© MSF/Ehab Zawati
31 May 21

Sudan: Striving for humanitarian care where no one cares

Jason Rizzo is a project coordinator who has worked with MSF since 2017 in Sudan, South Sudan, Democratic Republic of Congo, Libya and as part of MSF’s search and rescue mission for refugees and migrants on the Mediterranean Sea. Most recently, he spent five months in Sudan managing MSF’s emergency response for refugees arriving at Hamdayet border crossing from Ethiopia’s Tigray region.

"A grim and urgent image of humanitarian need"

“Oh my God,” a stunned Dr Balah whispered to himself as our pick-up, loaded with medicines and supplies, finally came to a stop.

It was 16 November and we had arrived at the small and dusty village of Hamdayet, wedged at the tip of Sudan’s tripartite border with Eritrea and Ethiopia. Before us lay thousands of refugees who had just fled Ethiopia’s Tigray region.

The Hamadayet border crossing, where refugees from Ethiopia cross the river into Sudan. New arrivals take whatever belongings they can carry with them, some have their livestock’s and  others left with nothing. November 2020.

People were sprawled out across the hard, gritty Sudanese terrain with nothing but an open twilight sky above them. 

"But it was impossible to know where to start when every last refugee among the thousands needed help"

Occasionally, large groups in the hundreds would frantically dash off in any given direction, hoping to find food, water, shelter or just an ounce of human compassion. It was a grim and urgent image of humanitarian need.

Incredibly, six months later, refugees in eastern Sudan are still struggling to fulfil their basic needs and live a dignified life in the face of what has amounted to a miserably inadequate response to their plight. 

"Simple in theory, but daunting in practice"

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As project coordinator for Médecins Sans Frontières/Doctors Without Borders (MSF) in Hamdayet, my assignment was simple in theory, but daunting in practice: to assess and respond to the acute medical and humanitarian needs of both refugees and the isolated Sudanese community that hosted them.

But it was impossible to know where to start when every last refugee among the thousands needed help. 

“Do you know when we’ll go to Um Rakuba?” a young man asked me, referring to the first permanent camp identified by the Sudanese government for newly arrived refugees.

“I’m not sure,” I responded as I fiddled with my phone, trying to get a WhatsApp message through to my head of mission and medical coordinator.

"I let the phone drop to my side and I looked up to see his eyes water"

Um Rakuba camp, Gedaref State, Sudan. November, 2020.

I learned that he was from Humera, about 7 km on the Ethiopian side of the border . “I hear Humera is a nice city,” I said, then added almost unconsciously, “well, was a nice city.”

The words had hardly come out of my mouth before I regretted them. I let the phone drop to my side and I looked up to see his eyes water.

“I’m so sorry… I didn’t mean…,” I searched in vain for a way to take back what I had said. “Yes, it was nice,” he replied. “But I can’t go back now. I don’t know when I’ll be able to go back… if ever.”  

In the days and weeks that followed, others would elaborate on why returning home was not an option for them.

Hamdayet crossing point, Sudan, early morning. November 2020. This crowd walked miles from neighbooring Ethiopia to reach Sudan to escape the conflict in their region.

They told me tragic stories of people being massacred, arrested, harassed, beaten, raped or wounded and left to die on the streets and in the hospitals.

They said that even those who managed to avoid the worst of the conflict were still subjected to decrees preventing them from moving about freely or speaking their native language. 

MSF's response

After arriving in Sudan, a sort of fragile and tense calm prevailed over the refugees in those early days.

There was a lingering sense of shock, loss and despair about being separated from family, community and homeland.

Ethiopian refugees after being dropped off at Al Tanidaba camp, arriving from Al Hashaba and Hamdayet transit centers.

But there was also a deep gratitude to the Sudanese community who opened their homes and hearts to their Tigrayan neighbours.

“There’s not a single Sudanese family that isn’t hosting refugees in their home,” a community leader told me of his neighbourhood in Hamdayet.

"After arriving in Sudan, a sort of fragile and tense calm prevailed over the refugees in those early days"

As for MSF, we sent healthcare workers along the banks of the Tekeze river and to other points where refugees crossed into Sudan so we could check everyone’s health and nutritional status.

Mahlet, 3 months, brought by her mother to the MSF clinic in Um Rakuba camp for the Ethiopian refugees in Gedaref, eastern Sudan.

We sent tractors to collect and chlorinate water from the river and distribute it throughout the village.

And we began supporting a small health facility in the main market, where MSF and Sudanese Ministry of Health staff provided general consultations and other healthcare services for refugees and the host community. 

The MSF workforce consisted of doctors, nurses, midwives, pharmacists, logisticians, community health educators, translators and many others, from both the refugee and Sudanese community.

For many of our refugee staff, work proved to be a welcome distraction from their many worries.

Um Rakuba camp, Gedaref State, Sudan. November 25, 2020.

One of our logistics staff hadn’t seen or heard from his wife in months, not knowing if she were dead or still alive in Tigray.

Another lost much of his savings when his private pharmacy was looted and destroyed.

Still others had suspended their university degrees, anxious to know when or how they could continue their studies. But all of them kept on with their work, while receiving words of support and empathy from their Sudanese colleagues.

"Enormous needs remain"

Despite everything we did and continue to do today, enormous needs remain. Refugees continue to arrive in Sudan at Hamdayet, albeit in lower numbers than before.

Resources have been pulled away to permanent camps, leaving people in Hamdayet without a full array of relief items to meet their needs.

"To their dismay, and despite their pleas, many refugees feel that no one cares"

Hamdayet crossing point, Sudan, early morning. November 2020. This crowd walked miles from neighbooring Ethiopia to reach Sudan  to escape the conflict in their region.

Basic things like sleeping mats, blankets, individual household shelters, culturally appropriate food and essential information that can allow people to make informed decisions are all in short supply, if they’re provided at all.

The same goes for special services and safe areas to care for unaccompanied minors, the elderly and disabled and vulnerable individuals.

To their dismay, and despite their pleas, many refugees feel that no one cares.

A lack of urgency and action at Hamdayet

It doesn’t have to be like this. Yet the lack of urgency and action at Hamdayet is sadly enshrined in a strategy which is referred to, rather ironically, as a ‘fast turnover emergency response operational model’.

Endorsed by the UN Refugee Agency, their partners and Sudanese authorities, the model classifies Hamdayet as a location where refugees should not receive comprehensive relief because, in theory, they stay no more than 72 hours before being moved further inland to a permanent camp.

Ethiopian refugees are being dropped off at Al Tanidaba camp, arriving from Al Hashaba and Hamdayet transit centers.

In reality, the idea that exhausted and traumatised refugees could cross into Sudan and quickly board a rickety bus to distant inland camps is about as feasible as taking a bath in a tub of boiling water.

It’s an unrealistic approach which already showed obvious flaws during past refugee influxes, such as in Bangladesh in 2017, and in Ethiopia’s Liben region in 2011.

Rather than staying 24-72 hours, the overwhelming majority of refugees remain in Hamdayet for weeks or months without receiving all of the basic services and relief they require.

People manage to escape war in Tigray only to undergo a needless trickle of continued suffering and neglect across the border.

After five months, I leave Sudan more concerned than ever about what lies ahead for refugees fleeing Tigray.

Hadahra, 60 year old woman at  Hamdayet Reception Area. February 2021.

Their stories, their tears and their persistence play across my mind as I realise that their plight in eastern Sudan won’t last forever.

Their struggle for basic needs and a dignified life will one day come to an end.

How we respond to the challenges between then and now will define who we are and how we view ourselves as humanitarians, and as an international community that cares… or doesn’t care.

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