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
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
Overview continued Health Problems in Children Barriers to Health Comparing Sudan to Australia Positive Development Languages What can you do? Resources
Where is Sudan? Sudan is slightly smaller than Western Australia. The Republic of Sudan is Africa’s largest country & is located in the northeast of the continent.
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.”.
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.
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 1 st civil war began shortly after independence & continued until 1972. 11 years of relative calm ended in 1983 when fighting broke out again.
War in Sudan continued The estimated toll from the 2 nd 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.
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.
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.
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.
What are they Escaping continued In the 2 nd 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. Burning village Um Zeifa, Darfur after a Janjaweed attack. A government soldier who began burning the food storage of the villagers in Marla.
The remains of the village of Jijira Adi Abbe in Darfur, western Sudan after the government attack. 2004 Burnt out village, west of Nyala.
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.
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
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."
Rape as a Weapon of War continued 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
The Long Walk Darfur refugees migrating to safety. Darfurian children taking refuge in their poorly built shelter.
The Long Walk continued Darfurian children taking refuge in their poorly built shelter. Refugees rest after walking 34 days to reach neighbouring Chad. 2004
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
Life in a Refugee Camp continued Refugees in Bredjing, a refugee camp on the easter frontier of the African nation of Chad, near the border with Sudan. 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
Life in a Refugee Camp continued A Sudanese woman in Touloum, a refugee camp in eastern Chad Under 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
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.
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.
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.
Life in a Refugee Camp continued In Darfur a horse and cart is used as an ambulance. 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.
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.
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.
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.
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.
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. MalnutritionNorth Sudan South Sudan Acute16%21% Chronic43%45%
Nutrition in Sudan continued A Sudanese refugee woman holds her sick child suffering from malnutrition. Children under weight for age 41% (of children under 5). Population undernourished 26% (of total pop.)
Nutrition in Sudan continued 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 The photo below shows an example of a daily ration (WFP Food Basket) that provides the required 2,100 Kilocalories (Kcal) of energy.
Nutrition in Sudan continued 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.
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)
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)
Diseases in Sudan continued Respiratory spread disease: Meningococcal meningitis Tuberculosis Measles Animal contact disease: Rabies (Bite from infected animal) Brucellosis (Ingestion of unsterilized meat/milk from animals or close contact with excretions)
Diseases in Sudan continued Other: Nodding Disease ( Fatal - mentally and physically disabling disease that only affects young children – only found in Southern Sudan 1980’s) HIV/AIDS Other Sexually Transmitted Infections
Health Issues In Australia Previous severe/chronic illness, physical trauma: Diseases from Sudan Nutrition/growth Development/Vision/Hearing Physical/Mental Impairment Diabetes Oral & Dental Health Immunisation
Health Issues In Australia continued Low Vitamin D: Healthy bones Optimal muscle function Optimal immune function ?Role in hypertension and CVD ?Role in certain cancers ?Role in Multiple Sclerosis
Witness/Victim of Violence, Torture, Rape. Separation from known life, family, friends: Uncertain of their safety. Guilt in leaving them behind, surviving. Resettlement stressors. Mental Health Issues
Post Traumatic Stress Disorder (PTSD) Anxiety & Depression Fear, Safety, Shame, Trust Issues Social Phobias Nightmares Poor concentration/memory Grief Relationship Problems Mental Health Issues continued
Intrusive images Lack of sleep Numbing & anhedonia Irritability Adjustment disorders Sexual dysfunction Feelings of powerlessness Mental Health Issues continued
Health Problems in Children Low vitamin D levels Positive Mantoux test Low vitamin A levels Anaemia/Iron deficiency Faecal Parasites Positive schistosoma serology Hepatitis B s Ag +ve Positive strongyloides serology Malaria 3 in 4 (29-87%) 1 in 2 (3-63%) 1 in 3 (19-38%) 1 in 3 (10-35%) 1 in 3 (11-39%) 1 in 3 (2-38%) 1 in 10 (2-16%) 1 in 20 (1-8%) 1 in 100 (0.5-10%)
Barriers to Health Language and systems literacy: Interpreters Handouts Print literacy Appointment letters Client awareness of services Service awareness of clients Service awareness of other parts of settlement
Barriers to Health continued Communication style Gender issues Confidentiality
Comparing Sudan to Australia SUDAN AUSTRALIA Land Size Out of 249 countries 10 th biggest6 th biggest Population Out of 237 Countries = 41,980,182 Sudan is 29 th 21,515,754 Australia is 54 th Population Growth Out of 233 Countries = 2.15% Sudan is 42 nd 1.171% Australia is 108 th Unemployment Rate Out of 233 Countries = 18.7% Sudan is 163 rd 5.6% Australia is 51 st Population Below Poverty Line 40%10%* Net Migration Rate Out of 233 Countries = Enter/Leave per 1000 pop 0.59 Sudan is 57 th 6.13 Australia is 11 th
Comparing Sudan to Australia continued SUDAN AUSTRALIA Age Structure 0-14 yrs = 15-64 yrs = 65 yrs and over = 40.2% 57.2% 2.5% 18.4% 67.8 % 13.7 % Total Median Age Male = Female = 19.3 yrs 19.1 yrs 19.5 yrs 37.5 yrs 36.8 yrs 38.3 yrs Total Population Literacy (2003) Male = Female = Definition: age 15 & over can read & write 61.1% 71.8% 50.5% 99% In Sudan only 6% of teachers had been formally trained and 45% had received limited in-service training.
Comparing Sudan to Australia continued SUDAN AUSTRALIA Total Life Expectancy at Birth Male = Female = Out of 224 countries 52.52 yrs 51.56 yrs 53.54 yrs Sudan is 207 th 81.72 yrs 79.33 yrs 84.25 yrs Australia is 8 th Total Infant Mortality Rate Male = Female = Out of 224 countries Deaths per 1000 Births 78.1 Sudan is 18 th 4.67 5 4.33 Australia is 195 th Birth Rate per 1000 pop Out of 223 countries 33.25 Sudan is 41 st 12.39 Australia is 162 nd Death Rate per 1000 pop Out of 222 countries 12.30 Sudan is 29 th 6.81 Australia is 146 th
Comparing Sudan to Australia continued SUDAN AUSTRALIA HIV/AIDS Adult Prevalence Rate Out of 170 countries 1.4% Sudan is 45 th 0.2% Australia is 92 nd People living with HIV/AIDS Out of 165 countries 320,000 Sudan is 22 nd 18,000 Australia is 81 st HIV/AIDS Deaths in 2007 Out of 156 countries 25,000 Sudan is 19 th 100 Australia is 127 th
Positive Development In January 2011, Southern Sudan will hold a referendum to determine whether it should remain part of the Sudan or become an independent country.
Language The number of individual languages listed for Sudan = 142. Of those, 133 are living languages & 9 have no known speakers.
What Can You Do? Increase Empathy: “Walk in the shoes of others.” Brings about attitudinal change. Raise Awareness: Prejudice, attitudes, beliefs. Encouraging people to identify positive alternative views of different groups. Provide Accurate Information: Address inaccurate beliefs/stereotypes about different groups.
What Can You Do? continued Recognising Incompatible Beliefs Increasing Personal Accountability Breaking down Barriers between groups Increasing Organisational Accountability: Includes workplaces, providers of services (school, health services), sports or social clubs. Building Positive Social Norms
What Can You Do? continued Organisational development: Identify & address discrimination. Policies, plans & operational processes. Diversity training. Training & resources that address discrimination & promote diversity. Communications & social marketing: Pro-diversity & anti-discrimination messages. Dispel myths & stereo-typing. Raise awareness.
What Can You Do? continued Legislative & Policy Reform: Develop & implementation of policies, plans & strategies – diversity/discrimination. Monitor existing plans & strategies. Direct Participation Programs: Strategies to engage & promote sustained contact between people from different groups. Community or school based awareness-raising or education programs.
What Can You Do? continued Community strengthening: Locally based efforts to address race-based discrimination. Support the development of leadership within affected communities. Networks, partnerships & activities between different groups. Community cultural development.
What Can You Do? continued Advocate: Challenge attitudes toward minority groups & help build new social norms. ESL support at school. Equivalent access to education, health, justice, housing, sports & recreation, local government, workplace. Peer support: Local groups e.g. sport, art, music. Homework clubs/groups. Social networks.
What Can You Do? continued Information: Understood. Same gender. Accessible. Interpreter.
Resources The following websites have helped with putting this presentation together: Foundation House Sudan Knowledge: www.sudanknowledge.orgwww.sudanknowledge.org World Health Organisation: www.who.intwww.who.int Forced Migration Online: www.forcedmigration.orgwww.forcedmigration.org Central Intelligence Agency: www.cia.govwww.cia.gov United Nations Sudan: www.unsudanig.orgwww.unsudanig.org Mine Action: www.mineaction.org Ethnologue: Languages of the World, Sixteenth edition: www.ethnologue.comwww.ethnologue.com SOS Children’s Villages: www.child-soldier.orgwww.child-soldier.org