Meetings

Unlike Iraq, where the UN had delayed their involvement, the UN was here in Sudan, and they were here with a vengeance. Although they were more outspoken and involved than I had ever seen them, the UN leadership still failed to step into the murderous quagmire and demand an end to the vicious hostilities in Darfur. There were no calls to send in UN peacekeeping forces. As if to underscore the UN’s lack of vision and courage, in April 2004, Sudan was nominated for voting membership to the UN Commission on Human Rights in Geneva, and membership was quickly granted. Only the United States protested the obscene image of Sudan voting on and guiding international human rights issues while it waged a murderous campaign against its own people.

Many UN agencies were represented here: the United Nations Office for the Coordination of Humanitarian Affairs (OCHA); the United Nations Children’s Fund (UNICEF); the World Food Programme (WFP); the United Nations Population Fund (UNFPA); the World Health Organization (WHO); the United Nations Development Programme (UNDP); and the Food and Agriculture Organization of the United Nations (FAO), with more still to come. Most of these agencies had been based here for years, involved in the intermittent wars and misery that had plagued most regions of Sudan at one time or another. For the Darfur crisis, the various UN agencies were gearing up and trying to respond to the needs there, which seemed to increase by leaps and bounds every minute of every day.

We attended endless meetings with the UN while we waited for travel permits. Aside from the overall informational meetings, we also attended sectoral meetings for planning in health, water and sanitation, food and food security, protection, shelter, and education. And when those were done, we attended planning meetings intended to plan still more meetings. There were days I thought my head would explode. The World Health Organization (WHO) had informed us at one of the endless meetings that there was essentially no primary health care in Darfur. For this devastated and diseased population, health care was nonexistent, and without rapid interventions, thousands would die needlessly, just as USAID had predicted. We were here and ready to help once allowed into the region, but without the necessary drugs and equipment, our presence in Darfur would be worthless.

I met with UNICEF, and they donated enough essential drugs to cover our anticipated needs for six months. As described by WHO, essential drugs are those that will provide curative care for expected diseases in a region. We signed an agreement that would require us to provide regular reports regarding the distribution of the medicines. With the supply of medicines, we were ahead of the game, and even if we obtained nothing else, we could function effectively.

IRC headquarters had reminded me before I’d left for Sudan that gender-based violence (GBV) and reproductive care are often neglected in disaster situations and that I should make every effort to initiate a reproductive health program. Women in Darfur and throughout Sudan were still routinely victimized by circumcision, or female genital mutilation (FGM), and would require special care to overcome the multiple complications associated with that practice. The women of Darfur were also being abducted, tortured, and raped in growing and alarming numbers. We had to provide care for all of these tormented women.

Female circumcision is traditionally carried out on small girls, usually between the ages of two and nine. The motivation behind FGM includes prevention of intercourse prior to marriage, promotion of cleanliness, and diminishment of women’s sexual pleasure, thereby ensuring faithful wives. Though cleanliness is reportedly a basis for FGM, the practice is anything but, and it often results in lingering infection and, sometimes, death.

There are two main categories of FGM. The suna form of FGM involves removal of the clitoris; the pharonic form involves removal of the clitoris and labia minora, and excision and sewing together of the labia majora. To check the efficacy of the sewing, nothing larger than a match should be able to be inserted into the vagina once the pharonic procedure is completed. This latter procedure allows only the flow of menstrual blood through the vaginal opening. Reversal of the procedure is said to be rarely undertaken, and these girls are allowed to later marry without reversal of the procedure, resulting in excruciatingly painful intercourse. Once a girl conceives, only surgery can release the glut of vaginal and perineal scar tissue so that a vaginal delivery can ensue. Without surgical release of the scar tissue, vaginal delivery will be impossible, and unless an emergency Cesarean section can be arranged, death for the mother and baby is inevitable. The maternal mortality rate in Darfur was among the highest in Sudan, at least in part due to the continuing practice of FGM.¹

Reproductive health care was therefore vital in this region, and to implement it effectively, we would need special obstetric equipment to help us provide routine pre- and postnatal care, in addition to ensuring access to clean deliveries and emergency obstetric care when necessary. We would also be providing rape counseling and providing routine women’s health care in this very un-routine environment. UNFPA had special kits for use in emergency situations, so I met with the director and his staff in Khartoum and presented them with a long list of equipment that IRC would require to provide effective and sustainable health care for women in Darfur. Initially, UNFPA was so bogged down with the bureaucracy of the UN system that it looked as though I would have to sign away my firstborn to access anything. After several meetings, we finally broke through the endless list of requirements and UNFPA donated valuable reproductive and women’s health equipment, which would cover the full spectrum of reproductive care in the coming months. On a handshake and a nod, our agreement was sealed.

I submitted a list of basic equipment needs, including blood pressure cuffs, stethoscopes, suture kits, and the like to WHO in Khartoum. They, too, quickly opened their cupboard and donated what we needed. No bureaucracy there; nothing to sign or even later report on. WHO only wanted to help, and help they did.

We were ready; now we just needed to get to Darfur.