Kalma Camp

There were no meetings here, at least not at first. My role was to get IRC’s clinic in Kalma up and running. There were approximately seventy thousand refugees in Kalma, a large and miserable plot of land dotted with UN tents and water pumps.¹ A few days before my arrival, there were fifteen reported deaths in Kalma—not so unusual, considering the circumstances, but those were only the reported deaths; the real toll was likely higher, as there was no system in place yet for following the mortality rate. Of those who’d died, five were children under age ten who’d succumbed to diarrhea. Of the adults, it seemed, at least by the anecdotal reports I received, that several had died of respiratory infections. These people were so fragile that minor illnesses were killing them.

Kalma was large, covering miles and miles, almost a village really. Bits of green shot through the brown earth, and though few trees remained, a few were visible just beyond the camp. The smell of wood fires filled the air as people prepared their food rations. Children, filthy and dressed in rags, played on a large pile of incinerated garbage, sifting through the ashes. Other children played in the puddles of standing water that had collected after the recent rains. Still others milled about the small bazaar where enterprising refugees were selling food and wares, and anything they could.

Sadly, Kalma already had a violent reputation. It had been closed to aid workers just before our arrival after a CARE employee was killed by IDPs. We learned that a Sudanese national staff member working for CARE was identified by an IDP woman as Janjaweed. She incited a riot when she started to yell that he was the one who had killed her husband. The IDPs, eager to take revenge on the hated Janjaweed, surrounded him, beat him with sticks and stones, and then dismembered and beheaded him. His body lay in the road for six hours before police got through. Once through, they closed the camp. It turned out the victim was not a member of the hated Janjaweed. He was an aid worker just trying to help. But in a volatile situation, no one can be sure who to trust.

The clinic in Kalma was busy from the moment we opened. The Ministry of Health had provided us with staff—one physician, several clinical assistants, nurses, midwives, and a pharmacist. We had medicine and supplies from UNICEF and WHO, and we were treating over three hundred patients daily. Aside from the usual diseases—malaria, fevers, diarrhea—there were exotic diseases as well, such as typhoid, cholera, polio, and meningitis. Added to that, we were mired in an outbreak of acute jaundice, called hepatitis E.²

Hepatitis E had invaded the camps of Darfur, turning young eyes a bright neon yellow and making the weakest even weaker. Tracking the disease was vital in preventing and stopping its spread. We spent our days like detectives, investigating the regions from which the hepatitis seemed to spread. Because symptoms started some six weeks after exposure, we had to find out where people had been six weeks before their symptoms began. Were they in camps, or villages, or on the move? Had they had access to latrines and soap and clean water? With the right information and tools—chlorination, soap, and plentiful latrines—we could halt the spread of this miserable epidemic, which had a 20 percent mortality rate among pregnant women.

Still, even with the emergence of acute jaundice, it was malaria, diarrhea, and malnutrition that were the primary diseases and killers of both young and old, and those would be our main concerns. Having enough medicine to treat our fragile patients was always a problem.

It was always early morning when I arrived at the clinic, but the people of Kalma were already well into their day. A line of people, mostly women, sat quietly on the ground, waiting to be seen. For most, it was likely their only chance to just sit, to rest, to look around. Once we opened the doors to the clinic, the queue for registration seemed endless. As one after another registered to be seen, the complaints seemed a poignant litany of their lives here: diarrhea, fever, weakness. To my eyes, they all appeared frail and sickly. Even the healthiest appearing among them would give us pause at home, but in Darfur, we had learned to accept the sight of these brittle-boned, weary people.

As in every clinic I worked around the world, we saw women and children first, men later. Tradition in so many of these places required that men be first in everything—food, shelter, education—but these women and children would always come first for me. Once registered, they were vaccinated and tested for malaria, then their physical complaints were addressed. Bellies were poked, chests were listened to, fevers were investigated, eyes and ears were examined. For perhaps the first time in their lives, they were the center of attention. Each was given a diagnosis and medicines, a validation of their maladies. The severely malnourished children were referred to feeding centers. For those older children and adults who were malnourished, there was no special center, no treatment, just a quiet understanding, an acknowledgement of their frailty.

People streamed into the clinic throughout the day, but the sickest seemed to come later in the day. They were carried on the back of donkey carts or in the arms of family, and we tended them with an urgency unfamiliar here. We shouted for intravenous fluids and medicines and watched for miracle improvements. Sometimes that happened, and sometimes it didn’t.

A ten-year-old boy, Ali, was carried into our clinic with a fever, vomiting, and abdominal pain. I leaned over his tiny, frail form and palpated his rigid abdomen. He jumped when I pressed in, and I quickly removed my hand from the right lower quadrant of his abdomen. There was nothing exotic about this diagnosis. He had the signs of a straightforward appendicitis, and we transported him to Nyala hospital, where an appendectomy was carried out. Ali was soon home, though home was a plastic-encased hut here in this camp.

Although the appendicitis was not one of them, there were exotic diseases here that we had to consider. Typhoid fever was a distinct threat, as was cholera, though I had not seen either yet. Meningitis and polio reared their feared heads in other areas of Darfur, but not then in Kalma. Our days were filled with the now mundane—malaria, diarrhea, and sometimes acute jaundice. But sickness is never mundane to the people it strikes.