SUDANESE… WHY DO THEY NEED OUR SUPPORT & CARE

1. SUDANESE…WHY DO THEY NEED OUR SUPPORT & CARE Jac Griffiths Castlemaine District Community Health (CDCH)

3. Overview • Where is Sudan? • Refugee? • War in Sudan • What are they escaping? • Sobering Facts • Rape as a Weapon of War • Child Soldiers • Trafficking Persons • Landmines

4. Overview continued • The Long Walk • Life in a Refugee Camp • Southern Sudan in 2010 • Living in Sudan • Health Care in Sudan • Nutrition in Sudan • Diseases in Sudan • Health Issues in Australia • Mental Health Issues

5. Overview continued • Health Problems in Children • Barriers to Health • Comparing Sudan to Australia • Positive Development • Languages • What can you do? • Resources

6. Where is Sudan? The Republic of Sudan is Africa’s largest country & is located in the northeast of the continent. Sudan is slightly smaller than Western Australia.

7. Refugee? Is someone who: “owing to a well founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion, is outside the country of his nationality, and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country, or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it.”.

8. War in Sudan • Since independence from joint British-Egyptian administration in 1956 it has been ravaged by drought, famine & war. • Sudan has seen regular turnover of governments but most have been military regimes controlled by Muslim, Arab northern Sudanese favouring Islamic-oriented policies.

9. War in Sudan continued • Disputes with largely non-Muslim, black African southern Sudanese over access to power & resources have resulted in 2 extended periods of civil war. • Sudan’s 1st civil war began shortly after independence & continued until 1972. • 11 years of relative calm ended in 1983 when fighting broke out again.

10. War in Sudan continued • The estimated toll from the 2nd war & associated famine included almost 2 million deaths & more than 4 million displaced people. • In January 2005 both sides signed the Comprehensive Peace Agreement (CPA), which ended the fighting & granted the southern part of the country autonomy for 6 years.

11. War in Sudan continued • Under the terms of the CPA, a referendum on the south’s political future is scheduled to be held in 2011. • Drought, famine, war damage and limited infrastructure in the south have hindered the return of the estimated 500 000 Sudanese refugees who fled to neighbouring countries. • Australia has assisted in resettling some of the worst affected people from the region.

12. War in Sudan continued • The CPA did not end internal conflict in Sudan. In 2003 fighting broke out in Darfur, in the country’s west. • The United Nations is providing humanitarian aid to people in the region. • Since 1983, an estimated 2 million people have been killed and another 4 million people forced to flee their homes & villages.

13. What are they Escaping • Government soldiers & Arab nomad militia, called “janjaweed,” frequently surrounded groups of villages, often encircling them with trenches. • In the 1st phase of the coordinated attacks, government air forces using Russian-built MiG & Antonov jets & attack helicopters, bomb the villages. This 1y.o suffered severe burns when the village of Gosmino in West Darfur was attacked by helicopters.

14. What are they Escaping continued • In the 2nd phase, the soldiers & militia move into the villages to loot, burn, kill, rape, & abduct. Bodies are left out in the open or thrown into the trenches. A government soldier who began burning the food storage of the villagers in Marla. Burning village Um Zeifa, Darfur after a Janjaweed attack.

15. What are they Escaping continued

16. What are they Escaping continued Burnt out village, west of Nyala. The remains of the village of Jijira Adi Abbe in Darfur, western Sudan after the government attack. 2004

17. What are they Escaping continued Mass graves encircle the village of Jijira Adi Abbe in Darfur, western Sudan after the government attack. 2004 Mihad Hamid, a year old girl, whose mother had attempted to escape an attack from helicopter gunships & Janjaweed marauders on their village, Alliet, in October 2004. Mihad had been hit by a bullet, puncturing her lungs.

18. Sobering Facts 100 unaccompanied minors UK, 2004: • Mean age 15 (11-17) • 1 in 3 (37%) death/persecution family members • 1 in 4 (24%) African girls raped 304 Sudanese unaccompanied minors US, 2005: • >1 in 2 (60%) witnessed close friends/family being tortured • 1 in 5 (20%) experienced torture themselves

19. Rape as a Weapon of War • As many as 40 percent of the women interviewed by Physicians for Human Rights for its recent study, Darfur: Assault on Survival, had been raped or sexually assaulted. • In Darfur, a conservative Muslim society, rape victims suffer from stigma and shame. Some married women who are raped are disowned by their husbands, while unmarried rape victims may never marry because they are considered by society to be "spoiled."

20. Rape as a Weapon of Warcontinued • Fearing social isolation, many rape victims do not tell anyone about their trauma, even health care workers. • In addition to suffering in private, many women do not receive necessary medical attention and psychological counselling.

21. Rape as a Weapon of War continued • Those who report rape to authorities but cannot produce four male witnesses may be prosecuted for adultery, whipped, & imprisoned. • Some women who were sexually assaulted were also beaten by their attackers, leaving them with broken bones & internal & external bleeding.

22. Rape as a Weapon of War continued • Post-traumatic stress disorder (PTSD) is also common among rape survivors, & can result in depression, anxiety, nightmares, social phobias, & physical complaints. • A woman who becomes pregnant from the rape must confront a difficult dilemma - abandon her baby, risk community rejection or even legal prosecution by caring for it. • Rape is used by the Janjaweed as a way to 'pollute' blood lines & undermine family bonds.

23. Child Soldiers • Boys and girls are recruited, often forcibly, into both government armed forces & armed groups. • They can serve as combatants, porters, spies, human mine detectors, & sex slaves.

24. Child Soldiers continued

25. Child Soldiers continued • As part of the peace process in Khartoum, the Sudan People's Liberation Army (SPLA) has been releasing hundreds of child soldiers since March 2004. • Many of these children, generally aged 10 to 17, had been recruited by force (from about aged 7 or 8) to fight.

26. Child Soldiers continued In 2001, UNICEF airlifted thousands of child soldiers out of conflict areas to safety zones. It was the largest effort of its kind ever undertaken in Southern Sudan.

27. Child Soldiers continued • Since then, an additional 20,000 Sudanese child soldiers have been released from armed groups (October 2004). Boy soldiers fighting in the oil fields of southern Sudan.

28. Trafficking Persons • Sudan is a source country for men, women, & children trafficked internally for the purposes of forced labor & sexual exploitation. • During the 2 decades-long north-south civil war, thousands of Dinka women & children were abducted and subsequently enslaved.

29. Landmines

30. Landmines continued • Mines were laid on routes, in villages and wells, and across arable land. • The general perception that many roads are mined has led to road closures, with many roads not being used for the past 20 years, at a considerable cost to the movement of people in the country. • This has also hindered aid delivery & development.

31. Landmines continued • The reported number of casualties has been declining over the past few years. • About 40 victims since the beginning of 2009, the majority in Lakes State & Darfur. Awad Wagan, 35 Lost both his lower limbs from a landmine.

32. The Long Walk Darfur refugees migrating to safety. Darfurian children taking refuge in their poorly built shelter.

33. The Long Walk continued Darfurian children taking refuge in their poorly built shelter. Refugees rest after walking 34 days to reach neighbouring Chad. 2004

34. Life in a Refugee Camp The Kounoungo refugee camp in eastern Chad. Iridimi refugee camp, Chad. A serious challenge is providing enough water for the refugees. May 2004

35. Life in a Refugee Camp continued Bahai, Chad. Hadiya Adam Ahmed, who recently crossed into Chad, lives under a tree. She was shot twice by a Sudanese soldier guarding a well. May 2004 Refugees in Bredjing, a refugee camp on the easter frontier of the African nation of Chad, near the border with Sudan.

36. Life in a Refugee Camp continued A Sudanese woman in Touloum, a refugee camp in eastern ChadUnder the midday sun, the temperature could reach a 110 degrees. Bahai, Chad. The few animals that refugees have brought with them are dying from lack of fodder & water around Bahai. The carcasses are burnt to prevent the spread of disease. May 2004

37. Life in a Refugee Camp continued Sudanese refugees wait in line to receive food rations for children under the age of 5 at Touloum refugee camp in eastern Chad. • Sudan is World Food Programme’s largest operation. • They aim to provide assistance to 11 million people in 2010.

38. Life in a Refugee Camp continued In addition to high temperatures in excess of 43.3 °C, the refugees also must cope with sandstorms. August 2010: 60,000 people displaced in Southern Sudan due to floods. Seasonal rains will add to their misery, making access to the camps more difficult & increasing the risk of diseases, such as malaria & cholera.

39. Life in a Refugee Camp continued A Sudanese woman in her tent in Farchana. A pregnant Sudanese woman in Bredjing, another refugee camp in eastern Chad.

40. Life in a Refugee Camp continued The women in Iridimi work every day to keep the refugee camps as clean as possible. They sweep the desert fields despite the sand storms. Animal excrement and garbage are removed every day. In Darfur a horse and cart is used as an ambulance.

41. Southern Sudan in 2010 • Local authorities & assessment teams have reported that approx 700 people have been killed in the violence & more than 152,000 people have reportedly been uprooted from their homes because of insecurity. Property destroyed in Tambura, Western Equatoria in May 2010.

42. Southern Sudan in 2010 continued • The World Food Programme (WFP) estimates the number of severely food insecure people at 1.5 million & the number of moderately food insecure at 1.8 million. • Local authorities & assessment teams have reported that approximately 700 people have been killed in the violence & more than 152,000 people have reportedly been uprooted from their homes because of insecurity.

43. Living in Sudan • There is a severe shortage of schools and health clinics. • People do not even have basic facilities such as electricity and running water. • Most people in Southern Sudan live in small huts and lead a subsistence lifestyle.

44. Health Care in Sudan • The standard of health care in Sudan is not high. • In 2006, Sudan had 22 physicians for every 100 000 people, compared to Australia where there were 247. • Doctors and hospitals are mostly in urban areas and in the north and there is a shortage of medicines.

45. Nutrition in Sudan • Malnutrition is common in Sudan as a result of famine caused by drought & war. • In Children Under 5: (MICS 2000, personal contact with FMOH). • People have insufficient access to safe drinking water.

46. Nutrition in Sudancontinued • Children under weight for age 41% (of children under 5). • Population undernourished 26% (of total pop.) A Sudanese refugee woman holds her sick child suffering from malnutrition.

47. Nutrition in Sudancontinued The photo below shows an example of a daily ration (WFP Food Basket) that provides the required 2,100 Kilocalories (Kcal) of energy. Ingredients: • 400g of cereal flour/rice/bulgur • 60g of pulses • 25 g of oil (vit. A fortified) • 50 g of fortified blended foods (Corn Soya Blend)  • 15g of sugar • 15g of iodized salt

48. Nutrition in Sudancontinued • Prevalence of micronutrient deficiency diseases are high (iodine, VA, iron/folic acid). • Malnutrition is recognized as an underlying cause to explain almost 60% of death in <5. • The three major causes of death in <5: pneumonia, diarrhoea and malaria. • Malnutrition is an outcome of socio-economic development.

49. Diseases in Sudan • Infectious diseases: Very High Risk • Food or Waterborne Diseases: • Bacterial and protozoal diarrhoea • Hepatitis A and E • Typhoid fever • Cholera (major cause of death in the world) • Water contact disease: • Schistosomiasis(Parasitic worm - water) • Guinea worm disease(Roundworm - drinking stagnant water)

50. Diseases in Sudan continued • Vectorborne Diseases: • Malaria (Spread by mosquito’s) • Dengue fever (Spread by mosquito’s) • African trypanosomiasis (Spread by the Tsetse fly–“Sleeping sickness”) • Leishmaniasis (Sandfly) • Loa Loa (Vector Fly - Common symptoms include itching, joint pain, and fatigue) • Filaria(Roundworm spread by mosquito’s – if left untreated it can cause Elephantiasis - thickening of the skin and underlying tissues) • Onchocerciasis (“River Blindness” – Black Fly)