350 a day could die in Sudan, UN says

[gottaB]

As many as 350 people could die daily in camps in Sudan's western Darfur region when the rainy season starts unless conditions improve dramatically, a United Nations health agency official said yesterday.

The World Health Organisation (WHO) estimates that one million of the 1.2 million of the regions' displaced ethnic Africans are staying in camps where they are dying at a rate of about 200 a day, said David Nabarro, the head of crisis operations for the WHO.

However, the figure is lower than in March, when people were dying at a rate of about 300 to 700 a day, he said.

"This may not seem like a lot but it's 20 times the normal death rate in a developing country," Dr Nabarro said. "And as the rains set in and if relief is not provided, we believe the death rate will bounce back up."

350 a day could die in Sudan....

***

Dr. Nabarro estimates that in the last six months, 50,000 people have died of disease. That would appear to be in addition to the oft-quoted figure of 30,000 who have been killed in the conflict. If these estimates are correct, then, the cumulative death toll for the military campaign against non-Arabs in Darfur could reach 100,000 before August.

I believe Dr. Nabarro's estimates are consistent with reports from independent journalists like Hilary Andersson of the bbc of the number of graves being dug in the refugee camps. From Andersson's latest report:

Sudan's government, under pressure from the outside world, has recently lifted many restrictions that were frustrating efforts to get aid into Darfur but aid agencies now face difficulties negotiating roads clogged by rains.

In Mornay alone, scores are dying of disease and malnutrition every week. New graves are being dug daily.

International aid agencies have warned that many thousands could die in the months ahead.

One of their greatest fears now is that there will be outbreaks of cholera.

At the moment I can't think of a full report that would either confirm or contradict Dr. Nabarro's estimates. The msf (Doctors Without Borders) reports tend to be bleak, e.g. from May, The Humanitarian Situation in Darfur, and their latest reports (MSF in Sudan: "We don't have any choice") indicate that in addition to a paucity of supplies, security continues to be a major problem.

***

On Edit: spoke to soon. There is a USAID study with revised figures of cumulative mortality. As summarized by Eric Reeves (Darfur mortality update)

In the absence of a credible rival figure, political action, news reporting, and moral assessment of the catastrophe in Darfur must presume a casualty total of approximately 135,000 human beings.

Reeves takes into account Dr. Nabarro's recent estimates.

[gottaB]

1. WHO mortality survey

The WHO concluded a mortality survey for idp camps in Darfur, Survey concludes deaths in Darfur exceed the emergency threshold. The report is not complete apparently because of problems with violence in South Darfur. Reuters filed a report, Up to 10,000 dying a month in Darfur camps -U.N., which features comments by Dr. Nabarro.

As awful as these numbers are, they seem to contradict the dire estimates of Eric Reeves (Darfur Mortality Update IV). Seem to. In fact, although the data are limited, it is clear that some of the conclusions reported by Reuters don't add up, and that although the situation is not nearly as bad as USAID's worstcase projections, it is far from rosy, and far worse than commonly reported.

How many have died? First, the claim that the mortality rates reported by the survey are in line with the total death toll estimate of 50,000, which Dr. Nabarro reportedly affirmed on Sept. 13, simply cannot be true if Dr. Nabarro's June estimate of 50,000 dead due to the effects of starvation and disease is also true. The 50,000 figure makes sense given the ranges between 700 deaths per day and 200 deaths per day that Dr. Nabarro reported for the months between February and June. Secondly, the lowest range reported for the rainy season months (6,000 per month, or roughly 200 per day) most certainly is too low based on the survey data. So it's not even a question of 50,000 plus 3 months of 6,000 people per day dying equalling 68,000 dead, which may be in some minds approximate enough that one needn't contradict other UN authorities.

How many are dying every day? The survey estimated a base population of 1,169,693 internally displaced persons (idps). In North Darfur, the population of idps was estimated to be 382,626 and the crude mortality rate (cmr) was found to be 1.5 deaths per 10,000 people per day. In West Darfur the population was estimated to be 498,528 and the cmr was 2.9. If one puts the an optimistic spin on it, and assumes that the cmr for South Darfur is as low as it is for North Darfur, then one can conclude that 100 people are dying each day in idp camps in North and South Darfur, and 145 people are dying each day in idp camps in West Darfur, for a total 245 deaths per day, or 7,350 per 30 day period. 6,000 per month is not a figure based on the survey data.

Is 7,350 per month close to the truth? Not especially. If one adds in the several hundred thousand Darfuri refugees in Chad, and the estimated 270,000 idps considered to be living in host communities that have not been reached by UN agencies--I'm not sure at the moment if that figure includes the multitudes hiding under shrubs--and one applies the lowest reported cmr, then one would assume that 71 of these people are dying each day, or 2130 per month. Therefore a death toll of 9,470 per month among the Darfur region's diplaced population represents the most optimistic view.

Is optimism warranted? Yes and no, but mostly not really. The WHO reports: "Data from Kalma camp near Nyala indicate high death rates and underscore the urgent need to complete data collection in the South." Based on that statment, one would not be inclined to think the cmr in West Darfur is remarkably anomolous. Applying the lowest reported cmr of 1.5 per 10,000 to other areas in all likelihood undrerepresents the number of total deaths.

And then there is the question of the total war-affected population, about 2.5 million if one includes those in Chad. I don't know of any total mortality survey for the war-affected, but it's likely that many people are dying unnecessarily outside the population in the idp camps.

The violence of course continues, and people are fleeing in the tens of thousands. Notably, the recent WHO survey reported violent deaths and deaths due to injury in the past 60 days, which particularly impacted adolescent and adult males. Dr. Nabarro's June estimate of 50,000 dead did not attempt to account for deaths due to slayings.

Bottom line: According to WHO mortality data, at least 78,410 Darfuris have died since February. That figure does not account for deaths due to violent bloodletting in the period between February and June. Nor does it account for deaths among the total war-affected population. This number represents a minimum estimate. There are indications that the actual number of dead will prove to be much larger.

[gottaB]

2. MSF reports

I haven't dug up the actual reports from Epicentre, but Doctors Without Borders (MSF) reports that mortality rates in some of the larger camps in South Darfur are significantly above the emergency threshhold (1 per 10,000 per day):

Aid to Displace People in South Darfur Remains Insufficient.

An MSF news update from August reported cmrs in various areas of Darfur of between .5 and 3 (MSF activities in Sudan, Aug 15, 2004).

The WHO's survey found a cmr of 3.9 for Kalma camp, iirc. MSF/Epicentre found it to be about 1.6, if I'm not mistaken in my calculations. The difference may be due to the difference in time frames. The MSF's retrospective mortality survey looked at the last seven months. The WHO's looked at the previous two monthts.

The UN has raised its estimate of the number of displaced to 1.65 million. That includes the refugees in Chad. I haven't seen a revised number of the population considered to be war-affected. That number is probably quite large.

MSF reports that violence acts continue to account for many deaths. Violations of the cease-fire on all sides have been reported. The government of Sudan continues to launch helicopter gunship strikes against civilians, according to AU monitors. People continue to flee by the thousands.

Given this data, I don't see any reason to assume that less than 10,000 people per day are dying in Darfur. Dr. Nabarro's orginal worried forecast of 350 deaths per day appears to have been close to the mark.

[gottaB]

3. WFP and WHO mortality data

The WFP concluded a nutritional survery that suggests that the crisis in Darfur is being brought under control:

http://www.wfp.org/newsroom/subsections/preview.asp?content_item_id=2000&item_id=1108§ion=13

Meanwhile, Dr. Nabarro crunched the numbers and made a mortality assessment that would suggest that the crisis has not been brought under control:

http://www.who.int/mediacentre/news/briefings/2004/mb5/en

Violence has increased in recent weeks, and aid agencies have withdrawn or been expelled from some camps. That leads me to suspect that Nabarro's worst case scenario may be close to the truth.

On a side note about worst case scenarios, USAID last month responded to criticisms of its mortality projections by claiming that they were still true, and that the death toll could reach 350,000 in the next several months. Actually, they fudged it. First, they moved the date range into early 2005, which is appropriate if one is making the point that many people are at risk, but is a different claim. Second, they did not reaffirm their initial worst-case scenario, which predicted that a million people could die.

I don't know why they just didn't admit that their projections had changed. If USAID's initial projection of a best case scenario turns out to have been off by a factor of .5, that's still (a) a lot of people killed for no good reason, and (b) more accurate than many other estimates that have been put forward. In any case, their current estimates seem reasonable. If the violence is halted and the aid agencies are allowed to do their jobs, then it will probably seem high. Otherwise, it will be on target, and could be low.