FAMINE
(Eric) We can no longer speak of the “threat of famine” in Darfur…famine has descended on this ravaged region. The absence of a reporting presence within the various regions of this vast part of Sudan (it is the size of Spain) limits our understanding of the full extent of malnutrition and food insecurity; but we have enough information—from various sources—to draw an inescapable inference. We may mitigate the effects of this famine, but we cannot stop it anytime soon. Indeed, we may end up measuring mortality from this man-made catastrophe in the hundreds of thousands.
The coordinating counselor for Team Zamzam has again provided a superb overview of the conditions that prevail within the IDP camp and its surroundings, including El Fasher. But my own effort here will be to give a more general account of the epidemiology of this most extreme form of food deprivation. By way of contextualizing a sometimes technical account, I begin with one of the “headlines” that has made its way, at least partially, into global awareness. The most shocking report comes from Doctors Without Borders/ Médecins Sans Frontières (MSF)—the only humanitarian organization with a true presence in Zamzam camp (operating an important, if limited, medical clinic):
“The malnutrition crisis in Zamzam camp, North Darfur, requires an urgent humanitarian response as an estimated one child is dying every two hours.”
But other accounts have been equally terrifying in their implications:
“In an exclusive interview yesterday with Radio Dabanga, Mary Louise Eagleton, deputy representative of the United Nations International Children’s Emergency Fund (UNICEF) in Sudan, sheds light on the organisation’s efforts to confront the dire humanitarian circumstances currently impacting at least ‘four million children with acute malnutrition, with ‘730,000 of them suffering from severe acute malnutrition’ in the country.”
Here I must pause to give a preliminary contextualizing to this comment. “Severe acute malnutrition” (SAM) is actually a technical term in humanitarian medicine and requires a certain threshold(s) to be met (e.g., a MUAC [Mid-Upper Arm Circumference] figure below 115mm) in children under the age of five, Mortality rates in this population have been assessed in various epidemiological studies at between 10 – 15 per cent.
And this is for children in medical settings; most children suffering from SAM—like those in most of Darfur—are unassessed and currently have no access to a medical facility, one that might provide the therapeutic feeding necessary to overcome the devastating effects of SAM. The mortality rate for such children simply can’t be calculated, but it must be extremely high.
Thus even if we use the lower estimate of 10% for SAM mortality rates, of 730,000 SAM cases in Sudan, 73,000 children will die, disproportionately in the peripheral and marginalized regions of Sudan. And the figures offered by UNICEF are already those for the recent past; as Darfur moves further and further into the “lean season” (also known as the “hunger gap”). These figures will grow dramatically, as the map below makes clear (there was virtually no harvest in much of Darfur this past agricultural season because of violence, and humanitarian food aid is not reaching Darfur in remotely adequate quantities):
This map indicates many things, but most terrifyingly that virtually all of Darfur is one step away from full-scale famine, famine that in fact has begun in many locations. And even were therapeutic feeding resources to become available in the near term—and there are no signs that this is the case—tens of thousands of children would die of starvation in any event: One study by The American Journal of Clinical Nutrition found that the mean inpatient mortality for SAM among children under five was 15.7%. Another study found that one in six children with SAM leaving a medical setting needed to return within a year.
The American Journal of Clinical Nutrition Severe has found that “acute malnutrition (SAM) is a medical emergency that if left untreated confers a risk of mortality on par with the worst diseases in pediatrics”—e.g., diarrhea, tuberculosis, pneumonia, malaria.
Food insecurity is of course a critical global issue. An article in the journal Nature Portfolio found this past summer that “Malnutrition underlies 45% of deaths in children under-5 years annually. UNICEF has found that: “Globally, 1 in 5 deaths among children under the age of 5 is attributed to severe wasting – also known as severe acute malnutrition – making it one of the top threats to child survival, robbing the lives of more than 1 million children each year.” The humanitarian organization World Vision notes starkly: “Acute malnutrition, also known as ‘wasting’, increases the risk of serious illness or death. Globally, an estimated 45 million children under five years suffer from wasting, yet only 1 in 3 children receive the necessary treatment.”
And SAM has come to Darfur, indeed has been increasing for months. The pain and frustration expressed so poignantly to members of Team Zamzam are to be found everywhere in Darfur. And here again, it is MSF’s assessment of Zamzam camp that should command our attention:
“A rapid nutrition and mortality assessment carried out by MSF reveals that a catastrophic situation has unfolded in Zamzam camp, North Darfur, since the conflict in Sudan began in April 2023. All emergency thresholds for malnutrition have been reached and MSF is calling for an immediate, coordinated and rapid scale-up of the humanitarian response in order to save lives.”
There is simply no reason to believe that the crisis in food security is any less urgent in other camps for displaced persons in Darfur, although for most there is no humanitarian presence to provide reports on conditions. Indeed, Zamzam IDP camp and the nearby capital of North Darfur State (El Fasher) have for many become magnets because of the (thoroughly) relative security of the area. El Fasher is the only State capital in Darfur not controlled by the unfathomably cruel and rapacious Rapid Support Forces and their Arab militia allies. They bear primary responsibility for the inability of humanitarian organizations to make their way to Darfur from Port Sudan on the Red Sea, a journey of roughly 1,500 kilometers.
And of course food insecurity takes its toll on the entire population; starvation spares no one. If children are more vulnerable, have fewer defenses against malnutrition and its typical co-morbidities, adults are already dying in Zamzam at a rate that—if extrapolated to areas not currently assessed—would make clear that famine is now expanding:
“The emergency threshold for moderate and severe acute malnutrition combined (the Global Acute Malnutrition rate – GAM), which indicates that urgent action must be taken, is 15 per cent—making it clear that a serious emergency situation is present in Zamzam camp.
“The total number of deaths in the camp per day was also cause for extreme alarm, with a crude mortality rate of 2.5 per 10,000 people per day – more than double the emergency threshold. Forty per cent of pregnant and breastfeeding women were also found to be malnourished – another indicator of the intense severity of the situation.”
This is indeed a shocking figure for Zamzam’s crude mortality rate (CMR) and augurs the bleakest of futures for all of Darfur.
What is the technical definition of famine?
The most commonly used definition of famine comes from the Integrated Food Security Phase Classification (IPC), stipulating three criteria:
[1] at least 20 percent of households face extreme food shortages with limited ability to cope;
[2] the prevalence of global acute malnutrition must exceed 30 percent; and
[3] crude death rates must exceed two deaths per 10,000 people per day.
We know that in Zamzam, MSF has found a crude mortality rate (CMR) of 2.5%, exceeding the famine threshold. We know from reports over the past year that coping strategies have been severely compromised throughout Darfur and that the Global Acute Malnutrition rate is at least the 15% MSF reports. We also know that the World Food Program has designated nearly all of Darfur, including North Darfur, as falling in its most extreme category short of famine: there is a “very high level of insufficient food consumption” (see above).
The Global Acute Malnutrition rate for Darfur offered for Zamzam by MSF does not reach the famine threshold, but this is unlikely to be representative of North Darfur as a whole and may not be representative of Zamzam as it exists since the MSF data were collected and analyzed. In any event, even using the MSF figure, the situation in Zamzam is already still perilously close to the IPC threshold of “at least 20 percent of households face extreme food shortages.” Moreover, the bi-monthly assessment missions by Team Zamzam over the past year certainly suggest a figure well in excess of 20% in Zamzam camp. The widely used Famine Early Warning System Network (FESWSNet) found earlier in February of this year that:
“Food assistance needs in Sudan are rapidly accelerating due to the recent expansion in fighting between the Sudan Armed Forces (SAF) and the Rapid Support Forces (RSF) into the southeast. Sudan is now expected to have the third highest share of the population in need among FEWS NET’s monitored countries in 2024.”
This “acceleration” derives in large part from a recurring calendric fact: “The lean season – when the harvest from the previous year has been exhausted and prices of food are at their highest – is expected to come as early as March,” [the FEWSNet spokesperson] said. “If nothing changes between now and then, we can expect deepening hunger in El Geneina, Omdurman, and other high-risk areas of Sudan.” Darfur as a whole is clearly a “high-risk area.”
Without data from locations other than Zamzam, we cannot say with certainty that famine exists in North Darfur or other states in Darfur. But all anecdotal information and reports, aggregated, strongly suggest that famine does indeed exist. (See this month’s report from the Coordinating Counselor for Team Zamzam here]
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Despite these grim reports, our project in Zamzam continues to provide significant assistance to thousands of people in desperate need, a fact not noted in a recent and insufficiently informed dispatch from The Guardian (dateline: Addis Ababa), “Inside the Darfur camp where a child dies every two hours.”
Counseling and other assistance have been provided to many thousands of girls and women traumatized by sexual violence of the past 20 years; we have fully rehabilitated eight water wells, now serving well over 10,000 people, according to my colleague Gaffar. Many thousands of pounds of food, medicine, sanitation supplies have been brought into the camp over the past three and a half years.
A recent distribution of milk to badly undernourished children
A special food distribution to children, October 2023
Distribution of food occurs throughout the month as long as our budget permits
Water from a recently rehabilitated well
A newly rehabilitated well is cause for a general celebration…and thanks…
Many are grateful
…and the need for psychosocial counseling for girls and women who have been the victims of brutal sexual violence continues unabated
In some sense this is a very small amount of assistance: after all, the population of Zamzam as a whole (including areas adjacent to the camp) has grown to some 450,000 people—perhaps greater. But Team Zamzam is a continual reminder to the camp that the world has not entirely forgotten them. In my twenty-five years of working to help the people of Sudan and South Sudan, nothing has seemed to me more powerful than their desire not to be forgotten, not to be left out, not to be without any hope of help. If nothing else, the Team Zamzam project sends a clear signal: “You will not be forgotten!”
How to Help
Assistance is urgently needed and will be greatly appreciated by Team Zamzam, and by the girls and women—indeed all camp residents—whose suffering they seek to alleviate. The distribution of food and medicine presently comes as many within the camp daily move closer to starvation and severe morbidity. Here I should also stress the tremendous efficiencies of purchases by a staff with local knowledge, as well as the value of their deep understanding of where need is greatest within this vast camp, swollen with recent displacements caused by insecurity.
NB: It is now possible to make a tax-deductible contribution to our project, using a portal on the website of a 501/c/3 organization operating in Sudan. Operation Broken Silence, working primarily on health and education issues in the Nuba Mountains of South Kordofan, has created a special site for a tax-deductible contributions to our project, and we hope this makes contributing to the health and well-being of girls and women in Zamzam easier for donors.
We also hope that all will keep in mind our project as a whole operates with truly extraordinary efficiency, in ways matched by no humanitarian organization operating in Darfur that I am aware of, a region I have been researching for two decades. There is absolutely no overhead for this project.
Those wishing to assist in funding the work of Team Zamzam may also send a check directly to Eric (Eric Reeves, 31 Franklin St., Northampton, MA 01060)
OR
Purchase one of his woodturnings: https://www.ericreeves-woodturner.com/gallery
100% of the purchase price of every woodturning directly supports the project in Zamzam.