(0:00) Hello, my name is Emmanuel Berbain, I'm the medical doctor, I'm nutrition referent with MSF France (0:10) and I'm currently in El Fasher, a locality in North Darfur, in east of Sudan. (0:17) For more than 8 months, in Darfur, the eastern region of Sudan has been facing major humanitarian crisis (0:23) with catastrophic consequences. (0:25) The war between Sudanese armed force and the Rapid Support Forces, the massacre of Masalit civilians, particularly in West Darfur (0:36) have led to massive population displacement across the border, notably to eastern Chad (0:41) and an internal displacement of people looking for safer area, including North Darfur (0:50) with disastrous health consequences for the civilian population.

(0:54) We now consider and approximate more than 1.1 million IDPs, internally displaced people, in North Darfur. (1:05) The population is surviving in a situation that remains unimaginable for the rest of the world (1:11) in terms of access to water, to food, to the minimum health services. (1:16) Before the start of the war, since April last year, in 2023, the population's minimum survival (1:21) was already really precarious, relying a lot on the support of international organizations.

(1:30) And this aid was abruptly halted, with roads and air supply routes severely hampered. (1:38) This added to a major economic crisis, population displacement, low agricultural production. (1:44) The health system has literally collapsed, and staff no longer receive salaries, equipment and medicines are in short supply (1:53) as well as the fuel for the generator, the water and other supplies to maintain the health facilities running.

(2:01) To date, MSF is the only major actor to provide free pediatric medical activities in the area. (2:10) In Zamzam Camp, the primary health center is one of the few outpatient centers in Darfur (2:17) to be supplied with inputs, with equipment, medicines. (2:23) The number, the severity of the patients is very high.

(2:27) The current package includes consultations for children, adults, vaccination, anti-postnatal care and treatment of malnutrition. (2:36) For the moment, the center is in a single site, for a camp covering a very large area, (2:43) an area of minimum 5 by 18 kilometers, and people, but apart from the camp, (2:51) people can travel more than 50 kilometers just to hope to find some medicines and nutritional products. (2:57) So in this context, we carried out, in January, a rapid nutritional assessment, (3:02) and the results of this assessment is extremely alarming.

(3:08) More than 23% of the children aged from 6 months to 5 years suffer from acute malnutrition, (3:16) and 7% of whom are severely malnourished, (3:20) which means that many of them suffering with marasmus, (3:25) one of the main forms of malnutrition, with muscle and fat wasting, (3:30) have an arm circumference less than 115 mm, 115. (3:38) These extremely malnourished children weigh around 6.5 kg for the age of 2 years old. (3:47) Those who haven't died yet are at high risk of dying within 3, 4, 6 weeks, (3:54) mainly because their immune system has been really compromised, (3:57) and death can occur with a very trivial infection, (4:01) so by diarrhea, with dehydration, by malaria, by pneumonia.

(4:06) We assessed also the malnutrition among pregnant and late-aging women, (4:10) and it's really high, more than 40%, based on MUAC, (4:16) and a mid-upper arm circumference of 230 mm. (4:21) Of course, this malnutrition impacts many obstetrical and neonatal complications, (4:29) including difficulties in breastfeeding, (4:33) which creates a vicious circle in terms of infantile malnutrition. (4:38) We also assessed the mortality rate, and they are very concerning.

(4:44) It's 2.3 children under 5 who die every day per 10,000 people, (4:50) which means that if we consider the population of the camp, (4:55) at the low range of 300,000 people, (4:59) it's more than 13 children dying every day. (5:02) We for now don't have a clear estimation of the population, (5:07) we consider it probably between 300,000 and 500,000 people, (5:11) but we also have to consider that the catchment area for the population of the camp, (5:16) for the health system, is much wider. (5:19) The mortality rate for children and adults, (5:22) what we call the crude mortality rate, (5:25) is massive, at 2.5 persons per day per 10,000 people, (5:32) which is really above the emergency threshold (5:36) for what we call a level 4 crisis, on a scale of 5.

(5:45) It's also important to understand that the current period, (5:49) and the period this assessment was done, is in January, (5:51) and it's a period of the year which is supposed to be at the lowest levels of malnutrition, (5:57) because the harvests have been done, (6:01) so households are supposed to have some stock of food, (6:05) and these really small stocks will continue to get slower in the coming months, (6:12) and we know that the usual period of the year where the malnutrition is at its highest (6:18) is starting from May, June, and after, (6:24) when there is no reserve for the majority of the people. (6:29) So this food insecurity that creates malnutrition is an accumulation of many factors, (6:35) and unfortunately we don't expect any of them to improve if nothing is done. (6:39) The rainfalls were really low, (6:42) people had difficulties to access the field and to do the harvest, (6:48) also due to security context.

(6:52) Some crops were destroyed by animals, (6:55) there was a real hyperinflation of food prices, (6:59) so even some food is available to buy in the market in Zamzam Camp, (7:02) but people cannot buy it in a context of economic and financial crisis. (7:09) And when the production is lower, of course the price of the food is higher, (7:14) and that's something that we're going to monitor, (7:17) in addition to a collapse of the system in the primary health care, as I was explaining, (7:23) population displacement, and the lack of water, and water-related risk management. (7:30)

(8:02) It's also to be considered that currently there is no major epidemic, (8:06) although the risk of many epidemics is real, including for measles, (8:08) vaccination coverage for measles is really low, (8:11) and we know that measles cases can occur after March, April, in this area. (8:18) There was an increase during the covering period of the assessment, (8:22) and there is still some mosquito-related diseases, especially malaria, (8:29) and it's also impacted with the fact that in 2023 there was no vector control in the area, (8:36) and in the camp, under control between the other years, (8:38) meaning no mosquito net distribution, no spraying, (8:43) and it's also something to consider, (8:45) malaria doesn't show any frank decrease in the current period.

(8:50) But the fact that this assessment was done without epidemics, apart from malaria, (8:56) makes us think that the situation may deteriorate if an epidemic occurs, (9:00) which is likely in this kind of context. (9:03) So, the humanitarian response to be deployed in this kind of situation is well known, (9:11) and we know the priorities, and international organizations, (9:15) and many 3FLs know how to face it, but we need resources. (9:21) And it is feasible in the context of al-Fashir in northern Sudan, (9:24) so this involves a major urgent scale-up in a coordinated response (9:31) to tackle these priorities, to prevent malnutrition mortality, (9:36) so it includes water and sanitation management, food distribution, (9:44) missiles, mass vaccination campaign, (9:47) and deployment of different sites for outpatient and inpatient treatment, (9:55) to include the malnutrition, but also medical care for pregnant and lactating women, (10:01) and general care for children and adults.

(10:03) To set up a large scale, at the camp level, epidemiological surveillance (10:07) to control the disease with epidemic potential. (10:15) These priorities and the means to implement them are really set, (10:20) we know how to tackle them, and they need to be put in place urgently. (10:24) This massive and urgent scale-up is urgent to save lives.