Eric Reeves
December 12, 2004
Building on nine previous assessments of global mortality in Darfur, the current assessment finds that approximately 370,000 have died since conflict erupted in February 2003, and that the current mortality rate has increased to approximately 35,000 per month, though this figure is poised to grow rapidly in light of food deficits forecast for early 2005, increasingly weakened populations that are only very partially served by current humanitarian operations, and accelerating violence that is severely curtailing humanitarian access and transport capacity. (Full text of the most recent previous mortality assessment [November 16, 2004] is available at:
http://www.sudantribune.com/article.php3?id_article=6536)
In less than a month, the genocidal destruction in Darfur will be half that of the Rwandan genocide of 1994. In Darfur, however, genocidal ambitions have a much more expansive time-frame for human destruction. Indeed, there is nothing presently in view that suggests how genocide by attrition can be halted. Present humanitarian aid operations cannot address humanitarian need that continues to increase rapidly; nor can a conspicuously inadequate African Union monitoring presence meaningfully address the acute insecurity that is daily worsening. Resumed diplomatic negotiations in Abuja, Nigeria show no signs of forcing Khartoum to make any political concessions that might resolve the crisis.
The killing will not stop until there is a concerted international humanitarian intervention, with all necessary military support. Such intervention seems wholly without diplomatic or political support.
MILITARY AND SECURITY CONTEXT
Any assessment of current and prospective mortality rates in Darfur must accept as context the very rapidly deteriorating security situation in the region. The primary cause at present is a massively disproportional military response by Khartoum, using all possible pretexts for military assaults that may (or may not) relate to actions by the Darfuri insurgents. This has had the effect of severely curtailing humanitarian operations, even as humanitarian need continues to grow. There are increasing numbers of “no-go” areas; humanitarian workers continue to operate amidst intolerable security risks; humanitarian transport corridors are being shut down; camps for displaced persons continue to be sites for rape, torture, and killings; huge numbers of vulnerable civilians remain trapped in inaccessible rural areas; and there are numerous credible reports of recent widespread civilian displacement as a result of violence by Khartoum’s regular forces and its brutal Janjaweed allies.
Of particular note are fully substantiated reports of large-scale aerial assaults by the Khartoum regime. These assaults, mainly by means of Antonov bombers, come despite Khartoum’s formal pledge to “refrain from conducting hostile military flights in and over the Darfur region” (clause 2 of the Security Protocol of November 9, 2004; signed in Abuja, Nigeria). What is most notable about Antonov bombing attacks is their thoroughly indiscriminate nature: Antonovs are not true military aircraft, but rather retrofitted cargo planes from which high-explosive anti-personnel bombs are rolled out the back cargo bay. They are notoriously inaccurate and of highly limited value for true military purposes. But they are exquisitely effective tools for civilian destruction and terror, as Khartoum has proved over many years in southern Sudan and the Nuba Mountains.
That Khartoum is intent on indiscriminate civilian destruction by military means is borne out by many other recent reports, including the following from the UN High Commissioner for Human Rights, Jose Luis Diaz:
“As an example of the ongoing conflict [Diaz] cited the launching of 18 mortars by Government [of Sudan] forces into the village of Masteri in West Darfur in response to an attack from that region.” (UN News Center, December 3, 2004)
Firing mortar rounds into a village such as Masteri, which has large concentrations of displaced persons (many poised to flee to Chad, according to the UN High Commission for Refugees), amounts to little more than indiscriminate civilian destruction, with the presence of insurgents a mere pretext.
Indeed, reports of extremely brutal military assaults on civilians—by both Khartoum and the Janjaweed—have been authoritatively reported in all three administrative states of Darfur. The regime’s strategy for circumventing the terms of the November 9 Abuja “Security Protocol” is now clear: using any military “provocation” (real or contrived) by the insurgents as pretext, Khartoum will unleash massively disproportional military responses, and count on the inability of the international community to articulate effectively how disproportional this response is.
A telling sign of international behavior in this vein is reflected in a comment by UN Undersecretary for Political Affairs Kieran Prendergast in his briefing of the UN Security Council on December 7, 2004:
“The [Sudan] Government’s use of aerial bombing in retaliation [for insurgency attacks], if confirmed, would also be in breach of the Abuja Protocols.” (Statement to the UN Security Council, December 7, 2004)
“If confirmed….” But of course the use of aerial military assets by Khartoum was fully confirmed over a week before Prendergast spoke. The New York Times reported on African Union monitors taking photographs of a bomb crater in the highly volatile Tawilla area of North Darfur on November 29, 2004:
“On Sunday morning [November 28, 2004], a team of nine African Union military observers, trailed by the first journalists to visit this town [Tawilla] since the attack last week, stared at the shallow crater that a government bomb had left in this now charred group of huts.” (New York Times [dateline: Tawilla], November 29, 2004 [filed November 28, 2004])
Another news correspondent reported from the Tawilla area on November 28, 2004 that, “about a half mile east of Tawilla, a Knight Ridder reporter and photographer found four more [bomb] craters” (Knight Ridder [dateline: Tawilla], November 28, 2004). AU investigators would certainly have also seen these craters.
Prendergast is evidently not interested in the inconvenient but fully established fact that Khartoum has egregiously violated a key term of the Abuja Security Protocol. Indeed, Save the Children/UK had publicly reported Khartoum’s bombing in Tawilla at the time it occurred—yet a week earlier (and because of this statement was targeted by Khartoum for harassment):
“Save the Children/UK said about 30 of its workers were forced to flee on foot when a bomb landed about 50 metres from one of its feeding centres in [Tawilla] town.” (Reuters, November 23, 2004)
Mr. Prendergast had no need for further “confirmation” of Khartoum’s deliberate, indiscriminate bombing attacks; rather, what was missing, as so often with UN political officials, was a willingness to tell the truths that are known. Indeed, Amnesty International had authoritatively reported the day before Prendergast’s comments:
“Two days later [November 28, 2004—i.e., two days after the abduction of 19 men by Khartoum’s army and Khartoum-backed Janjaweed], the Sudanese army and the Janjawid launched a massive raid on Adwa, which was already swollen by tens of thousands of people forced from their homes by previous Janjawid raids. An Antonov aircraft and two helicopter gunships also bombed the town. Estimates of those killed range from 90 to 140. [ ] Some 40,000 people are said to have fled to nearby areas. African Union monitors who came to investigate the attack the following day also came under fire, apparently from the Janjawid.” (Amnesty International press release, December 6, 2004; AI Index: AFR 54/161/2004)
These are the inconvenient realities Prendergast chose to ignore in addressing the Security Council. This unwillingness to speak honestly about Khartoum’s actions in Darfur is part of an ongoing effort to create a factitious “moral equivalence” between the regime and the insurgents, motivated in large part by what is transparently UN impotence in responding meaningfully to the crisis, particularly within the Security Council.
Jan Pronk, Kofi Annan’s special representative for Sudan, is equally culpable, especially in refusing to look at the series of events that have defined escalating violence in the Tawilla area. Pronk has also responded in wholly inadequate fashion to the numerous credible reports of massively disproportional military “response” by Khartoum in other areas of Darfur, and to ongoing violent abuse in the camps for displaced persons (the Sudan Organization Against Torture [SOAT] has recently provided a number of highly authoritative and detailed reports on abductions, arbitrary arrests, torture, death from torture, and rape by Khartoum’s security forces and the Janjaweed in the camps).
Most conspicuously, UN commentary on the violence in the Tawilla area has consistently failed to recognize the terrible atrocities that are the context for the violence now unfolding. One example from earlier this year—one of scores—should suggest why it is entirely unreasonable to expect restraint in the face of ongoing and unconstrained Janjaweed predations in this area:
“In an attack on 27 February [2004] in the Tawilah [Tawilla] 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)
Until there is honesty about the nature of human destruction over the past 22 months of violent conflict in Darfur, it will be all too easy for the UN to contrive “moral equivalence” in describing the continuing violence, and thereby avoid the most basic truth about Darfur: the Khartoum regime has no intention of halting the genocide, or disarming the Janjaweed (who are not party to the November 9 Abuja Security Protocol and act with according impunity, despite a UN Security Council “demand” that Khartoum disarm this brutal force). Current insecurity, created by massively disproportional military actions, ensures that humanitarian capacity will remain severely limited.
THE CURRENT HUMANITARIAN SITUATION
The effort to provide food and other essential relief to civilians in Darfur is failing. This is partly obscured by the shameful belatedness of the UN’s Darfur Humanitarian Profile No. 8 (due at the beginning of November). Nonetheless, much of the data that will appear in this belated document is already available from various other sources. The US Agency for International Development reports that:
“From November 1 to November 28, [the UN] World Food Program (WFP) dispatched 20,151 metric tons of food commodities to implementing partners for distribution to more than 1.1 million conflict-affected beneficiaries. WFP’s planned food distribution for November was 31,500 metric tons for 1.8 million beneficiaries.” (US AID “fact sheet,” Darfur—Humanitarian Emergency, December 3, 2004)
Disturbingly, WFP has without justification lowered its target figure from 2 million to 1.8 million, even as the number of people in need of food assistance is climbing rapidly throughout Darfur. Indeed, the total number of conflict-affected persons in need of humanitarian assistance is approximately 3 million (see below). As long ago as this past June in the so-called day “90-day Plan of Action,” the UN was projecting a population in need of food assistance of 2 million people for October. The October 1, 2004 UN Darfur Humanitarian Profile (No. 7) clearly indicated that the “target population” for food in September was over 2 million (Darfur Humanitarian Profile No. 7, page 15, Chart 8). On what basis other than expediency has the WFP lowered its target figure for November?
Moreover, it must be stressed again that the quality of food aid is seriously inadequate even for those beneficiaries who are reached. A recent study by another part of WFP and the Centers for Disease Control and Prevention (“Emergency Nutrition Assessment of Crisis Affected Populations, Darfur Region,” based on data collected between September 2 and September 20, 2004), reported:
“Of those households with a ration card [troublingly, only 78%—ER] that received a ration in September [2004], more than half did not receive oil or pulses [leguminous foods] (64.5% and 72.8% respectively). [ ] More than half of households (57%) only received a cereal in the general ration in September.” (page 3)
Nor are food supply issues going to diminish any time soon. The head of the International Committee of the Red Cross recently estimated that “around 2-3 million people in Sudan’s Darfur region could be dependent on food aid next year [2005] because insecurity has prevented crop planting” (Reuters, November 30, 2004). This figure does not include the refugee population in Chad, and presumes a very conservative number for the needy populations in rural areas of Darfur presently beyond humanitarian access or assessment. The number in need of food aid will certainly be much closer to 3 million, and could well exceed this immense number.
Moreover, there are few signs that security will permit a spring/early summer planting season in 2005, ensuring that millions of people who are food-dependent will continue to be so into 2006.
There are other problems with the humanitarian relief effort in Darfur. The UN Advance Mission in Sudan (UNAMIS), which has such large oversight and reporting responsibilities for Darfur, has failed to fashion itself into an effective team. It is, according to reports from disaffected sources within UNAMIS, a “nightmare of bureaucracy, inefficiency, and lack of direction.” There is a lack of moral resolve animating this ad hoc organization, far too much merely intellectual debate, and too little hard work.
From the field in Darfur, another extremely seasoned humanitarian worker reports that there is severe deficiency in the overall quality of staff on the ground. While there are of course superb personnel, there are far too many problems in the skill level and field experience of many aid workers, as well as excessive turnover. Moreover, the management capacity and “energy level” on the ground is described as “deplorable,” and there is concern that in many quarters there is insufficient capacity to absorb efficiently new revenues and supplies. Infighting between UN agencies is also reliably reported. Clearly there are severe problems and UNAMIS seems wholly inadequate to provide the necessary oversight. Again, there are notable exceptions, but the global picture of humanitarian personnel, management, and UN operations is troubling.
Khartoum also continues to interfere with humanitarian operations. Reuters reports today that the regime has made good on its efforts to expel Shaun Skelton, head of country operations for Oxfam International. Oxfam was singled out for harassment because of its scathing criticism of the entirely worthless UN Security Council Resolution 1574, November 19, 2004: “The head of the British charity Oxfam has left the country, days after Sudanese officials ordered him to leave for working under a wrong visa” (Reuters, December 12, 2004)
Even Kofi Annan is obliged to note in his December 3, 2004 report to the Security Council that,
“during the last two weeks [of November], [Khartoum’s] process of issuing visas has slowed down for the nongovernmental organizations [NGOs] compared to previous months. In addition, some Government authorities seem to have hardened their position towards international NGOs in allowing them to continue their work unconditionally.” (Section VII, paragraph 28)
THE NUMBER OF DISPLACED PERSONS
The number of displaced persons continues to be severely under-reported in various quarters. Agence France-Presse reported on November 23, 2004 that a senior UN World Food Program official had declared: “By December, there will be two million displaced persons,” and that “this estimate of the region’s torrents of displaced persons was a staggering 300,000 people higher than a World Food Program estimate issued just one week ago [November 16, 2004]” (AFP, November 23, 2004).
But even this estimate for the current month does not take account of refugees in Chad or the large numbers of people displaced since November 23, 2004. In one example, Doctors Without Borders/Medecins Sans Frontieres (MSF) reported on December 1, 2004:
“Two thousand civilians were yesterday forced to flee the village of Saraf Ayat in North Darfur, following the latest in a series of attacks in the region. Many of those caught up in yesterday’s [November 30, 2004] attack had already been forcibly displaced from their original home villages several days.” (MSF, Brussels/Khartoum, December 1, 2004)
Though unstated, the circumstances of the MSF dispatch make unambiguously clear that this was a Janjaweed attack. And again the December 6, 2004 account from Amnesty International indicates the flight of 40,000 civilians from the Adwa area north of Nyala, South Darfur (see above).
In calculating the total number of displaced persons, it is important to recognize that this number has been rising for months (since June 2004) at an average rate of 150,000 per month (Darfur Humanitarian Profile No. 7 [October] shows a straight-line rise in the graph representing internal displacement [page 6, chart 2]). The number of internally displaced persons (IDPs) increased from approximately 1 million in June 2004 to 1.6 million at the beginning of October 2004—again, an average monthly increase of 150,000. In short, there are presently, according to these UN data, approximately 2 million IDPs, the very figure suggested by the UN’s WHO for December 2004 (see above).
But this figure does not include the more than 200,000 people who are refugees in Chad; nor does it represent displacement within the increasingly distressed rural populations that are beyond humanitarian access or even assessment—populations likely in excess of the 500,000 estimated in Darfur Humanitarian Profile No. 6 (September 2004). These populations have continued to be targeted for destruction and displacement by both the Janjaweed and Khartoum’s regular military forces. The data in aggregate suggest a total displaced population of 2.5 million in the greater humanitarian theater. Beyond this, there are likely another 500,000 in growing need of humanitarian assistance. This includes host families and communities whose food supplies have been exhausted; increasingly distressed populations in urban areas not part of the camps; and the remaining elements of the rural population beyond humanitarian reach or access, who may not have been displaced but are unable to produce or acquire food.
DISAGGREGATED MORTALITY ESTIMATES
There are two appendices offered here in support of the conclusions about global mortality in Darfur with which this assessment began: Appendix 1 on violent deaths as of October 8, 2004, and Appendix 2 on deaths from malnutrition and disease.
There have been no recent important additions to the data or reports bearing on violent mortality. It is, however, important to bear in mind a conclusion reached in a key study of violent mortality (The Lancet, October 1, 2004) and recently reiterated by MSF in connection with the Janjaweed attack on Saraf Ayat:
“Mortality studies carried out by MSF show that during the early phases of the Darfur conflict the pattern of repeated violence and consequent displacement was the cause of very high mortality.” (MSF, Brussels/Khartoum, December 1, 2004)
Given the high levels of continued violent displacement over the past two months, we must assume that many thousands more have died, in addition to the figure cited here in Appendix 1. A figure of “over 200,000” violent deaths looks increasingly conservative.
Appendix 2 presents the data and analysis indicating that approximately 135,000 people had died of disease and malnutrition as of November 16, 2004.
The mortality assessment of November 16 also provided data (primarily from the UN’s World Health Organization and the two most recent Darfur Humanitarian Profiles) indicating a monthly mortality rate of 30,000 (again, full text of this previous mortality assessment is available at:
http://www.sudantribune.com/article.php3?id_article=6536). Given the continuing severe shortfalls in humanitarian relief, this monthly mortality rate is clearly rising along with the global Crude Mortality Rate (deaths per day per 10,000 of affected population); the denominator for the current CMR is certainly also increasing (here the continued increase in the number of displaced persons is of particular relevance). An increasing CMR and a population of more, and more severely affected, persons justifies extrapolation of a current monthly mortality rate of approximately 35,000.
Total mortality to date is thus approximately 370,000.
Eric Reeves
Smith College
Northampton, MA 01063
413-585-3326
ereeves@smith.edu
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Appendix 1: October 8, 2004 Retrospective Assessment of Violent Deaths
The previous mortality analysis by this writer (September 15, 2004) highlighted several important new sources of mortality data. The most important of these was a very extensive study conducted by the distinguished Coalition for International Justice (“Documenting Atrocities in Darfur”). On the basis of 1,136 carefully randomized interviews, conducted among the Darfuri refugee population in Chad at a number of camp locations along the border, the Coalition for International Justice (CIJ) found that “sixty-one percent [of those interviewed] reported witnessing the killing of a family member.”
The total number of refugees in Chad is now greater than 200,000. If we assume that this population of persons displaced from Darfur is representative of many hundreds of thousands of violently displaced persons within Darfur, then the total number people represented by the CIJ study is over 1.5 million, and may reach to 2 million.
How do we establish the approximate figure for those people violently displaced, either into camps, into towns, within inaccessible rural areas in Darfur—or into Chad?
In its most recent “Darfur Humanitarian Profile,” the UN Office for the Coordination of Humanitarian Affairs estimated that 1.45 million people have been displaced into accessible camps within Darfur; this figure is based on food assistance registrations by UN and nongovernmental humanitarian organizations (“Darfur Humanitarian Profile,” No. 6, September 16, 2004, page 5). The UN report also estimates that an “additional 500,000 conflict-affected persons are in need of assistance” (page 9), and it is reasonable to assume that most of these are displaced persons in inaccessible rural areas. (Even a figure of 500,000 almost certainly understates the number of displaced persons in rural areas.) Moreover, the UN report does not attempt to assess either the host communities or the size of displaced populations in the three state capitals because there are still no systematic food registrations in these large urban areas.
Thus out of a total displaced population in Darfur of over 2 million, we require an estimate of the number of persons who experienced violent displacement of the sort that created refugees in Chad. Given the extremely high level of village destruction throughout Darfur, and the tenacity with which these people have sought to cling to their land and livelihoods, displacement per se is a very likely indicator of violent displacement.
Moreover, a recent epidemiological study published in The Lancet offers clear evidence that displacement is overwhelmingly related to violent attacks. In two camps, Zalingei and Murnei, statistically rigorous assessments found that “direct attack on the village” accounted for displacement of 92.8% of the Zalingei population and 97.4% of the Murnei population (the combined camp populations is approximately 110,000) (The Lancet, October 1, 2004, “Violence and mortality in West Darfur, 2003-04”).
If we conservatively assume that 80% of the total displaced populations that have remained in Darfur were driven to flee by “direct attack on villages,” the number of violently displaced persons is 1.6 million.
This yields a total figure of violent displacement, for Chad and Darfur, of very approximately 1.8 million. The average family size in Darfur is slightly more than five, suggesting that a population of 1.8 million represents almost 360,000 families. If randomized interviews by the Coalition for International Justice (CIJ) find that “sixty-one percent [of those interviewed] reported witnessing the killing of a family member,” then this yields a mortality figure for violent deaths of over 200,000 human beings.
Caveats and other considerations:
There is some chance that despite randomizing of interviews in Chad, and multiple camp locations at which interviews were conducted, overlaps exist in the “family members” identified as having been seen killed. This is a negligible number if “family” refers to nuclear family. Indeed, the chances of overlap even for members of extended families are quite small, given the diversity of interview locations.
More significant is the fact that those conducting interviews for the CIJ found that interviewees often reported more than one family member had been killed, often several more than one. Yet the statistical derivation offered here presumes that only one family member has been killed among the 61% who reported seeing (at least) one family member killed.
Secondly, the study cannot take account of the number of families in which all members were killed, and who thus had no reporting presence in the camps where interviews took place. The CIJ study does report that 28% of those interviewed “directly witnessed” persons dying from the consequences of displacement before reaching Chad. These deaths must be considered the direct consequence of violence, if not violent deaths per se, and would significantly increase violent mortality totals.
Moreover, the CIJ study indicates that 67% of those interviewed “directly witnessed” the killing of a non-family member.” As the raw data from the CIJ study is soon scheduled for release, it may be possible to put this extraordinary figure in a statistical context that is yet more revealing of violent mortality. Given the number camp locations (19), and the randomizing techniques used within the camps—
“refugees were selected using a systematic, random sampling approach designed to meet the condition in Chad. Interviewers randomly selected a sector within a refugee camp and then, from a fixed point within the sector, chose every 10th dwelling unit for interviewing. [ ] One adult [from the dwelling unit] was randomly selected [for interviewing]” (page 5)—
—the figure of 67% of refugees “directly witnessing” the death of a non-family member strongly suggests that assumptions made in this analysis may lead to significant underestimation.
In light of these various CIJ findings, and data reported in The Lancet, a figure of 200,00 violent deaths over the past 20 months of conflict seems a conservative estimate.
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Appendix 2: November 16, 2004: Retrospective Assessment of Deaths from Disease and Malnutrition
Mortality figures and reports continue to be very badly misrepresented in news accounts; this is true in particular of the assessment by the UN World Health Organization (WHO) study of health-related mortality in Darfur. This misrepresentation has had the extremely unfortunate effect of giving apparent UN authority to a putative total morality figure of “50,000” deaths (and more recently “70,000”). What the WHO study and accompanying public commentary represented—as explicitly confirmed to this writer by David Nabarro, chief of emergency operations for WHO—was a figure of more than 50,000 deaths from disease and malnutrition, from early April 2004 to mid-September 2004, in camps to which there has been humanitarian access.
The WHO figure did not include violent deaths; it did not represent morality in Chad; and it did not represent mortality in areas inaccessible to humanitarian operations. Most significantly, it did not include deaths from disease and malnutrition prior to April 2004 (again, the conflict began in February 2003). In short, the mid-September WHO figure was of highly limited relevance. Further, as Dr. Nabarro confirmed to this writer by telephone communication, the WHO figure for monthly mortality should be closer to 10,000 in the “6,000 to 10,000 deaths per month” range reported as coming from WHO. Only such a higher number begins to take adequate account of populations more difficult to assess.
In the two months since the WHO report was published (assuming with Nabarro the higher mortality rate), 20,000 people have died, suggesting that more than 70,000 people have died in accessible areas since April 2004.
Mortality in rural areas to which there is no access is best assessed on the basis of the US Agency for International Development projections (“Projected Mortality Rates in Darfur, 2004-2005” (http://www.usaid.gov/locations/sub-saharan_africa/sudan/cmr_darfur.pdf). We may use as a very conservative denominator for these projections the figure of 500,000 inaccessible persons in need of humanitarian assistance, promulgated by the UN in its September “Darfur Humanitarian Profile” No. 6 (troublingly, no updated figure was estimated in the October “Darfur Humanitarian Profile” No. 7). For the past five months, US AID projections indicate an average Crude Mortality Rate of almost 10 per day per 10,000 (for a population without humanitarian relief and experiencing severe food shortages). Over 150 days, assuming an average denominator of 500,000, total mortality is approximately 75,000. These deaths would be primarily among very young children, the elderly, and those made vulnerable from violent trauma.
Still, a figure of 75,000 may be too high for several reasons, primarily the highly developed foraging abilities of these people and the use (and likely exhaustion) of food reserves. On the other hand, insecurity produced by continuing Janjaweed predations would compromise both of these food sources. If we assume (very conservatively) that a figure of 75,000 overstates by 100%, this still leaves a figure of over 35,000 deaths from malnutrition and related disease over the past five months in inaccessible areas of Darfur. Together with the figure deriving from the September WHO report and data, this suggests a composite figure of 105,000 deaths from malnutrition and disease since April 2004.
Still excluded from this figure, however, is the number of deaths from disease and malnutrition during the period February 2003 to April 2004. During this period several humanitarian organizations reported high Crude Mortality Rates at various junctures. Many thousands died in the camps, especially children, though there is no systematic data that permits extrapolation of a total figure. If we assume a level of death from disease and malnutrition only one-fifth the current rate estimated by WHO (for a stronger camp population, and one that has only gradually grown to its present size), then another 30,000 have died from these causes.
Total mortality from disease and malnutrition is thus approximately 135,000.