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Perspectives from the field

Nurse and international aid worker Ruth Jebb shares here experiences from Darfur, Sudan, where she was managing a Red Cross feeding centre for malnourished children.

I was being driven home from the feeding centre in one of our clearly marked International Committee of the Red Cross (ICRC) land cruisers, unaware that we were being followed. It turned out three armed persons had been following the land cruiser. What I later discovered was that the minute I entered my residence, the armed persons approached the driver and demanded the keys to the land cruiser. They were all armed with AK-47s. He managed to narrowly avoid any harm, but as a result security was heightened and ICRC staff were unable to move around in land cruisers.

The stories I will share with you occurred in 2008 in Darfur, Sudan where I was coordinating and managing a feeding centre for malnourished children. At the time, there were 2,500 malnourished children enrolled in the feeding program. The compounding effect of this single event on my ability to carry out the work I was there to do was significant. All activities, including those conducted at the primary health clinic, feeding centre and all outreach clinics were temporarily suspended for three days, until the motivation behind the attack could be established.

What this meant was that moderately and severely malnourished children did not receive the essential nutritional supplements and medical treatment they required to survive. For some children this was the only food they were receiving. Children that were already on the brink of life and death were further compromised and as a result some died.

Following security clearance, it was decided that all ICRC activities had to be conducted using local transport methods, such as donkey and horse carts, impacting significantly on our ability to respond to emergencies, and transport supplies and patients to the hospital. Sometimes you had to wait an hour for the transport, limiting the medical work you could carry out in one day.

Because of the increase in violence and unpredictable armed movements in the camp after dark, security could not be guaranteed by all the governing parties. This limited our ability to provide adequate health and nutritional services to the internally displaced population over a 24-hour period.

As a result, the feeding centre program was limited to eight hours per day. Malnourished children were seen and treated for a short eight hour period during the day, and then sent home in the hope that they would not deteriorate overnight. Many children required 24-hour intensive nutritional and medical treatment, but due to the security risks associated with running a 24-hour program, the most severely affected had to be flown one hour out of camp in order to access appropriate care.

There were obvious limitations in sending children away from the camp for specialist treatment. Mothers were often unable to accompany their unwell children (as they had other children to care for, or may have been the primary breadwinner for their family); and many of these children died, which added the challenge of dealing with the death and burial of a child away from their family and community.

As a health care worker, though I have not been the victim of violence in the field, the threat of violence has directly impacted not only on my personal sense of safety and security, but also on my ability to meet the ICRC health goal to "give people affected by armed conflict and other situations of violence access to basic health care".

The compounded costs associated with violence against health care workers, facilities and beneficiaries are health care staff leaving their posts, clinics running out of supplies, and suspension of essential health services. These effects dramatically limit access to health care for entire communities, meaning that the sick and wounded do not get the treatment they need, which is often the difference between life and death.

The ICRC HCiD project is one step forward for finding tangible solutions to address one of the biggest humanitarian issues facing us today - ensuring health care workers such as myself can effectively deliver timely health care to those in need.


Photos courtesy Ruth Jebb and IFRC