saharan populations. In Kass and Kalma, the under 5-year mortality rates exceeded the 2 per 10,000 per day used as the emergency benchmark." Deaths from medical causes predominated in Kass and Kalma with diarrheal diseases responsible for many of those deaths affecting mainly young children under 5 and adults older than 50. "Violence was the major cause of death in Muhajiria (72 percent), with all but one of the 25 violent deaths in men."
"The prevalence of acute malnutrition was high, particularly in Kalma where nearly 24 percent of children younger than 5 years were affected. Reported measles vaccination coverage ranged from 46 percent to 70 percent." The surveys also found that even if households had access to food and nonfood items, many still lacked access to safe water and sanitation.
"Additional efforts from humanitarian and governmental actors are urgently needed to guarantee acceptable living standards for these populations," the authors conclude.
(JAMA. 2005; 293: 1490 - 1494. Available post-embargo at JAMA.com)
Editor's Note: This study was supported by Médecins Sans Frontières, Amsterdam, the Netherlands. Nutrition kits used for height and weight assessment were donated by the United Nations Children's Fund.