<$BlogRSDURL$>

Friday, August 13, 2004

DARFUR MORTALITY UPDATE: August 13, 2004 

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

Eric Reeves
August 13, 2004

This update on total mortality in Darfur draws upon several previous
assessments (July 6, 2004, July 15, 2004, and July 30, 2004; available upon request), as
well as recent reports from UN field workers, humanitarian organizations, and
news reports. Its primary statistical tool for estimating current and projected
global mortality remains the US Agency for International Development's
"Projected Mortality Rates in Darfur, 2004-2005"
(http://www.usaid.gov/locations/sub-saharan_africa/sudan/cmr_darfur.pdf). The
first appendix to this analysis explains the particular significance of this
superb work of epidemiological research, currently without any significant rival.

CURRENT MORTALITY

The present analysis offers an estimated total of 180,000 deaths in Darfur over
the past 18 months. This includes a figure of 80,000 violent deaths, derived
largely from the only data extant, viz. the Doctors Without Border/Medecins Sans
Frontieres study in the Mornei area (this derivation is included here as a
second appendix). In light of the very recent report by UN Special Rapporteur for
Extrajudicial Executions Asma Jahangir, however, this figure appears to be
conservative; indeed, it may understate very considerably. Special Rapporteur
Jahangir has spoken of a "staggering" number of deaths, and found an extremely
alarming percentage of families that have lost relatives to violence: "'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" (UN News Centre,
June 29, 2004).

100,000 human beings are here estimated to have already died from disease and
the effects of malnutrition, a figure of course impossible to verify. Far fewer
than 50% of the total population of displaced persons (those most at risk) have
been registered or assessed in camps; the figure may be lower than 30%. The
names, gravesites, dates and causes of death, and other confirming information
demanded by the Khartoum regime obviously do not exist---though many thousands of
names do exist, if we would but collate data and information from sources in
Darfur and in Chad. The present figure of 100,000 deaths is a statistical
inference, with a number of variables. It has perforce a very significant margin of
error---both lower and higher (see appendices for the ranges of key figures
deployed).

But the data make clear that the mid-July 2004 UN figure of 30,000-50,000 total
deaths offered by Jan Egeland, Undersecretary for Humanitarian Affairs, is
untenably low, even as the previous figure of 10,000 deaths (the only UN number
offered for mortality from March 2004 to July 2004) was also clearly untenably
low. Moreover, no explanation of methodology or the nature of the data has ever
been offered by the UN in conjunction with these mortality estimates; deaths are
not even generally categorized as a function of violence or disease and
malnutrition. All this follows a pattern of both underestimation and belatedness that
has marked UN efforts in the World Food Program, the World Health Organization,
and the UN High Commission for Refugees.

This writer has previously solicited, as responses to mortality analyses,
correcting data, skeptical assessment of methods, and corrections of statistical
inferences; none has so far been forthcoming, though the invitation is herewith
renewed.

CURRENT CONTEXT

The current enormous mortality figure here hazarded appears unlikely to remain
static. Indeed, the US Agency for International Development's "Projected
Mortality Rates in Darfur, 2004-2005" suggests that over 2,500 people are now dying
daily---mainly invisibly. Moreover, the Crude Mortality Rate (CMR, measured in
deaths per day per 10,000 of affected population) continues to rise. The
mid-August CMR is 11 deaths per day per 10,000; this rises to 15 per day per 10,000
at the end of September, and to 20 per day per 10,000 in December.

The current "war-affected" population may reasonably be estimated at over 2.3
million (for a justification of this figure, see the third appendix to this
analysis). The figure offered in a June 3, 2004 joint communiqué from the UN, the
European Union, and the US was 2.2 million "war-affected," though with much too
little explanation of the term "war-affected." In the intervening 10 weeks,
the rains have greatly intensified, logistical resources and transport capacity
have proven ever more inadequate, and fewer than 1 million people received food
from the World Food Program in July, though this represented a significant
increase from June. Clean water, sanitary provisions and latrines, shelter, and
cooking fuel (essential if women and girls are not to be forced to venture far
from the camps for firewood and thus risk rape by marauding Janjaweed
forces)---all are dramatically inadequate for the camp populations, let alone for the
larger populations of displaced.

Indeed, the most troubling part of any calculation of mortality and morbidity
in Darfur is the unknown number of people who are neither in the camps, nor
accessible by UN or humanitarian organizations. The World Food Program internal
working figure for this population was 300,000 in July (confidential source), a
number that is deliberately obscured in a World Food Program statement of August
11, 2004 indicating that access to insurgency-controlled areas of Darfur would
increase by "tens of thousands" the number of people who might benefit (UN
Integrated Regional Information Networks, August 12, 2004). The number is hundreds
of thousands, as the World Food Program well knows---indeed, some on the ground
in Darfur, or who have recently returned from Darfur, suggest that the number
may be greater than 1 million. This deliberate "low-balling" (directly and
indirectly) of numbers on the part of the World Food Program continues a disturbing
pattern, and it is immensely dangerous.

Here again it is important to note that most estimates of total population for
Darfur are between 6 million and 7 million (though some are lower, and there
are a number of complicating demographic issues); and estimates of the percentage
belonging to the targeted African tribal populations are generally around 70%.
This suggests that there is a population---systematically attacked and
displaced over a period of 18 months---that is greater than 4 million human beings.
Aerial and satellite imagery, as well as reports from humanitarian organizations
on the ground and from Darfurian sources, suggest that well over 50% of the
African villages have been destroyed. Some estimates are over 75%. And many more
people who haven't been directly displaced by violence have simply abandoned
vulnerable villages in anticipation of attacks by Khartoum and its Janjaweed
militia.

Where are all these people?

They are certainly aren't in the camps, which may hold over 1 million people at
this point, but not over 1.5 million. Where are the other 2.5 million to 3
million people of the African tribal groups that trying to survive without food or
humanitarian assistance? These people have also been left without the ability
to use traditional foraging methods and coping strategies because of the threat
posed by marauding Janjaweed forces. If we address this large issue honestly,
the mortality projections from the US Agency for International Development are
much more readily comprehended.

POLITICAL CONTEXT

The realities of mortality in Darfur---with a present total mortality that the
best data available suggest is approximately 180,000, climbing at a rate of
2,500 people per day---present with overwhelming clarity the moral imperative of
humanitarian intervention. Indeed, precisely because the imperative is so
clear, Khartoum has begun to work energetically to forestall any possibility of such
international action. The first step has been to deny the deployment of
African Union (AU) forces to function as peacekeepers, despite a decision last week
by the AU to deploy 2,000 troops with precisely this mandate. Instead, Khartoum
is permitting only the very limited number of troops necessary to protect the
"cease-fire" monitors. The statement of Interior Minister Abdel Rahim Mohamed
Hussein stands:

"'We will not agree to the presence of any foreign forces, whatever their
nationality,' Sudanese Interior Minister Abdel Rahim Mohamed Hussein said in an
interview with London's Asharq al-Awsat newspaper published on Friday." (Reuters,
August 6, 2004)

The UN for its part is simply acquiescing in the face of Khartoum's
intransigence. Jan Pronk, UN Secretary-general Kofi Annan's special representative for
Sudan, continues with policies of expediency and temporizing. An Agence
France-Presse dispatch yesterday (August 12, 2004) from Khartoum ("UN envoy eases
pressure after Khartoum irked by Darfur criticism") tells us far too much about
Pronk's primary mission, which is to ensure that the issue of Darfur does not
become an occasion for further action by, and inevitable division within, the UN
Security Council when it returns to the concerns of Resolution 1556 on August 30,
2004 (17 days from today).

Agence France-Presse notes in particular the agreement signed earlier this week
(August 12, 2004) by Pronk and NIF foreign minister Mustafa Ismail:

"The deal was already backtracking on a July 30 [2004] UN Security Council
resolution giving Khartoum 30 days to crack down on the pro-government Arab
Janjaweed militias." (Agence France-Presse, August 12, 2004)

Instead of increasing pressure on Khartoum to disarm the Janjaweed, to control
violence in Darfur, and to assist humanitarian relief efforts, Pronk has
resorted to appeasement:

"The United Nations' envoy to Sudan tried to ease the pressure on Khartoum
after a flurry of indictments of the government's failure to end the crisis in
Darfur drew irate reactions from President Omar al-Beshir. Jan Pronk, quoted
Thursday in the Akhbar Al-Youm daily, said an action plan agreed to by Khartoum 'does
not set 30 days as a deadline but as a period which can be renewed and amended
until all provisions' of a Security Council resolution are implemented."
(Agence France-Presse, August 12, 2004)

Though Akhbar Al-Youm must typically be regarded with caution as a source,
there has been no correction issued over the past day and no sign that Akhbar
Al-Youm has misquoted Pronk. Indeed, all evidence to date suggests that this
extraordinary loosening of an already culpably expansive Security Council deadline is
fully in character for Pronk.

What is Pronk responding to? How is this appeasement? Agence France-Presse
also reports:

"Speaking to reporters Wednesday [August 11, 2004], Sudanese Foreign Minister
Mustafa Osman Ismail had asked the UN to control its statements 'if it really
wants security to prevail in Darfur, otherwise the government will reconsider its
commitments.'" (Agence France-Presse, August 12, 2004)

What is the meaning of Ismail's threat that Khartoum will "reconsider its
commitments" to the UN (both in responding to Security Council Resolution 1556 and
the July 3, 2004 memorandum of understanding with Kofi Annan)? Clearly he is
threatening that Khartoum will not disarm the Janjaweed, nor bring its leaders to
trial, nor end its obstruction of humanitarian relief (we should recall again
that Khartoum very recently "inexplicably grounded" UN World Food Program planes
[BBC, August 10, 2004]).

And what are Ismail's demands? What is the meaning of his "ask[ing] the UN to
control its statements"? A recent sampling of "statements" from various UN
humanitarian organizations operating in Darfur makes clear what Ismail finds so
distressfully authoritative, and what he wants "controlled," i.e., halted:

UN Special Rapporteur for Extrajudicial Executions Asma Jahangir announced in
conjunction with the release of her recent report on executions in Darfur that,
"'it is beyond doubt that the Government of the Sudan is responsible for
extrajudicial and summary executions of large numbers of people over the last several
months in the Darfur region.'" (Associated Press, August 6, 2004)

Other UN agencies have also offered deeply damning accounts of Khartoum's vast
human destruction in Darfur:

"'Janjaweed attacks on internally displaced persons in and around Internally
Displaced Persons settlements continue to be reported in all three Darfur
states,' [according to OCHA]." (Reuters, August 10, 2004)

"[UN sources on the ground in Darfur reported yesterday that' 'fresh violence
today [August 10, 2004] included helicopter gunship bombings by the Sudanese
government and Janjaweed attacks in South Darfur,' the UN [Office for the
Coordination of Humanitarian Affairs (OCHA)] said." (Reuters, August 10, 2004)

"Meanwhile, Dafuris continue to be displaced from their homes and villages. In
recent days, hundreds of people have fled from [the villages of] Serengabo,
Taweela, Tebeldia and Qasar villages into squalid makeshift camps near Nyala." (UN
High Commission for Refugees press release [Geneva], August 10, 2004)

"UN spokesman Fred Eckhard told reporters in New York on Monday that UN
officials on the ground had reported that 'the security situation in Darfur remains
tenuous, with more violence directed at, and displacing, civilians in North and
South Darfur.' 'Militia men suspected to be Janjaweed attacked some 35 families
in Tawilla, North Darfur on Saturday. Meanwhile, reports continue of attacks by
armed men on horses and camels, supported by uniformed men and military
vehicles, in South Darfur,' Eckhard said." (Associated Press, August 11, 2004)

The UN High Commission for Refugees also notes that it has received reports
that in camps not run by UNHCR, the rape of women and girls "is in fact
escalating" (UNCHR press release [Geneva], August 10, 2004).

Silence on these realities is what Ismail is demanding---this is Khartoum's
condition for keeping its "commitments" to the UN. Bearing in mind the serial
refusal of Khartoum to honor any of its previous commitments, one might think that
UN special representative Pronk should be doing more of the demanding and less
of the acquiescing. The grotesque reversal of roles, along with an ever more
expansive time-frame for Khartoum, clearly indicates that the UN will do nothing
to change the fundamental dynamic of human destruction in Darfur.

Mortality will continue to accelerate, and by the time the UN Security Council
reconvenes to discuss Darfur on August 30, 2004, the number of deaths will be
in excess of 200,000---and climbing ever more rapidly. The recently reported
(and unprecedented for Darfur) outbreak of Hepatitis E is a sign that other
water-borne diseases are in the process of exploding (Hepatitis E is fatal in
approximately 20% of pregnant women contracting the illness). Malaria is taking an
increasing toll (the International Committee of the Red Cross reports today
[August 13, 2004] that 20% of the diagnoses at Abshok camp in West Darfur are for
malaria), and will continue to do so for at least several months. Diarrheal
diseases continue to increase dramatically as well, and cholera could explode at
any time, in multiple locations.

Malnutrition is rising in virtually all the camps, and is simply unfathomable
in the rural areas beyond humanitarian reach.

We are in the midst of the killing season, and there is nothing that gives hope
it can be foreshortened. Genocide continues unabated.

Eric Reeves
Smith College
Northampton, MA 01063

413-585-3326
ereeves@smith.edu

APPENDIX 1: 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, through July 1, 2004 there was strong evidence
suggesting that the projections may in fact have underestimated both mortality and
malnutrition rates.

Results of a nutritional survey conducted in June 2004 by Action Contre la Faim
(ACF) in the Abu Shouk camp for the internally displaced [North Darfur]
indicated Global Acute Malnutrition (GAM) rates of 39 percent and Severe Acute
Malnutrition (SAM) of 9.6 percent. These are extremely high rates, and occurred
despite ongoing food distributions; these data are most suggestive of the condition
of people that more recently arrived in the camp.

On June 17, 2004 Save the Children released the results of a 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 tracked well higher than the Global Acute
Malnutrition data and projections from US AID's "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 may also
have been running higher than US AID projections.

Most telling for earlier assessment of morbidity 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)
(These mortality rates exceeded the contemporary rates in US AID's "Projected
Mortality Rates in Darfur.")

The most recent data comes in a survey from the US Agency for International
Development (fact sheet #18, "Darfur---Humanitarian Emergency," August 13, 2004),
and finds that Global Acute Malnutrition (GAM) ranges from 13% up to 39%
according to the US AID Disaster Assistance Response Team. This upper figure is
approximately that predicted in the US AID "Projected Mortality Rates" graph; since
these figures do not include the populations beyond humanitarian access (like
the earlier studies in individual camp settings), they undoubtedly fail to
reflect higher GAM rates, and the greater consistency with which the more elevated
GAM rates can be found, in rural Darfur.

In general, studies of malnutrition have consistently borne out the US AID
predictions of GAM at various points over the past four months. The overall
conclusion must be that US AID's "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.

[We should not forget that comparably high levels of malnutrition also exist in
the refugee camps in Chad, especially in the northern sector.]

APPENDIX 2: Violent deaths in Darfur:

Asma Jahangir, the UN Special Rapporteur on extrajudicial, summary or arbitrary
executions, reported at the end of June 2004 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. If we took 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," the number of violent deaths would be far
in excess of the figure of 80,000 derived below from data from Doctors Without
Border/Medecins Sans Frontieres.

Doctors Without Border/Medecins Sans Frontieres (MSF) released in June 2004
important epidemiological research on violence committed against the African
populations of Darfur; indeed, it is our only such data:

"A recent survey conducted by MSF and the epidemiological research center
Epicentre in the town of Mornei, 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 Mornei 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 very approximately
estimated average 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 twenty-five
weeks since the end of February, violent killings have continued to be reported on
a very wide-scale throughout Darfur, especially February to 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.

APPENDIX 3: The "war-affected" population in Darfur:

Scandalously, there continues to be confusion around key figures defining the
scale of the human catastrophe unfolding in Darfur. Of particular concern for
estimating current mortality is the figure that is actually deployed in the
context of the US Agency for International Development "Projected Mortality Rates
in Darfur, 2004-2005" (see Appendix 1), which requires an operative figure of
"war-affected persons" for calculation of deaths. But there can be little doubt
that this figure is well over 2 million; it is very likely over 2.5 million.

The Executive Summary from the recent "Darfur Humanitarian Profile---July 2004"
(office of the UN Resident and Humanitarian Coordinator for Sudan) offers a
"war-affected" figure of "more than two million people" (full report available
upon request). This figure includes Internally Displaced Persons, as well as
those living with host families whose food reserves have been exhausted, and those
who have simply fallen through the cracks of statistical assessment. This
figure essentially reiterates the figure of 2.2 million "war-affected persons" used
in the joint communiqué of the UN, US, and the EU on June 3, 2004.
(Significantly, the UN World Food Program [in the June 28, 2004 "90-Day Humanitarian Action
Plan for Darfur"] commits to a figure of 2 million for food aid only in October
2004; this implies a highly dramatic shortfall in current response by the WFP.)

But even the figure of 2.2 million speaks to conditions six weeks ago. In the
interim there have been numerous reports of continued violence and displacement
(though diminished from the levels of spring 2004), and surviving food reserves
have been fully depleted for more and more of Darfur's population. Moreover,
there is growing evidence that the UN Resident and Humanitarian Coordinator
report considerably understates the number of people in critical need in areas to
which there is no humanitarian access.

In this present context, it has seemed most reasonable to use an estimate, very
likely conservative, of 2.3 million to 2.5 million, in determining the
population that must figure in any calculation of 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.

Comments: Post a Comment

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