Awatif is 26 years old and in the last month she has seen two of her four children die from malnutrition, within a week of each other. And the one he carries on his back, tied with a threadbare towel, dozes in an alarming state. The young Sudanese woman is one of the 40 women who queue under a scorching sun to collect the bag of food that the United Nations World Food Program (WFP) delivers to people who have just crossed the Chadian border of Adré fleeing the Sudan war. But Awatif says that she arrived months ago in this small town of 12,000 inhabitants, with adobe houses without electricity or running water, next to which more than 140,000 refugees from the neighboring country now live, in the nearby camp of Camp École. From here, the Government of Chad transfers thousands of people in trucks to the official camps that it has distributed along the border, in isolated places and with even harsher conditions.
That of Awatif Issakh Mahamat could be the robotic portrait of those affected by the Sudanese conflict in the Darfur region, which has mutated into ethnic cleansing, which together with the insufficient funds to face the largest humanitarian crisis on the planet in these moments has led to the largest hunger crisis in decades. Different UN spokespersons have been warning of the catastrophe for months, without managing to attract international attention. On the ground, it translates into the state of shock in which Awatif lives, an erratic soul who burns the few calories he eats looking for something to feed his children and going to fetch water.
The woman explains, in a few words, the hell she comes from. Her husband was murdered by the Rapid Support Forces (RSF), successors to the Arab militia that dictator Omar al Bashir commissioned to carry out the 2003-2005 genocide in Darfur. This paramilitary group, which in 2021 supported the Army in its coup d'état against the Government, has been waging a war against it since April 15, 2023 to seize power. In Western Darfur, once again, the RSF is carrying out ethnic cleansing against the Masalit people, a dark-skinned African ethnic group to which Awatif belongs.
According to Human Rights Watch estimates, more than 13,000 Masalit, most of them men and boys, have been killed in the last year. Awatif, like thousands of people, escaped with his children, traveling on foot the five kilometers that separate El Geneina, in Darfur, from Adré. Awatif explains that the militiamen beat and tortured them. He does not specify whether he also suffered sexual violence, a weapon of war that the RSF has systematically used, according to journalistic investigations.
But Awatif's hardships are not over. She is now a victim of the collapse of the international humanitarian aid system, like the almost two million Sudanese who have sought refuge in Chad, South Sudan, Egypt and the Central African Republic. For the first time, in 2023 the United Nations budget for humanitarian emergencies was lower than the previous year: from 30 billion dollars in 2022 (about 28 billion euros) to 21 billion in 2023. And one of its agencies most affected by the cuts has been the World Food Programme. His spokesperson, Pierre Honorat, has said, in reference to the crisis caused by the war in Sudan, that he has never seen “such a large operation so poorly financed.”
Meanwhile, his team in Chad works tirelessly: up to 16 hours a day, 7 days a week. After the previous monthly food distribution, at the end of February, weeks passed without knowing when they could do it again. The situation became so serious that in mid-March they began a new project to deliver four days of food to those who had just crossed the border. Finally, this week they are delivering a monthly package, although with reduced rations due to lack of budget.
“The situation is very critical because it is an emergency that affects many people and, therefore, a lot of food is needed, and the WFP is facing a very serious financial crisis. Thus, we work month by month and once again we don't know if we will be able to make the distribution in May. If we don't do it, it is clear that cases of malnutrition will multiply and deaths will also multiply,” predicts Vanesa Boi, WFP Emergency Manager in the crisis in eastern Chad, in the same plastic store where they make deliveries.
After being alerted about the condition of Awatif's baby and another refugee woman, Boi transfers them to the clinic that Doctors Without Borders (MSF) has built next to the thousands of cane huts that the Government of Chad calls a transit camp. . The doctors confirm the obvious: both suffer from severe malnutrition and must be hospitalized. “In that state, they can only survive a week if they do not receive treatment,” explains Boi. 40% of the minors who are brought by their mothers to this emergency clinic are diagnosed with acute malnutrition. According to WFP estimates, more than 11% of Sudanese refugees suffer from malnutrition when crossing the Chad border, and more than 40% of women and children in the camps suffer from anemia. Awatif stays with her child, while a neighbor takes care of her other son, who she says is in good health.
Doctors Without Borders has been able to allocate a million-dollar budget to care for the victims of this war in Sudan and Chad thanks to the funds provided by its partners. At the Adré clinic alone, they see between 350 and 500 patients daily. The most serious cases are referred to the city hospital, which the NGO manages 50% with the Ministry of Health. The problem is that after being treated, boys and girls have to return to their reality, which is why there are cases like that of Ikram Malik, whose three-year-old son has been hospitalized up to three times. “Here he gets better, but in the countryside, in the heat, living in those conditions, with hardly any water or food, he gets sick again,” he explains while rocking him in another of the hospitals that MSF has built, in this case in Metché. There, two and a half hours of tortuous desert travel, the Government of Chad has resettled more than 50,000 people.
Cordula Haeffner, medical director of the Metché hospital, details: “Many of our minor patients have malnutrition, malaria, respiratory problems... And the worst is yet to come. With the rainy season, we will experience the peak of malaria, which, together with malnutrition, is very worrying.” In one of her beds, Yaya Mohammed lies and keeps flies away from her two twins, who were born weighing less than a kilo each. “In a European hospital, it would be easy to get them ahead, but here it requires a lot of effort and we don't always succeed. Yesterday we had another premature birth. The baby was born alive, but died a few hours later,” explains Haeffner.
Cristina Arquero, head of the nine-person team that MSF has assigned to Adré in the WASH (water, sanitation and hygiene) area, describes: “We are trying to avoid collapse. In emergencies, the minimum amount of water per person is set at 20 liters [per day]. Here, in Adré, we started working when they could only barely get 8 liters. For everything: washing, drinking, cooking, everything. That is what we use to flush the toilet in Spain. Thus it is impossible to maintain minimum hygiene conditions so that diseases and epidemics do not proliferate.” They have opened dozens of wells in the countryside. “Now we are at 13 liters per person, which is still absolutely insufficient. And yet, the most worrying thing at the moment is the lack of latrines. We only have 200 operations, that is, 400 people for each one,” explains Arquero. And without water or latrines, it is impossible to avoid diarrhea - the first trigger of malnutrition - but also other diseases that can be fatal such as hepatitis E - feco-oral transmission - of which there are already numerous cases that, it is feared, , can end in an epidemic.
Sexual violence
Next to the room where Awatif has stayed taking care of her son at the Adré clinic, there is the mental health area. “We cannot contemplate a health access project that does not include the area of mental health,” explains Meria Nadje, MSF project coordinator in this town. The brutality of the ethnic violence unleashed in Darfur makes it even more necessary than in other emergencies: murders in front of family members, disappearances, torture and sexual violence have been used on a massive scale. “Many young women come to us looking for a safe place to tell that they have suffered violence and they usually tell us that they have not yet told it to their families because it is very recent, because of fear, because of the taboo, because of shame. But they need to tell it,” explains Cynthia Matildes, head of Mental Health at MSF in Adré.
In several camps, it is the refugee women themselves who have launched self-support groups to share what happened. Of the more than 15 women interviewed, all of them wanted to explain that they had witnessed this violence. But the means remain absolutely insufficient, despite the fact that some 5,000 people continue to arrive in Chad every month fleeing hunger and war. Víctor García Leonor, head of mission in Chad and Sudan for MSF-Spain, has a request: “We need more NGOs and more United Nations agencies to come. The Government of Chad is open, you can work here. We urgently need more hands.” Soon, when he is discharged, Awatif will have to take her son back to the place and conditions that made him sick. And it is not yet known if by then, the WFP will be able to distribute minimum food rations.