MSF calls for a change
webplaced: December 23, 1999
By Dr. Jean-Marie Kindermans
The 1998 famine in Sudan produced the highest malnutrition rates MSF has ever seen and revealed the inadequacies of the international relief framework of Operation Lifeline Sudan.
The civil war in South Sudan, which began over 40 years ago in 1956, is the longest running conflict in Africa. With over two million lives lost, the vast majority among civilians, it has also been responsible for the greatest number of deaths. The war between the Khartoum government and the rebel groups in the south of the country is not clear-cut. Although religion and ethnic identity are the main points of contention, the picture is confused by the extreme fragmentation of the parties involved as they have split into various factions and alliances, as well as the involvement of various militia groups pursuing their individual interests. Economic factors such as the right to exploit oil and water reserves also play an important part. All this has subjected the people of Sudan to a chronic war interspersed with periods of acute famine.
MSF has been working in Sudan since 1985 and some of its sections are members of the coalition of UN agencies and NGOs that established a pioneering relief programme in 1989 known as Operation Lifeline Sudan (OLS). OLS was intended to initiate constructive change through negotiations for access to the most vulnerable groups combined with the delivery of humanitarian aid. OLS operates under a tripartite agreement signed by the government, the rebel movements and the UN. It delegates and recognises a role for the humanitarian wings of the rebel movements in the organisation of relief supplies.
This is in itself a dubious practice as it is in their nature to continue to promote the political and military interests of their movements. The unfortunate reality is that by breaking or manipulating the OLS agreement, the government and other warring parties have consistently and successfully denied humanitarian access to many regions of both North and South Sudan (the Nuba Mountains, the Blue Nile and Western Upper Nile). This breach of the access agreement played a critical role in limiting the humanitarian response to the 1998 famine, particularly in the Bahr el Ghazal region.
Although an early warning system predicted significant food shortages in Sudan for 1998, it did not foresee the scale of the famine that hit Bahr el Ghazal and other parts of Southern Sudan. However, despite the forecast of an almost certain famine, the humanitarian response including that of MSF was grossly inadequate in regard to both timing and the amount of aid required. Although OLS intervention achieved some positive impact in certain parts of Sudan, MSF was in a position to estimate the real extent of the tragedy in Bahr el Ghazal. In May 1998 we were therefore compelled to draw the attention of the world's media and donor governments to the undeniable and overwhelming level of suffering. The essential priority was to save as many people as possible.
However, even where there is geographical access and relief agencies are present with adequate resources, effective humanitarian is not guaranteed unless the volunteers and the resources are directly targeted towards the most vulnerable. The failure to do this in Sudan last year explains why the impact of the response was greatly reduced and the enormous suffering continued for far too long. It also revealed the weaknesses in the application of humanitarian principles in a context in this case a well-established system in which aid agencies are prevented from independently assessing needs and setting the priorities for food distributions.
The worst situation arose in the town of Ajiep and highlighted the problem. Over 100,000 people had sought refuge in the Bahr el Ghazal region from the fighting in Wau, Gogrial and Aweil in January 1998. A quarter of this number was present in Ajiep, as a partial ban on essential relief flights at that moment did not extend to this area. The partial ban meant that flights were only allowed to land in selected places. Therefore Ajiep, with the highest concentration of vulnerable and malnourished displaced persons, was the largest famine pocket in Bahr el Ghazal.
Although no military action impeded access to Ajiep and considerable food relief was available despite very considerable logistical constraints, MSF nutritional surveys showed that malnutrition rates remained extremely high over many months. Indeed, MSF was eventually facing malnutrition at rates that we have never previously seen and they may well have been even higher in those places to which we did not have access. In July over 80% of under-fives in Ajiep were malnourished and mortality was almost thirty times higher than the internationally recognised critical level.
By October, after over five months of emergency food relief, more than half the children in Ajiep were still malnourished and it is estimated that at least 3,000 people died there during this period.
Two major factors are mainly responsible for these appalling statistics. First, the displaced were most often excluded from food distributions. This arose from the distribution system itself. According to the OLS agreement and established practice, food relief in Bahr el Ghazal was controlled by the local authorities and the humanitarian wings of the rebel groups, (in this case the Sudan Relief and Rehabilitation Association, or SSRA), and not by the humanitarian organisations in the field. It was these groups that set the priorities and the main beneficiaries tended to be local residents rather than the most vulnerable: the displaced who had already been forced from their homes by war and hunger.
The second factor was the straightforward diversion of food aid by the rebel groups and their humanitarian wings. An investigation in August 1998 by a joint task force of OLS, SSRA and SPLM (Sudan People's Liberation Movement) representatives confirmed that the local authorities and other groups were operating a systematic taxation system on all food distributed. However, it was impossible to estimate the scale of the diversion and its impact on the population as we were also prevented from setting up a systematic post-distribution monitoring system.
The ultimate conclusion to be reached from the experience of this terrible famine is that the OLS system, which has been in place for the past ten years, has become overly institutionalised and must be overhauled. Indeed, the inadequacies of the OLS framework significantly contributed to the inability of the humanitarian organisations to reach the most vulnerable because they were not permitted to carry out independent needs' assessments (including estimating population numbers), to control distributions or to conduct post-distribution monitoring. At the beginning of 1999 MSF therefore called for radical changes to the OLS and hopes that these will eventually be implemented.