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Conflict in Nuba mountains may lead to devastating epidemics, say doctors


A mother and her child shelter from air strikes in a cave in South Kordofan in the Nuba mountains. Photograph: Adriane Ohanesian/AFPConflict in Nuba mountains may lead to devastating epidemics, say doctors

Health workers warn that UN aid agencies are being prevented from delivering vital supplies of vaccines to the children of refugees fleeing the fighting in Sudan

Maeve McClenaghan and Tracy McVeigh

UN aid agencies are under attack from doctors working with refugees who have been displaced by fighting in Sudan, with claims that they are not doing enough to get medical supplies through to children in desperate need.

Common vaccines against childhood diseases are part of Unicef's programme to protect the most vulnerable, but supplies dried up nearly a year ago in areas of conflict around the Nuba mountains, according to research by the London-based Bureau of Investigative Journalism.

Now there are fears that outbreaks of infectious diseases, including measles, could prove devastating to people sheltering from the violence, especially young children.

More than a million people have fled to the Nuba mountains after a rise in violence along the border of the newly created South Sudan. Local militias are fighting over water, cattle and land, while there are bigger political conflicts between Khartoum and Juba yet to be resolved.

But the area has provided little safety. It is being held by the Sudan People's Liberation Army and is regularly bombed by aircraft operated by the forces of the Sudanese government. Sudan's President Omar al-Bashir has banned all UN agencies from operating in the area, with specific exceptions.

According to Unicef, its workers have managed to carry out only one vaccination campaign in the area since June last year. The children's agency says the polio campaign reached 1,700 children under five in areas of the Nuba mountains controlled by the rebel Sudan People's Liberation Movement-North (SPLM-N). They had aimed to reach 4,000. The UN agency also claims it managed to transfer 1,500 polio doses to the area but admits those supplies have long since run out.

However, doctors in the area angrily reject the claims being made by Unicef. They say the last batch of vaccines they received was in August and they were unusable, after being exposed to sunlight and heat when the box that contained them was opened by security forces in Kadugli, the province's capital.

Dr Alamin Osman, director-general of the secretariat of health for the region, said: "I can confirm the last vaccines received in good condition were before the war. Unicef in Sudan must answer to the world why they allowed Sudan security to mishandle those items they claim to have sent."

Osman is worried a health disaster could be on the way. He ran out of vaccines a long time ago. "There are reported cases of measles, but I am not in a position to do anything," he said.

According to experts, an outbreak of measles could prove devastating to children weakened by hunger and upheaval.

Tim O'Dempsey of the Liverpool School of Tropical Medicine said: "Measles can spread rapidly, particularly in situations of overcrowding. In situations like this about 20% of children with measles may die and survivors may be disfigured, or may be left blind, both common complications in severely malnourished children."

Author and journalist Aidan Hartley, who has just been through the region, said: "I saw rural clinics where the only medicines were ones captured from the SAF [Sudan Armed Forces] government forces or herbs or salt and water. It was medieval. Thousands are going to die in Nuba. Deaths could be avoided if there were vaccines, emergency relief, basic drugs and food, but there aren't."

The actor George Clooney, who went to Nuba earlier this year, has co-founded the Enough Project with activist John Prendergast, which aims to raise awareness of the humanitarian situation in Sudan and South Sudan. Prendergast claimed Bashir was deliberately strangling supplies to refugees.

"When the Khartoum government uses starvation as a war tactic by denying access to humanitarian organisations, there are other quiet killers that often end up being more deadly than starvation itself," Prendergast said.

"In famines, health crises usually take more lives than hunger. If kids can't be vaccinated against some of the deadliest diseases in the world, then the crisis that is unfolding in the Nuba mountains right now could be even worse than the worst-case scenarios."

A few smaller NGOs, such as the Irish charity Trócaire, are managing to get limited supplies into the region's only hospital, but this trickle does not come close to requirements.

Dr Tom Catena, an American missionary and the only trained surgeon in Nuba, said: "We've had no resupply of vaccines since they ran out several months ago. We've been trying to get some, but to no avail."

Ahmed Saeed, a humanitarian aid worker with a coalition of groups in the area, said: "Only a consensual access that is negotiated by the parties and internationally supported assistance on a large scale will meet the needs.

"I am expecting the UN to be pushing for unimpeded humanitarian access to all affected areas rather than justifying their tamed and limited presence in Kadugli by claiming access to SPLM-N-held areas," he added.

Unicef and other agencies need permission from Bashir to operate in the country and they say negotiations with Khartoum are continuing.

A spokesman for Unicef denied the shipment that had got through was ruined, saying: "The inspector opened the lid very briefly and only to confirm that they were indeed vaccines contained within the box."

The concerns come as Médecins Sans Frontières released a report ahead of next week's meeting in Geneva of the World Health Assembly, the decision-making body of the World Health Organisation, which will be considering its new global vaccine action plan. The report, entitled The Right Shot, claims that the global vaccine strategy will fail to deliver by concentrating too heavily on getting newer vaccines to children and not enough on getting the basic package out to the "unreached" – 19 million of the poorest children who are not getting even the cheapest jabs.

"We, of course, welcome the effort to protect children from deadly diseases by getting vaccines, including new vaccines, but we feel the strategy is imbalanced, focusing too much on getting newer vaccines and not enough on those 19 million," said a spokesperson for Médecins Sans Frontières.

It wants more focus on developing medicines that don't need cold storage or follow-up doses, in order to deal with the practical problems on the ground in many underdeveloped nations.

Places like Nuba, where a million refugees are already isolated from the outside world and face restrictions from the Sudanese government, are in an increasingly precarious position. The approach of the rainy season, say those working in the area, will cause further problems by making the roads into the area impassable, sealing people off from outside help.

Source: The Observer UK



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