<$BlogRSDURL$>

Friday, July 16, 2004

Darfur Mortality Update: July 15, 2004 

Current data for total mortality from violence, malnutrition, and disease

Eric Reeves
July 15, 2004

So high are current mortality rates in Darfur, so great is previous human
destruction, that the current (and static) UN figure of 10,000 deaths for the entire
duration of this massive catastrophe must be regarded as both statistically
irrelevant and morally slovenly (it was proffered by the UN in March 2004, without
explanation or context). We certainly have no means of ascertaining with any
precision what the number is; nor will we ever have a precise figure. But too
much extant data and evidence suggest that a reasonable figure is already well
in excess of 100,000 dead.

According to data authoritatively assembled by the US Agency for International
Development, the present Crude Mortality Rate (CMR) is 7 per day per 10,000 for
the affected population. Using as the basis for calculations the most recent
UN figure of up to 2 million people "in need of emergency relief" (UN News
Centre, July 13, 2004), the daily death toll is now approximately 1,400 human
beings---or approximately 10,000 per week ("Projected Mortality Rates in Darfur,
2004-2005, at
http://www.usaid.gov/locations/sub-saharan_africa/sudan/cmr_darfur.pdf).

[The figure here of 2 million is at once lower than the total number of
"war-affected" persons (now greater than 2.3 million if we use as a base figure the
June 3, 2004 estimate contained in joint UN, US, and European Union communiqué in
Geneva) and higher than the number of Internally Displaced Persons (1.2.
million) and the UN World Food Program estimate of Darfur's food-dependent population
in June 2004 (1.2 million, though climbing to 2 million for October). The
relation of these figures is discussed in a first appendix to this analysis.]

In other words, the current mortality figure offered by the UN for the past 17
months of extreme violence and displacement in Darfur is the equivalent of what
US AID data suggest is the death toll for the past week. Such a gross
disparity should be the occasion for serious and urgent re-thinking of a reasonable
mortality figure for Darfur. Nongovernmental organizations concerned with Darfur
should commit the resources necessary to synthesize all data and evidence
available. To date there has been no such effort.

This writer has distributed several previous attempts to "Quantify Genocide" in
Darfur (available upon request). Given the absence of serious attempts to
ascertain the immense scale of human destruction that has already occurred in
Darfur, further efforts seem to be justified. So, too, do efforts to offer updates
to figures for internal displacement, the "war-affected population," the
percentage of this population in need of food aid, and the numbers of refugees in
Chad. This is the first of continuing weekly updates on casualty totals,
surveying previous data and statistical inferences, and incorporating new data and
evidence.

[Since this and previous accounts draw so heavily on data from the US Agency
for International Development "Projected Mortality Rates in Darfur, 2004-2005,"
it has seemed useful to provide a more particular account of these data, their
statistical basis, confirming evidence from nutritional studies, and other
relevant information. This account appears as a second appendix at the end of the
present analysis.]

CURRENT CUMULATIVE MORTALITY IN DARFUR

Current data support a working figure of approximately 135,000 total dead in
Darfur from violence, malnutrition, and disease. This represents an increase of
15,000 from the figure of 120,000 offered by this writer on July 6, 2004
(available upon request). The previous figure of 120,000 was calculated on the basis
of data from four primary sources: (i) the recent assessment of violent deaths
and executions in Darfur by Asma Jahangir, the UN Special Rapporteur on
extrajudicial, summary or arbitrary executions; (ii) the June 2004 survey report on
violent deaths in the Mornay area by Doctors Without Borders/Medecins Sans
Frontieres and the epidemiological research center Epicentre; (iii) July 2004
disease-specific mortality predictions from the UN's World Health Organization (WHO);
and (iv) data from US AID's "Projected Mortality Rates in Darfur." [Key
portions of these reports and accompanying statistical inferences appear as a third
appendix to the present analysis.]

The increase of 15,000 in total mortality for the three Darfur states derives
from further extrapolation from two of these sources.

In the past nine days, the Crude Mortality Rate (CMR) has risen from
approximately 4 per day per 10,000 of affected population to 7 per day per 10,000. The
Crude Mortality Rate is projected to increase to 10 per day per 10,000 by August
1, 2002 and to 20 per day per 10,000 by January 1, 2005. (These numbers are of
course subject to change, depending on the nature of the humanitarian response,
including the possibility of humanitarian intervention.) The severity of
famine conditions, as well as accompanying morbidity, continues to rise throughout
Darfur as more and more families have fully depleted their dwindling foodstocks.

Using an average CMR of 5.5 per day per 10,000 over the past nine days, and a
figure of 2 million people "in need of emergency relief," the increase in total
mortality is approximately 11,000.

A second increase drives from the assessment offered by David Nabarro, head of
the UN World Health Organization's unit for health action in crises:

"Some 10,000 people in Darfur could die of cholera and dysentery in July alone
unless a massive aid operation can be set up to helicopter in food and
medicines. 'We anticipate that if things go ahead as at the moment, 10,000 people will
die in the next month,' David Nabarro, head of the World Health Organization's
unit for health action in crises, told a news briefing in Geneva after a trip
to Darfur." (Reuters, July 2, 2004)

No such intervention has taken place, "things have gone ahead as at the
moment," and we may reasonably assume that in the past nine days, Nabarro's prediction
suggests that an additional 3,000 of the predicted 10,000 have died. Reports
from various camps for the displaced, throughout Darfur, indicate that with the
continued onset of heavy rains sanitary conditions are rapidly deteriorating,
producing a dramatic acceleration in the rates of various diarrheal diseases.

These two increases suggest that total mortality has increased by approximately
15,000 persons. This inferred increase does not include any deaths from
violence, though reports of widespread violence continue to come from many quarters
in Darfur. It does not include any increase from mortality among refugees in
Chad, though this number is also rapidly growing. It does not include any
increase from continuing executions, including mass executions, in Darfur.

In the absence of a credible rival figure, political action, news reporting,
and moral assessment of the catastrophe in Darfur must presume a casualty total
of approximately 135,000 human beings.

Eric Reeves
Smith College
Northampton, MA 01063

413-585-3326
ereeves@smith.edu
**************************************************
APPENDIX 1: There continues to be confusion around key figures defining the
scale of the human catastrophe unfolding in Darfur. Of particular concern for
estimating a current mortality total is the figure to be deployed in the context
of the US Agency for International Development "Projected Mortality Rates in
Darfur, 2004-2005" (see Appendix 2).

At a minimum we must use a figure of 1.2 million, coincidentally the current
estimate for Internally Displaced Persons in Darfur as well as the target figure
in June 2004 for the UN's World Food Program. The UN "90-Day Humanitarian
Action Plan for Darfur" (June 28, 2004; internally circulated) declares that, "the
magnitude and severity of the crisis [in Darfur] has severely undermined the
livelihoods of about 1.2 million people, who are now in need of food assistance,"
page 7). But there is very considerable evidence that the World Food Program
estimate falls far short of current need, even as the UN agency was able to
reach only 700,000 of this targeted population in June 2004. Moreover, the UN
report speaks of a figure of 2 million for October 2004.

At this point in the crisis, the internally displaced population is by
definition in need of food assistance, having long consumed any food reserves.
Tremendous numbers of host families, as well as those who are not displaced but have
no means of producing food, must be included in any estimate of those in need of
food assistance. There also seems to be some serious reluctance or inability
on the part of the UN World Food Program to keep abreast of the Darfur
catastrophe (represented most consequentially in the failure to preposition food
throughout Darfur in anticipation of the present level of crisis). The June 2004
figure of 1.2 million is certainly well below the current needs in mid-July 2004,
and may derive in part from a silent acknowledgement of sheer incapacity.

A more reasonable number to use in estimating mortality comes from the UN
statement of July 13, 2004, using a figure of "up to 2 million people in need of
emergency relief" (UN News Centre, July 13, 2004). The estimate here is lower
than the figure of 2.2 million for "war-affected" persons included in the June
3, 2004 joint communiqué in Geneva on the part of the UN, the US, and the
European Union. This represents the fact that people are inevitably affected
seriously by war without a clear or present threat of death. But it is also the case
that the number of "war-affected" persons has certainly grown by at least
100,000 over the past six weeks, given reports from humanitarian organizations, news
reporters, reports from within the camps inside Darfur, and indications of
continuing violence and significant accompanying displacement.

In this context of competing figures and estimates, it has seemed most
reasonable to use a figure of 2 million in determining mortality on the basis of US
AID's "Projected Mortality Rates in Darfur, 2004-2005." This decision is
justified in the views of several senior aid officials.

APPENDIX 2: Data from the US Agency for International Development, "Projected
Mortality Rates in Darfur, 2004-2005"

The US Agency for International Development "Projected Mortality Rates in
Darfur, 2004-2005"
(http://www.usaid.gov/locations/sub-saharan_africa/sudan/cmr_darfur.pdf)
currently has no rival. Notably, it draws heavily on statistical studies of famine in
Ethiopia and in Bahr el-Ghazal Province in southern Sudan (1998). To date,
there is no evidence disconfirming the US AID projections (the data were assembled
in April 2004 by a team of superb epidemiologists working in this grim field of
study). On the contrary, there is strong evidence suggesting that the
projections may in fact underestimate both mortality and malnutrition rates.

Preliminary results of a recently completed nutritional survey conducted by
Action Contre la Faim (ACF) in the Abu Shouk camp for the internally displaced
[North Darfur] indicate Global Acute Malnutrition (GAM) rates of 39 percent and
Severe Acute Malnutrition (SAM) of 9.6 percent. These are extremely high rates,
and are occurring despite ongoing food distributions; these data are most
suggestive of the condition of people that have more recently arrived in the camp.

On June 17, 2004 Save the Children released the results of a new study of
malnutrition and food insecurity in Malha, North Darfur. Assessment teams found an
acute crisis in nutritional status with GAM rates of 33 percent and SAM rates
of 5.4 percent. These rates are especially alarming since the Malha area has
been relatively less affected by conflict than other parts of Darfur.

The rates from both these studies track well higher than the Global Acute
Malnutrition data and projections from the US AID "Projected Mortality Rates in
Darfur"; and given the very high correlation between acute malnutrition and
mortality, these data strongly suggest that the actual Crude Mortality Rate is also
running higher than US AID projections.

Most telling on the issue of mortality rates is a nutritional study by Doctors
Without Borders/Medecins Sans Frontieres during April and May 2004 ("On the
Brink of Mass Starvation," May 20, 2004 at
www.doctorswithoutborders.org/pr/2004/05-20-2004.shtml):

"The nutritional study was conducted among 921 children and their caregivers in
five locations---Garsila, Mukjar, Bindissi, Deleij, and Um Kher---where nearly
150,000 displaced people have sought refuge from extreme violence. The study
revealed that global acute malnutrition affects 21.5% of the population while
3.2% suffer from severe acute malnutrition. The mortality rate for children under
five years of age is 5.2 deaths per 10,000 people per day while the rate for
those over five years of age is 3.6 deaths per 10,000 people per day." (Doctors
Without Borders/Medecins Sans Frontieres, "On the Brink of Mass Starvation," May
20, 2004)

Of particular significance is the fact that these mortality rates were at the
time again running ahead of those for US AID's "Projected Mortality Rates in
Darfur."

Why have these or other organizations not done more global statistical studies
of mortality in Darfur? The difficulty in obtaining appropriate data from
multiple representative sites within the region is the chief reason. Such a task
poses daunting challenges even to a mission specifically tasked with mortality
assessment. It is also important to remember that these organizations are more
concerned with implementing than shaping humanitarian policy. They are more
concerned with their effects on the ground than in providing statistical
overviews, especially when they are operational in only a part of an area in crisis
(Darfur is the size of France and this makes a true survey presence impossible).

Even so, it must also be said that there should be more of an effort to make
data and statistical findings more compatible between organizations and
susceptible of combination. There is a great deal of data, but not much effort at
coordination between organizations.

Even so, it is clear that the overall conclusion must be that the US Agency for
Development "Projected Mortality Rates in Darfur, 2004-2005" has been confirmed
to a very high degree, both in predicting mortality and malnutrition, and that
in the days and weeks and months ahead is likely to offer all too telling a
measure of daily human destruction. A fortiori, it is an extremely useful tool in
retrospective analysis of mortality.


APPENDIX 3: Previously assembled evidence and data on mortality in Darfur
[June 6, 2004, revised]

Asma Jahangir, the UN Special Rapporteur on extrajudicial, summary or arbitrary
executions, reported recently that the "number of black Africans killed by Arab
militias in the Darfur region of Sudan is 'bound to be staggering'":

"Ms. Jahangir said that during her visit, 'nearly every third or fourth family'
she spoke to in the camps for internally displaced people (IDPs) within Darfur
had lost a relative to the militias. 'It's very hard to say [accurately] how
many people have been killed,' she said, but interviews with IDPs indicated it
would be 'quite a large number. They are bound to be staggering.'" (UN News
Centre, June 29, 2004)

This finding alone indicates a huge number of dead---certainly many times the
figure of 10,000 if we may take as statistically representative Ms. Jahangir's
finding that, "'nearly every third or fourth family' she spoke to in the camps
for internally displaced people within Darfur had lost a relative to the
militias."

Doctors Without Border/Medecins Sans Frontieres (MSF) has also recently
released important epidemiological research on violence committed against the African
populations of Darfur:

"A recent survey conducted by MSF and the epidemiological research center
Epicentre in the town of Mornay, West Darfur State, where nearly 80,000 people have
sought refuge, found that one in 20 people were killed in scorched earth
attacks on 111 villages from September 2003 until February 2004. Adult men were the
primary victims, but women and children were also killed. Today, one in five
children in the camp are severely malnourished while irregular and insufficient
food distributions do not come close to meeting the basic needs of people
weakened by violence, displacement, and deprivation." (Doctors Without Border/Medecins
Sans Frontieres, "Emergency in Darfur, Sudan: No Relief in Sight," June 21,
2004; release at http://www.doctorswithoutborders.org/pr/2004/06-21-2004.shtml).)

If we make the very conservative assumption that the Mornay region has been
especially violent, and that the 1 in 20 figure overstates by 50% the global death
rate for armed killings in Darfur, this still implies (for a displaced
population of 1.2 million) that over 40,000 people had been violently killed between
September 2003 and February 2004 (this represents a weekly casualty figure of
approximately 1,600). In the more than four months (18 weeks) since the end of
February, violent killings have continued to be reported on a very wide-scale
throughout Darfur, especially in March and April, subsiding recently only because
the destruction of African villages is now largely completed. Many people were
of course killed violently before September 2003 (the insurgency conflict broke
out in February 2003; Janjaweed attacks on civilians accelerated dramatically
in the late spring of 2003). These data aggregated (including the implied
weekly casualty rate) suggest a very approximate figure of 80,000 killed violently
in the course of the war.

For the past three months, according to data from the US Agency for
International Development
(http://www.usaid.gov/locations/sub-saharan_africa/sudan/cmr_darfur.pdf),
mortality from malnutrition and disease has been rising for the larger population of
[2 million people in need of humanitarian assistance]. The Global Mortality
Rate has moved from 1 death per day per 10,000 (April) to 3 per day per 10,000
(early June) to 4 deaths per day per 10,000 (currently). During these
approximately thirteen weeks alone, mortality from malnutrition and disease in the needy
population may be estimated at approximately 40,000.

These data (and the numerical conclusion) are supplemented by recent
predictions of disease mortality from the UN's World Health Organization, predictions
that are already relevant to estimates of current mortality levels:

"Some 10,000 people in Darfur could die of cholera and dysentery in July alone
unless a massive aid operation can be set up to helicopter in food and
medicines. 'We anticipate that if things go ahead as at the moment, 10,000 people will
die in the next month,' David Nabarro, head of the World Health Organization's
unit for health action in crises, told a news briefing in Geneva after a trip
to Darfur." (Reuters, July 2, 2004)

The World Health Organization also warned that,

"A cholera epidemic could break out within weeks now that heavy rains have
begun, striking 200,000 to 300,000 of the more than one million displaced in the
troubled western area of Sudan, a top WHO official told a news briefing. Cholera
is an extreme form of watery diarrhoea which killed tens of thousands of
Rwandans who fled genocide in 1994, according to the WHO. Dysentery, a bloody form of
diarrhoea which is harder to treat, and malaria, a mosquito-borne disease,
would be expected to follow in August." (Reuters, July 2, 2004)

Malaria---an often fatal disease among weakened populations---is also already
claiming lives, as the rains have produced numerous ponds that are the breeding
grounds for the mosquitoes that carry the disease (and much more readily in
crowded camp conditions). The UN has recently reported a sharp uptick in malaria
cases.

CONCLUSION

Given the severe limits on humanitarian access, more global assessments of
various populations in the three Darfur states have not been undertaken. The data
above are representative of all that we have. But given the scale of the human
catastrophe in Darfur, and the thoroughly implausible figure of 10,000 offered
by the UN, statistical inferences concerning current total mortality are
demanded.

The data above, in aggregate, yield a total civilian mortality figure to date
of approximately 120,000.

[June 6, 2004, revised]



Comments: Post a Comment

This page is powered by Blogger. Isn't yours?