September 15, 2004
This present analysis of mortality in Darfur (the sixth in a series) concludes that the current aggregated data for violent deaths and deaths from disease and malnutrition indicate a total mortality in excess of 250,000, possibly in excess of 300,000. Though this marks a significant increase from the August 27, 2004 analysis (available upon request), the recent US State Department report (“Documenting Atrocities in Darfur”) demands a very significant upward revision in the estimate for violent deaths.
The report (now available at http://www.state.gov/g/drl/rls/36028.htm) is based on data very carefully collected and collated by an investigating team organized and overseen by the distinguished Coalition for International Justice. In one of its most startling and important conclusions, the investigating team found that “sixty-one percent [of those interviewed on a randomized basis] reported witnessing the killing of a family member.”
The implications of this statistic can hardly be overstated. If we assume that the population of more than 200,000 refugees in Chad is also representative of the more than 1.8 million people displaced internally in Darfur, and if we assume an average family size of 5, then we must conclude that more than 200,000 people have died violent deaths in the 19 months of the Darfur conflict. (See Appendix 1 fuller for analysis of this conclusion.)
At the same time, evidence from malnutrition studies suggests that the current benchmark mortality projection (“Projected Mortality Rates in Darfur, 2004-2005” (http://www.usaid.gov/locations/sub-saharan_africa/sudan/cmr_darfur.pdf), is now overstating the number of deaths from malnutrition and disease. Nonetheless, the food deliveries that have evidently forestalled famine mortality at the rate projected by US Agency for International Development in April 2004 have had an ominous effect: displaced persons are concentrated in far too few locations in order to obtain food (and tenuous security), and this has produced camps that are the sites of extreme health threats: Hepatitis E (already uncontrollable), cholera (present in western Chad, though not yet in eastern Chad or Darfur), dysentery, and other diarrheal diseases. Mosquito-borne malaria is taking ever-greater numbers of lives as the heaviest part of the rainy season continues, and polio may become an acute threat within a month. This grim trade-off—food at the price of living in terribly unsanitary and tremendously overcrowded conditions—is analyzed in Appendix 2.
The data available, and the consequent revision of the US AID projections, suggest that the global number for those who have died from disease and malnutrition in Darfur is very approximately 80,000.
THE U.N. WORLD HEALTH ORGANIZATION MORTALITY STUDY
Many wire service reports have taken note of a recent mortality study conducted by the UN’s World Health Organization (WHO) (“Retrospective Mortality Survey Among the Internally Displaced Population, Greater Darfur, Sudan, August 2004,” hereafter “the WHO report”). More accurately, wire reporters have taken note not of the report itself but of public comments made by Dr. David Nabarro, head of crisis operations for WHO. These comments are deeply misleading and finally disingenuous about what the WHO report actually tells us about mortality in Darfur.
Even so, the numbers reported by WHO are shocking and suggest a monthly mortality rate of 6,000 to 10,000 people in camps for the displaced, a range which, in context, is established with compelling authority. But we must attend very carefully to what Nabarro has said publicly and what the report itself says (available at: http://www.who.int/mediacentre/news/releases/2004/pr63/en/).
The report is very clear about its ultimately limited “primary objective”:
“To estimate the crude mortality rate in the 62 days from 15th June to 15th August 2004, among the Internally Displaced Population (IDP) present in the settlements at the time of the survey, in each of the three states of Greater Darfur.” (page 4 of the WHO report).
“The study population was defined as all IDPs living within accessible IDP settlements in North Darfur, West Darfur, and South Darfur.” (page 5 of the WHO report)
“Internally Displaced Persons living within accessible Internally Displaced Person settlements”: this is most emphatically not a global mortality study for Darfur; it is not even a study of all Internally Displaced Persons in Darfur. And because if focuses only on people who have arrived in camps, it can reach no conclusion about people who have died violent deaths and never reach a camp. Nor does it include the many camps to which there is no access. In short, the WHO report looks only at the population that is most likely to survive amidst the maelstrom of violence, suffering, trauma, acute deprivation, and destruction that defines so much of Darfur outside the camps. Violent death (as opposed to sexual violence) is much less prominent in the camps themselves, though there are significant numbers of killings in and around the camps because of Janjaweed presence.
Any mortality data generated by a study guided in this fashion will be relevant only to the camp population. Moreover, the WHO report does not offer a survey of South Darfur State (insecurity prevented the WHO team from reaching the various camps selected: only the huge Kalma camp was assessed). Despite the sharply limited focus of the report, it nonetheless refers at various points to the Internally Displaced Persons of Darfur as if they were all “living within accessible IDP settlements.” This is deeply distorting of the realities in Darfur (see Appendix 2).
Because the focus of the WHO mortality study is so limited, the tenor of public comments by Dr. David Nabarro must be regarded as deeply misleading. Associated Press reports:
“The WHO survey results confirm an estimate of a total death toll of 50,000 in the Darfur region since the start of the conflict 19 months ago, said Dr. David Nabarro, head of crisis operations for the World Health Organization.” (Associated Press [Geneva], September 13, 2004)
The WHO report suggests no such estimate for Darfur as a whole; it suggests only the mortality total that can be extrapolated from the populations who are presently most food-secure and most likely to receive medical treatment, however inadequate and however threatening camp conditions may be. Most critically, the WHO report can suggest nothing about violent deaths in Darfur outside the camps. It cannot begin to address the implications of the US-government-funded study by the Coalition for International Justice, which found that “sixty-one percent [of those interviewed on a randomized basis] reported witnessing the killing of a family member.”
Nor can the WHO report, focusing only on IDPs presently in accessible camps, begin to address the implications of the findings of Asma Jahangir, the UN Special Rapporteur on extrajudicial, summary or arbitrary executions, who 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)
The WHO report cannot respond even to well-documented reports of killings and atrocities, including those recorded in this telling dispatch from the UN Integrated Regional Information Networks (originally reported in a UN “sit rep” from the ground in North Darfur):
“In an attack on 27 February  in the Tawilah area of northern Darfur, 30 villages were burned to the ground, over 200 people killed and over 200 girls and women raped—some by up to 14 assailants and in front of their fathers who were later killed. A further 150 women and 200 children were abducted.” (UN Integrated Regional Information Networks, March 22, 2004)
Nor can the WHO report purport to represent mortality among the displaced persons in inaccessible camps, or mortality in other concentrations of displaced persons. Nor can it tell us anything about mortality among the populations that are still wholly beyond reach or possible assessment. These latter populations, in which mortality from malnutrition is certainly escalating rapidly, are unknown but must be estimated in any meaningful assessment of total deaths in Darfur.
For Nabarro to suggest the WHO report supports a global mortality total— “a total death toll of 50,000 in the Darfur region since the start of the conflict 19 months ago”—is disgracefully disingenuous. The WHO report supports no such global conclusion about mortality..
The report is also marred at various points by confusing or inadequate exposition, mistakes (it refers to an “East Darfur” on page 4), a troublingly low and unexplained population estimate for all of Darfur (“between five and six million people”), and serious methodological problems (none of the people who were found to have “disappeared” or become “absent” during the 62-day survey period figure in the total for “deaths”; no explanation is offered for their exclusion from the mortality calculations).
Moreover, in assessing the work of WHO, we should remember that it has continually been conducted in partnership with the Khartoum regime’s “Ministry of Health.” Khartoum is obviously interested in keeping mortality data and totals as low as possible—indeed, is prepared to lie brazenly, as the Associated Press reported yesterday:
“A Sudanese official [Minister of Humanitarian Affairs Ibrahim Hamid] said Tuesday that disturbingly high UN estimates of death among Darfur’s displaced were mistaken and claimed the health situation was ‘normal’ in the region gripped by what the United Nations has called the world’s worst humanitarian disaster.” (Associated Press [Khartoum], September 14, 2004)
This is Khartoum’s view of the human catastrophe in Darfur: a “normal” health situation. We must, as a consequence, ask what effect the potentially ominous presence of Khartoum’s representatives would have had in the collection of WHO data:
“Interviewers were accompanied during the interview by WHO or [Khartoum’s] Ministry of Health team members.” (page 24 of the WHO report)
THE W.H.O. TRACK RECORD IN DARFUR
We should also consider the WHO’s track record on mortality estimates in the camps. A month ago WHO found that the total number of deaths, in all the camps surveyed, for a five-week period was just 363 people:
“The UN’s World Health Organization bulletin [August 17, 2004]
registered 363 [sic] deaths in the camps in the five weeks up to the end of July,” (Reuters, August 17, 2004)
As several epidemiologists have pointed out, given the figure that WHO is using for the total camp population, this implies a mortality rate—in conditions defined by terrible hygiene, lack of clean water, inadequate food supplies, and woefully inadequate medical treatment—that is lower than the US mortality rate. This absurd (though revealing) conclusion is an embarrassment to many within the UN, who will say as much privately; the August WHO report has rightly been dismissed as transparently politicized and tendentious. These concerns are not allayed by the way in which the present report on mortality has been publicly presented.
WHO, the UN humanitarian organization perhaps most deeply corrupted by international politics, has been inept or simply wrong on a number of other occasions as well. Dr. Nabarro, who has misrepresented the import of the current WHO mortality study, was also shamefully inept in speaking about health conditions in Darfur during July 2004:
“Dr. Nabarro says WHO did not think the situation in Darfur would become as desperate as it is. He says the agency underestimated the difficulty of getting enough water supplies and of improving sanitation facilities in the camps.” (Interview with Voice of America, July 18, 2004)
Such culpable ineptitude calls into serious question the work of WHO in a crisis situation. So too does a recent WHO assessment of Hepatitis E, an extremely serious health threat in both Darfur and within the refugees camps in Chad:
“A slight decrease in Hepatitis E cases has been reported in the troubled Sudanese states of South and West Darfur, although the overall death toll since the cases were first reported on 22 May had reached 55 across the region, the World Health Organization (WHO) said.” (UN Integrated Regional Information Networks [Nairobi], September 10, 2004)
For the true situation we must turn elsewhere:
“The International Rescue Committee (IRC) in Darfur has launched a pre-emptive strike against infectious diseases after new data showed a spike in hepatitis E, an incurable liver disease. The incidence of a major hepatitis symptom—acute jaundice—doubled during the first ten days of September at the two camps where the IRC has built health clinics in recent weeks, said Roberta Gately, the IRC’s health coordinator in South Darfur. ‘We are seeing a worrisome increasing trend in the numbers of acute jaundice syndrome,’ Gately said.” (The International Rescue Committee, “IRC Boosts Disease Prevention in Darfur,” September 13, 2004)
The disparity in assessments is too striking. This should be an alert to the international community that WHO is capable of seriously misleading statements, careless assessment of data, and ineptitude in looking forward during a crisis. The politicization of WHO, along with the obligation to work with Khartoum’s “Ministry of Health,” should give serious pause to any crediting of their work in Darfur.
THE PRESENT CONTEXT FOR MORTALITY ASSESSMENT/
If we consider the larger context—military, political, and diplomatic—for future mortality in Darfur, we must despair. The new US-sponsored UN Security Council resolution has become precisely the “milquetoast” the Washington Post described in its editorial of September 12, 2004. This resolution, like the previous resolution of July 30, 2004, is stuffed with “stressings,” “emphasizings,” “declarings,” “deplorings,” “welcomings,” and “recallings.” But in the only language that matters—what is “demanded” of the Khartoum regime—the resolution is meaningless, not even reiterating the demand of the previous resolution that:
“the government of Sudan fulfill its commitments to disarm the Janjaweed militias and apprehend and bring to justice Janjaweed leaders and their associates who have incited and carried out human rights and international humanitarian law violations, and other atrocities.” (UN Security Council Resolution 1556, July 30, 2004, paragraph 6)
Instead, the new resolution demands only that:
“the Government of Sudan submit to the African Union Mission for verification documentation, particularly the names of the Jinjaweed militiamen disarmed and the names of those arrested for human rights abuses and violations of international humanitarian law, to account for its performance relative to Resolution 1556.” (draft introduced September 14, 2004)
This shamefully weak document was evidently the product of China’s veto threats, but enjoyed Security Council support from Russia, Pakistan, and Algeria, as well as strong diplomatic support from the Arab League. Critically, there is no threat of sanctions, let alone sanctions directed against the “petroleum sector” that figured so prominently in Senate testimony by Secretary of State Colin Powell (September 9, 2004). Instead, the resolution contains only capitulatory language: “[the Security Council] shall consider taking additional measures…” (paragraph 14).
The Security Council, at some future and unspecified date, “shall consider taking additional measures.” Even a commission of inquiry to investigate “violations of international humanitarian law and human rights law,” “requested” of the Secretary-General and merely “calls on all parties to cooperate fully with such a commission” (paragraph 12). The signal sent to Khartoum is unambiguous: the UN will simply not act in a meaningful way on Darfur, will not make any “demands.”
PEACE NEGOTIATIONS IN ABUJA (NIGERIA)
Reuters, the Associated Press, and Voice of America are all reporting today (September 15, 2004) that the peace talks in Abuja (Nigeria) have collapsed over a failure to reach agreement on security issues. The collapse comes even as there is considerable evidence that Khartoum’s military operations are increasing, resulting in very large numbers of newly displaced persons, numbering in the many tens of thousands. African Union monitors in Darfur have reported the use of helicopter gunships as recently as September 3, 2004. An attack on the village of Mellit occurred at the very time that peace talks in Abuja were most endangered, and was clearly designed as a provocative move to undermine the possibility of a negotiated settlement (the attack is reported in the UN Security Council resolution, paragraph 1).
It is no coincidence that National Islamic Front First Vice President Ali Osman Taha has evidently begun to speak, without real commitment, about resuming talks to complete the north/south peace agreement in Naivasha (Kenya): with one peace process collapsing, the regime will use the occasion to switch negotiating venues in an attempt to forestall criticism for its intransigence in Abuja. Since a north/south agreement was the diplomatic prize that muted US and the UK criticism of Khartoum’s genocide in Darfur for so many months, Khartoum calculates that resumed talks will again diminish the force of criticism over Darfur, especially from the US.
International hopes continue to be concentrated, by default, on the possibility of an African Union peacekeeping force. But Khartoum has consistently and adamantly refused to countenance any change in the mandate for the small contingent of monitors, and the forces to protect these monitors. An increase in the number of monitors is all that Khartoum has accepted; the insistence that there be no change in mandate has been made clear repeatedly in Abuja, and by various National Islamic Front officials in Khartoum. The present UN resolution offers no diplomatic leverage to the international community: there are no specified consequences if Khartoum continues to refuse a peacekeeping mandate for a possibly expanded African Union force.
Moreover, Khartoum continues to impede the operations of the African Union monitoring force. It is worth recalling an extraordinary recent dispatch on the problems facing the AU force, with a dateline of el-Fasher (North Darfur) military air base:
“The troops were ready, the mission decided and the flight crew was standing by, but the African Union ceasefire monitors still lacked one vital element. ‘The Sudanese say there is no fuel,’ said one of the soldiers waiting to board. ‘They say there’s a fuel problem whenever they want to keep us on the ground. They don’t want us to see. It’s a big ceasefire violation.'”
“Hours later, as a Sudanese army attack helicopter came in to land, its own mission complete, the ‘shortage’ was suddenly resolved. Fuel trucks that had sat all the while on the other side of the fence lumbered towards the aircraft, chartered to carry the troops on observation missions across the region.” (The Telegraph [UK], September 5, 2004; dateline al-Fasher military airfield)
For those who count on near-term deployment of a robust African Union peacekeeping force of several thousand in Darfur, this account should be sobering. How will the international community force Khartoum to accept such a deployment? and the necessary transport and logistics? There are no answers evident in a political and diplomatic climate defined by the new US resolution before the UN Security Council.
THE SITUATION ON THE GROUND IN SUDAN
Humanitarian capacity in Darfur continues to be woefully inadequate to humanitarian need, with ever-more deadly consequences. Even food aid, which has done so much to forestall some of the famine mortality predicted by the US Agency for International Development, shows clear signs of falling further short of the goals projected by the UN’s World Food Program (WFP)—goals that already seriously understate global food need in Darfur. The target for August was 1.2 million; WFP reached only 940,000, leaving by the organization’s own estimate 260,000 people without food. The WFP estimate for September, another very rainy and logistically challenging month, is 2 million. The capacity to move the required 35,000 metric tons of food alone (leaving aside essential medical, shelter, and sanitation supplies) is nowhere in sight.
Camp populations continue to swell uncontrollably, as violence surges again in Darfur. The recent statement (September 13, 2004) by the humanitarian organization Oxfam is only the most dramatic:
“In recent days Greda camp has been overwhelmed by fresh arrivals fleeing renewed violence. On August 26  the camp housed approximately 10,000 displaced people, by September 7 the camp had boomed to over 40,000 people. People are still arriving every day at the camp. ‘Literally tens of thousands of people have poured into the camp in recent days and the flow still hasn’t stopped. A quadrupling of numbers puts a massive strain on resources and infrastructure.'” (Oxfam Press release, September 13, 2004)
And huge numbers of people continue to be completely beyond humanitarian reach. Khartoum’s failure to rein in the Janjaweed denies this desperate population the opportunity to use their superb coping and foraging skills. They are dying invisibly—beyond reach and beyond hope.
There is nothing in sight that promises to stop the terrible engine of genocidal human destruction in Darfur. Security has not improved at all in the month and a half since the UN Security Council “demanded” that “the government of Sudan fulfill its commitments to disarm the Janjaweed militias.” The reference to “commitments” here is to the July 3, 2004 Joint Communiqu signed by Kofi Annan and the Khartoum regime, in which Khartoum “committed” to “immediately start to disarm the Janjaweed and other armed outlaw groups” and to “ensure that no militias are present in all areas surrounding IDP camps” (“Joint Communiqu between the Government of Sudan and the UN, on the occasion of the visit of the UN Secretary-General” [Khartoum, July 3, 2004). This “commitment,” made almost two and a half months ago, has meant nothing.
And still the UN can do no more than “declare” that if Khartoum refuses to respect these various commitments, the Security Council will “consider taking additional measures.” This is abject diplomatic failure.
On the ground, amidst a catastrophe that is generating no meaningful political action, people continue to die. They die from violence, disease, starvation—and no doubt in many cases from despair.
Their staggering numbers will not be acknowledged for reasons we may only surmise. But despite the disingenuous claims from WHO, the aggregated data—from all sources—suggest a casualty figure exceeding 250,000 human beings. Darfur is rapidly achieving ghastly status as one of the most destructive episodes in recent human history. Unless the Khartoum regime and its Janjaweed militia allies are confronted vigorously, there is every reason to assume that this number will continue to grow at an unforgivably rapid rate.
Northampton, MA 01063
The most crucial change in the mortality assessment offered here is in the number of violent deaths: more than 200,000 over the course of 19 months of extremely violent conflict. The derivation of this figure from the US-government-sponsored study by the Coalition for International Justice is statistically straightforward, though several assumptions and qualifications must be offered.
The total number of people assumed here to be represented by the refugee population in Chad is 2 million; these are people violently displaced, either into camps, into towns, into inaccessible rural areas, or into Chad (for a full account of this figure for total displacement, see mortality assessment of August 27, 2004 by this author; available upon request).
The UN figure cited in the WHO report (approximately 1.2 million Internally Displaced Persons) represents only the aggregating of camp populations in South, West, and North Darfur:
“The study population includes all IDPs within the accessible areas of the three states of Greater Darfur estimated to be 498,528, 382,626 and 288,539 for the West, North and South Darfur respectively by the World Food Programme (WFP).” (WHO Press Release [Geneva], September 13, 2004)
These revealingly (and uselessly) precise figures do not include those who have been displaced into towns; those displaced into camps to which there is no access, or other spontaneous groupings of displaced persons; those displaced persons in the vast rural areas to which there is no access; and the more than 200,000 displaced into Chad. It is these additional displaced persons that justify the assertion that a total of 2 million people are represented by the population in Chad.
The report based on data collected by those working for the Coalition for International Justice (CIJ) is important on many counts, but especially for the finding that “sixty-one percent reported witnessing the killing of a family member.”
Demographic data from the camps and from field workers in Darfur suggest that an average family size of 5 is a reasonable assumption, yielding a total of 400,000 families. If we assume that 61 percent of 400,000 families witnessed the killing of a family member, the total is 244,000 deaths,
This may reflect the same family member being reported by more than one interviewee, but this is very unlikely to be a significant number given the sampling methods of the CIJ team: they chose only one member from any given “household” and randomized both the selection of households and the selection of members from within the households.
A far more significant concern is the fact that in many cases interviewees reported the killing of more than one family member—often several. But in the statistical calculation of “61 percent of families,” this indication of greater mortality is lost. So too are the cases of families that were killed in their entirety before reaching Chad.
We must take the CIJ figure extremely seriously in assessing mortality from violence, and it requires at a minimum that we assume 200,000 violent deaths, allowing a significant margin of error to accommodate the possibility that the Chad population, however accurately assessed, may have been especially susceptible to violent killings. There is, however, no obvious explanation for such heightened susceptibility.
When the US Agency for International Development offered its mortality projections for Darfur in April 2004, a number of assumptions were made, some of which no longer seem to hold (“Projected Mortality Rates in Darfur, 2004-2005” (http://www.usaid.gov/locations/sub-saharan_africa/sudan/cmr_darfur.pdf). Nonetheless, the data cannot be dismissed, and we must look at other mortality factors that were not considered in the original US AID projections.
The US AID mortality projections assumed no successful humanitarian intervention, so that the famine conditions of Bahr el-Ghazal (1998) and Ethiopia (2000) would define both Global Acute Malnutrition and mortality rates (the two correlate extremely highly). Initial malnutrition studies, through June 2004, bore out US AID projections; but subsequent humanitarian intervention has clearly brought down malnutrition and thus mortality. A figure of 13 per day per 10,000 for the war-affected population seems too high for the present, and looking back over the past two months this dictates that the previous estimates for morality related to malnutrition and disease be lowered. The figure suggested by this writer on August 27, 2004 (“over 100,000”) should be lowered to the approximate range of 80,000.
But this is hardly the end of the mortality story on this gruesome front. One reason that mortality is less than the US AID projections indicated in April is that food has begun to reach people in significant quantities (though far fewer than half those in need). But given the logistical difficulties and the lack of transport capacity, food is being distributed within Darfur in such a way that camps have become “food magnets” for increasingly desperate populations. This produces the massive overcrowding we see at camps like Kalma (South Darfur) and contributes to the fourfold increase Oxfam reported recently in Greda. Further, populations that have migrated to the towns and urban areas of Darfur are proving especially difficult to feed, and these populations may soon find themselves forced to migrate to the camps in search of food.
Camp capacity is vastly overstretched at present, with not nearly enough in the way of sanitary facilities or clean water. No matter how valiant the efforts of humanitarian organizations working on the ground, they cannot overcome the sheer demographic force of this accelerating catastrophe and the health threats posed by lack of sanitation, clean water, and access to medical care (critically important if cholera strikes, for example).
In short, though current mortality has been mitigated, it may be a case of “deferred mortality.” An explosive jump in water-borne diseases, related to the manner in which camps have become the only source of food in Darfur, could yet bring mortality to the levels forecast, for different reasons, by US AID.
Significantly, the US AID mortality projections did not assume that continued insecurity would define the humanitarian crisis five months after their data were published. Such insecurity as we find in Darfur today had no counterpart in either Bahr el-Ghazal or Ethiopia (though Khartoum-sponsored muraheleen did present serious security issues in Bahr el-Ghazal: see Human Rights Watch, “Famine in Sudan, 1998” [published 1999]). The consequences of present insecurity have recently been authoritatively discussed by Alex de Waal in the context of the 1984-85 famine in Darfur:
“Apocalyptic predictions of mass starvation were made after the 1984 drought—up to a million dead, aid agencies said, if there wasn’t food aid. The food didn’t come, and many died—around 100,000—but Darfur society didn’t collapse because of the formidable survival skills of its people. They had reserves of food, they travelled huge distances in search of food, work or charity, and above all they gathered wild food from the bush. Today, food reserves and animals have been stolen, and what use is the ability to gather five different kinds of wild grasses, 11 varieties of berry, plus roots and leaves, if leaving a camp means risking rape, mutilation or death?” (London Review of Books, August 5, 2004).
Between insecurity in the rural areas, which prevents critical survival foraging, and increasingly dangerous concentrations of people in terribly overcrowded camps, US AID projections may prove all too accurate.