Home | News    Sunday 21 December 2003

Health-Care Effort Tests Fears Of Sudanese War-Zone Victims


By Emily Wax, The Washington Post

LUWERE, Sudan, Dec 21, 2003 — She waited just as the others did, wondering what the needle would feel like. Jamila Ibrahim, 39, stood in a messy line that fanned out under a wild fruit tree in order to receive the first injection ever pressed into her skin. She gently explained that she and her three wide-eyed daughters had never been vaccinated against any disease.

In front of her were mothers who quieted children sore from the shot. Behind her were the anxious and the curious, including one woman with a baby on her back, another nursing at her breast and a toddler clinging to her leg. All looked exhausted.

Under a beating sun, the line swelled. Health care is a luxury in Sudan’s central Nuba Mountains, where periodic fighting in a 20-year war kept Ibrahim and many mothers like her huddled in the grassy hills. The land mines that stud the hills left them too terrified to cultivate fields. Hunger made them too weak to walk three hours to a source of clean water.

"We are stuck in the middle," explained Ibrahim’s daughter, Kaka Mahjubua, 18, who proudly approached a line to receive her first vaccination for tetanus, provided by UNICEF, the U.N. children’s agency. "We fear our health is spoiled because of it."

Diseases that were eradicated in much of the rest of the world are still sickening people in southern and central Sudan. The country has 80 percent of the world’s cases of dracunculiasis or guinea worm, a debilitating illness in which a parasite enters the body in contaminated water. Sudanese also suffer from leprosy, sleeping sickness, measles, polio, elephantiasis, HIV-AIDS and malaria.

Negotiators are near a peace deal in the war, which was fought over oil, religion and culture. The conflict was between the Sudanese government, dominated by the Muslim Arabs of the north, and rebels from the black African south. The war has taken 2 million lives, many from disease and starvation, and uprooted 4 million people from their homes.

The Nuba Mountains, a golden sweep of hills about the size of Maine, were included in the north by British colonizers. The people are Africans, and they have long sided with the south’s main rebel group, the Sudan People’s Liberation Army. To claim fertile land and build an oil pipeline, the government bombed many areas in Nuba.

"This is one of few places in the world where people had it better 50 years ago," said Alex de Waal, author of "Facing Genocide: The Nuba of Sudan." "The Nuba have seen a campaign to push them off land, deny them medical treatment and at times starve them."

A cease-fire in the Nuba Mountains last year has allowed humanitarian aid to get through and gave health workers a chance to begin work.

Measles has killed 108 children and adults this year, according to health workers. Diarrhea is also a cause of death, said Brigitte Toure, a UNICEF health coordinator for the rebel-held areas of Sudan. Mothers without health education often stop giving their children water when they should be rehydrating them, she said.

There are concerns about HIV-AIDS because 150,000 refugees have returned to the area, some from countries with high infection rates.

"We brought condoms here. Nobody uses them. They don’t like them. They sit in a box over there, untouched," said Abdulaziz Adam Alhilu, the regional governor, pointing to a hut in the distance.

"There are not more than seven doctors here for 400,000 people, and no surgery to speak of," the governor said. Land mines are also a concern, he said.

A team from the Danish agency DanChurchAid was sent out to remove mines and hit one several miles from Luwere, the administrative capital, in early October. Eight people were killed and two were injured. Confidence was shattered.

"It doesn’t take more than a few mines, or the perceptions of mines, to keep people hiding where they can’t get clean water or health care or harvest their crops," said Nils Carstensen of the aid group.

To encourage participation in the vaccination campaign, Toure’s team sent local health workers out on bikes. They charted safe pathways and urged people down from the hills. They also told them that next time, the injections might take place in their homes. That’s because a pre-filled, single-use device called Uniject, manufactured by Becton, Dickinson and Co., was tested during this vaccination.

For Ibrahim, even getting to the vaccination site was filled with fears. She woke early to complete chores so she could fit the vaccinations into her long day. Her daughter, smiling by her side, acknowledged that she begged her mother to come.

"I was thinking, I would like to see what would happen," said Mahjubua, a pretty girl with a wide smile and a torn dress. Then she marched off to get her shot.

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