DARFUR MORTALITY UPDATE

August 13, 2004
Current data for total mortality from violence, malnutrition, and disease

Eric Reeves

This update on total mortality in Darfur draws upon several previous assessments (July 6, 2004, July 15, 2004, and July 30, 2004), as well as recent reports from UN field workers, humanitarian organizations, and news reports.  Its primary statistical tool for estimating current and projected global mortality remains the US Agency for International Development's "Projected Mortality Rates in Darfur, 2004-2005" ( http://www.usaid.gov/locations/sub-saharan_africa/sudan/cmr_darfur.pdf ).  The first appendix to this analysis explains the particular significance of this superb work of epidemiological research, currently without any significant rival. 

CURRENT MORTALITY

The present analysis offers an estimated total of 180,000 deaths in Darfur over the past 18 months.  This includes a figure of 80,000 violent deaths, derived largely from the only data extant, viz. the Doctors Without Border/Medecins Sans Frontieres study in the Mornei area (this derivation is included here as a second appendix). In light of the very recent report by UN Special Rapporteur for Extrajudicial Executions Asma Jahangir, however, this figure appears to be conservative; indeed, it may understate very considerably.  Special Rapporteur Jahangir has spoken of a "staggering" number of deaths, and found an extremely alarming percentage of families that have lost relatives to violence: "'nearly every third or fourth family' she spoke to in the camps for internally displaced people (IDPs) within Darfur had lost a relative to the militias" (UN News Centre, June 29, 2004). 

100,000 human beings are here estimated to have already died from disease and the effects of malnutrition, a figure of course impossible to verify.  Far fewer than 50% of the total population of displaced persons (those most at risk) have been registered or assessed in camps; the figure may be lower than 30%.  The names, gravesites, dates and causes of death, and other confirming information demanded by the Khartoum regime obviously do not exist---though many thousands of names do exist, if we would but collate data and information from sources in Darfur and in Chad.  The present figure of 100,000 deaths is a statistical inference, with a number of variables.  It has perforce a very significant margin of error---both lower and higher (see appendices for the ranges of key figures deployed). 

But the data make clear that the mid-July 2004 UN figure of 30,000-50,000 total deaths offered by Jan Egeland, Undersecretary for Humanitarian Affairs, is untenably low, even as the previous figure of 10,000 deaths (the only UN number offered for mortality from March 2004 to July 2004) was also clearly untenably low.  Moreover, no explanation of methodology or the nature of the data has ever been offered by the UN in conjunction with these mortality estimates; deaths are not even generally categorized as a function of violence or disease and malnutrition.  All this follows a pattern of both underestimation and belatedness that has marked UN efforts in the World Food Program, the World Health Organization, and the UN High Commission for Refugees. 

This writer has previously solicited, as responses to mortality analyses, correcting data, skeptical assessment of methods, and corrections of statistical inferences; none has so far been forthcoming, though the invitation is herewith renewed.

CURRENT CONTEXT

The current enormous mortality figure here hazarded appears unlikely to remain static.  Indeed, the US Agency for International Development's "Projected Mortality Rates in Darfur, 2004-2005" suggests that over 2,500 people are now dying daily---mainly invisibly.  Moreover, the Crude Mortality Rate (CMR, measured in deaths per day per 10,000 of affected population) continues to rise.  The mid-August CMR is 11 deaths per day per 10,000; this rises to 15 per day per 10,000 at the end of September, and to 20 per day per 10,000 in December. 

The current "war-affected" population may reasonably be estimated at over 2.3 million (for a justification of this figure, see the third appendix to this analysis).  The figure offered in a June 3, 2004 joint communiqué from the UN, the European Union, and the US was 2.2 million "war-affected," though with much too little explanation of the term "war-affected."  In the intervening 10 weeks, the rains have greatly intensified, logistical resources and transport capacity have proven ever more inadequate, and fewer than 1 million people received food from the World Food Program in July, though this represented a significant increase from June.  Clean water, sanitary provisions and latrines, shelter, and cooking fuel (essential if women and girls are not to be forced to venture far from the camps for firewood and thus risk rape by marauding Janjaweed forces)---all are dramatically inadequate for the camp populations, let alone for the larger populations of displaced.

Indeed, the most troubling part of any calculation of mortality and morbidity in Darfur is the unknown number of people who are neither in the camps, nor accessible by UN or humanitarian organizations.  The World Food Program internal working figure for this population was 300,000 in July (confidential source), a number that is deliberately obscured in a World Food Program statement of August 11, 2004 indicating that access to insurgency-controlled areas of Darfur would increase by "tens of thousands" the number of people who might benefit (UN Integrated Regional Information Networks, August 12, 2004).  The number is hundreds of thousands, as the World Food Program well knows---indeed, some on the ground in Darfur, or who have recently returned from Darfur, suggest that the number may be greater than 1 million.  This deliberate "low-balling" (directly and indirectly) of numbers on the part of the World Food Program continues a disturbing pattern, and it is immensely dangerous.

Here again it is important to note that most estimates of total population for Darfur are between 6 million and 7 million (though some are lower, and there are a number of complicating demographic issues); and estimates of the percentage belonging to the targeted African tribal populations are generally around 70%.  This suggests that there is a population---systematically attacked and displaced over a period of 18 months---that is greater than 4 million human beings.  Aerial and satellite imagery, as well as reports from humanitarian organizations on the ground and from Darfurian sources, suggest that well over 50% of the African villages have been destroyed.  Some estimates are over 75%.  And many more people who haven't been directly displaced by violence have simply abandoned vulnerable villages in anticipation of attacks by Khartoum and its Janjaweed militia.

Where are all these people? 

They are certainly aren't in the camps, which may hold over 1 million people at this point, but not over 1.5 million.  Where are the other 2.5 million to 3 million people of the African tribal groups that trying to survive without food or humanitarian assistance?  These people have also been left without the ability to use traditional foraging methods and coping strategies because of the threat posed by marauding Janjaweed forces.  If we address this large issue honestly, the mortality projections from the US Agency for International Development are much more readily comprehended.

POLITICAL CONTEXT

The realities of mortality in Darfur---with a present total mortality that the best data available suggest is approximately 180,000, climbing at a rate of 2,500 people per day---present with overwhelming clarity the moral imperative of humanitarian intervention.  Indeed, precisely because the imperative is so clear, Khartoum has begun to work energetically to forestall any possibility of such international action.  The first step has been to deny the deployment of African Union (AU) forces to function as peacekeepers, despite a decision last week by the AU to deploy 2,000 troops with precisely this mandate.  Instead, Khartoum is permitting only the very limited number of troops necessary to protect the "cease-fire" monitors.  The statement of Interior Minister Abdel Rahim Mohamed Hussein stands:

"'We will not agree to the presence of any foreign forces, whatever their nationality,' Sudanese Interior Minister Abdel Rahim Mohamed Hussein said in an interview with London's Asharq al-Awsat newspaper published on Friday." (Reuters, August 6, 2004)

The UN for its part is simply acquiescing in the face of Khartoum's intransigence.  Jan Pronk, UN Secretary-general Kofi Annan's special representative for Sudan, continues with policies of expediency and temporizing.  An Agence France-Presse dispatch yesterday (August 12, 2004) from Khartoum ("UN envoy eases pressure after Khartoum irked by Darfur criticism") tells us far too much about Pronk's primary mission, which is to ensure that the issue of Darfur does not become an occasion for further action by, and inevitable division within, the UN Security Council when it returns to the concerns of Resolution 1556 on August 30, 2004 (17 days from today). 

Agence France-Presse notes in particular the agreement signed earlier this week (August 12, 2004) by Pronk and NIF foreign minister Mustafa Ismail:

"The deal was already backtracking on a July 30 [2004] UN Security Council resolution giving Khartoum 30 days to crack down on the pro-government Arab Janjaweed militias." (Agence France-Presse, August 12, 2004)

Instead of increasing pressure on Khartoum to disarm the Janjaweed, to control violence in Darfur, and to assist humanitarian relief efforts, Pronk has resorted to appeasement:

"The United Nations' envoy to Sudan tried to ease the pressure on Khartoum after a flurry of indictments of the government's failure to end the crisis in Darfur drew irate reactions from President Omar al-Beshir. Jan Pronk, quoted Thursday in the Akhbar Al-Youm daily, said an action plan agreed to by Khartoum 'does not set 30 days as a deadline but as a period which can be renewed and amended until all provisions' of a Security Council resolution are implemented." (Agence France-Presse, August 12, 2004)

Though Akhbar Al-Youm must typically be regarded with caution as a source, there has been no correction issued over the past day and no sign that Akhbar Al-Youm has misquoted Pronk.  Indeed, all evidence to date suggests that this extraordinary loosening of an already culpably expansive Security Council deadline is fully in character for Pronk. 

What is Pronk responding to?  How is this appeasement?  Agence France-Presse also reports:

"Speaking to reporters Wednesday [August 11, 2004], Sudanese Foreign Minister Mustafa Osman Ismail had asked the UN to control its statements 'if it really wants security to prevail in Darfur, otherwise the government will reconsider its commitments.'" (Agence France-Presse, August 12, 2004)

What is the meaning of Ismail's threat that Khartoum will "reconsider its commitments" to the UN (both in responding to Security Council Resolution 1556 and the July 3, 2004 memorandum of understanding with Kofi Annan)?  Clearly he is threatening that Khartoum will not disarm the Janjaweed, nor bring its leaders to trial, nor end its obstruction of humanitarian relief (we should recall again that Khartoum very recently "inexplicably grounded" UN World Food Program planes [BBC, August 10, 2004]). 

And what are Ismail's demands?  What is the meaning of his "ask[ing] the UN to control its statements"?  A recent sampling of "statements" from various UN humanitarian organizations operating in Darfur makes clear what Ismail finds so distressfully authoritative, and what he wants "controlled," i.e., halted: 

UN Special Rapporteur for Extrajudicial Executions Asma Jahangir announced in conjunction with the release of her recent report on executions in Darfur that, "'it is beyond doubt that the Government of the Sudan is responsible for extrajudicial and summary executions of large numbers of people over the last several months in the Darfur region.'" (Associated Press, August 6, 2004)

Other UN agencies have also offered deeply damning accounts of Khartoum's vast human destruction in Darfur:

"'Janjaweed attacks on internally displaced persons in and around Internally Displaced Persons settlements continue to be reported in all three Darfur states,' [according to OCHA]." (Reuters, August 10, 2004)

"[UN sources on the ground in Darfur reported yesterday that' 'fresh violence today [August 10, 2004] included helicopter gunship bombings by the Sudanese government and Janjaweed attacks in South Darfur,' the UN [Office for the Coordination of Humanitarian Affairs (OCHA)] said." (Reuters, August 10, 2004)

"Meanwhile, Dafuris continue to be displaced from their homes and villages. In recent days, hundreds of people have fled from [the villages of] Serengabo, Taweela, Tebeldia and Qasar villages into squalid makeshift camps near Nyala." (UN High Commission for Refugees press release [Geneva], August 10, 2004)

"UN spokesman Fred Eckhard told reporters in New York on Monday that UN officials on the ground had reported that 'the security situation in Darfur remains tenuous, with more violence directed at, and displacing, civilians in North and South Darfur.' 'Militia men suspected to be Janjaweed attacked some 35 families in Tawilla, North Darfur on Saturday. Meanwhile, reports continue of attacks by armed men on horses and camels, supported by uniformed men and military vehicles, in South Darfur,' Eckhard said." (Associated Press, August 11, 2004)

The UN High Commission for Refugees also notes that it has received reports that in camps not run by UNHCR, the rape of women and girls "is in fact escalating" (UNCHR press release [Geneva], August 10, 2004).

Silence on these realities is what Ismail is demanding---this is Khartoum's condition for keeping its "commitments" to the UN.  Bearing in mind the serial refusal of Khartoum to honor any of its previous commitments, one might think that UN special representative Pronk should be doing more of the demanding and less of the acquiescing.  The grotesque reversal of roles, along with an ever more expansive time-frame for Khartoum, clearly indicates that the UN will do nothing to change the fundamental dynamic of human destruction in Darfur.

Mortality will continue to accelerate, and by the time the UN Security Council reconvenes to discuss Darfur on August 30, 2004, the number of deaths will be in excess of 200,000---and climbing ever more rapidly.  The recently reported (and unprecedented for Darfur) outbreak of Hepatitis E is a sign that other water-borne diseases are in the process of exploding (Hepatitis E is fatal in approximately 20% of pregnant women contracting the illness).  Malaria is taking an increasing toll (the International Committee of the Red Cross reports today [August 13, 2004] that 20% of the diagnoses at Abshok camp in West Darfur are for malaria), and will continue to do so for at least several months. Diarrheal diseases continue to increase dramatically as well, and cholera could explode at any time, in multiple locations.

Malnutrition is rising in virtually all the camps, and is simply unfathomable in the rural areas beyond humanitarian reach.

We are in the midst of the killing season, and there is nothing that gives hope it can be foreshortened.  Genocide continues unabated.

Eric Reeves
Smith College

APPENDIX  1:  Data from the US Agency for International Development, "Projected Mortality Rates in Darfur, 2004-2005":

The US Agency for International Development "Projected Mortality Rates in Darfur, 2004-2005" ( http://www.usaid.gov/locations/sub-saharan_africa/sudan/cmr_darfur.pdf ) currently has no rival.  Notably, it draws heavily on statistical studies of famine in Ethiopia and in Bahr el-Ghazal Province in southern Sudan (1998).  To date, there is no evidence disconfirming the US AID projections (the data were assembled in April 2004 by a team of superb epidemiologists working in this grim field of study).  On the contrary, through July 1, 2004 there was strong evidence suggesting that the projections may in fact have underestimated both mortality and malnutrition rates.

Results of a nutritional survey conducted in June 2004 by Action Contre la Faim (ACF) in the Abu Shouk camp for the internally displaced [North Darfur] indicated Global Acute Malnutrition (GAM) rates of 39 percent and Severe Acute Malnutrition (SAM) of 9.6 percent.  These are extremely high rates, and occurred despite ongoing food distributions; these data are most suggestive of the condition of people that more recently arrived in the camp.

On June 17, 2004 Save the Children released the results of a study of malnutrition and food insecurity in Malha, North Darfur.  Assessment teams found an acute crisis in nutritional status with GAM rates of 33 percent and SAM rates of 5.4 percent.  These rates are especially alarming since the Malha area has been relatively less affected by conflict than other parts of Darfur. 

The rates from both these studies tracked well higher than the Global Acute Malnutrition data and projections from US AID's "Projected Mortality Rates in Darfur"; and given the very high correlation between acute malnutrition and mortality, these data strongly suggest that the actual Crude Mortality Rate may also have been running higher than US AID projections.

Most telling for earlier assessment of morbidity is a nutritional study by Doctors Without Borders/Medecins Sans Frontieres during April and May 2004 ("On the Brink of Mass Starvation," May 20, 2004 at www.doctorswithoutborders.org/pr/2004/05-20-2004.shtml ): 

"The nutritional study was conducted among 921 children and their caregivers in five locations---Garsila, Mukjar, Bindissi, Deleij, and Um Kher---where nearly 150,000 displaced people have sought refuge from extreme violence. The study revealed that global acute malnutrition affects 21.5% of the population while 3.2% suffer from severe acute malnutrition. The mortality rate for children under five years of age is 5.2 deaths per 10,000 people per day while the rate for those over five years of age is 3.6 deaths per 10,000 people per day." (Doctors Without Borders/Medecins Sans Frontieres, "On the Brink of Mass Starvation," May 20, 2004)
(These mortality rates exceeded the contemporary rates in US AID's "Projected Mortality Rates in Darfur.")

The most recent data comes in a survey from the US Agency for International Development (fact sheet #18, "Darfur---Humanitarian Emergency," August 13, 2004), and finds that Global Acute Malnutrition (GAM) ranges from 13% up to 39% according to the US AID Disaster Assistance Response Team.  This upper figure is approximately that predicted in the US AID "Projected Mortality Rates" graph; since these figures do not include the populations beyond humanitarian access (like the earlier studies in individual camp settings), they undoubtedly fail to reflect higher GAM rates, and the greater consistency with which the more elevated GAM rates can be found, in rural Darfur.

In general, studies of malnutrition have consistently borne out the US AID predictions of GAM at various points over the past four months.  The overall conclusion must be that US AID's "Projected Mortality Rates in Darfur, 2004-2005" has been confirmed to a very high degree, both in predicting mortality and malnutrition, and that in the days and weeks and months ahead is likely to offer all too telling a measure of daily human destruction.  A fortiori, it is an extremely useful tool in retrospective analysis of mortality.

[We should not forget that comparably high levels of malnutrition also exist in the refugee camps in Chad, especially in the northern sector.]

APPENDIX  2: Violent deaths in Darfur:

Asma Jahangir, the UN Special Rapporteur on extrajudicial, summary or arbitrary executions, reported at the end of June 2004 that the "number of black Africans killed by Arab militias in the Darfur region of Sudan is 'bound to be staggering'":

"Ms. Jahangir said that during her visit, 'nearly every third or fourth family' she spoke to in the camps for internally displaced people (IDPs) within Darfur had lost a relative to the militias. 'It's very hard to say [accurately] how many people have been killed,' she said, but interviews with IDPs indicated it would be 'quite a large number. They are bound to be staggering.'"  (UN News Centre, June 29, 2004)

This finding alone indicates a huge number of dead.  If we took as statistically representative Ms. Jahangir's finding that, "'nearly every third or fourth family' she spoke to in the camps for internally displaced people within Darfur had lost a relative to the militias," the number of violent deaths would be far in excess of the figure of 80,000 derived below from data from Doctors Without Border/Medecins Sans Frontieres.

Doctors Without Border/Medecins Sans Frontieres (MSF) released in June 2004 important epidemiological research on violence committed against the African populations of Darfur; indeed, it is our only such data:

"A recent survey conducted by MSF and the epidemiological research center Epicentre in the town of Mornei, West Darfur State, where nearly 80,000 people have sought refuge, found that one in 20 people were killed in scorched earth attacks on 111 villages from September 2003 until February 2004. Adult men were the primary victims, but women and children were also killed. Today, one in five children in the camp are severely malnourished while irregular and insufficient food distributions do not come close to meeting the basic needs of people weakened by violence, displacement, and deprivation." (Doctors Without Border/Medecins Sans Frontieres, "Emergency in Darfur, Sudan: No Relief in Sight," June 21, 2004; release at http://www.doctorswithoutborders.org/pr/2004/06-21-2004.shtml ).)

If we make the very conservative assumption that the Mornei region has been especially violent, and that the 1 in 20 figure overstates by 50% the global death rate for armed killings in Darfur, this still implies (for a very approximately estimated average displaced population of 1.2 million) that over 40,000 people had been violently killed between September 2003 and February 2004 (this represents a weekly casualty figure of approximately 1,600).  In the twenty-five weeks since the end of February, violent killings have continued to be reported on a very wide-scale throughout Darfur, especially February to April, subsiding recently only because the destruction of African villages is now largely completed.  Many people were of course killed violently before September 2003 (the insurgency conflict broke out in February 2003; Janjaweed attacks on civilians accelerated dramatically in the late spring of 2003).  These data aggregated (including the implied weekly casualty rate) suggest a very approximate figure of 80,000 killed violently in the course of the war.

APPENDIX  3: The "war-affected" population in Darfur:

Scandalously, there continues to be confusion around key figures defining the scale of the human catastrophe unfolding in Darfur.  Of particular concern for estimating current mortality is the figure that is actually deployed in the context of the US Agency for International Development "Projected Mortality Rates in Darfur, 2004-2005" (see Appendix 1), which requires an operative figure of "war-affected persons" for calculation of deaths.  But there can be little doubt that this figure is well over 2 million; it is very likely over 2.5 million.

The Executive Summary from the recent "Darfur Humanitarian Profile---July 2004" (office of the UN Resident and Humanitarian Coordinator for Sudan) offers a "war-affected" figure of "more than two million people" (full report available upon request).  This figure includes Internally Displaced Persons, as well as those living with host families whose food reserves have been exhausted, and those who have simply fallen through the cracks of statistical assessment.  This figure essentially reiterates the figure of 2.2 million "war-affected persons" used in the joint communiqué of the UN, US, and the EU on June 3, 2004. (Significantly, the UN World Food Program [in the June 28, 2004 "90-Day Humanitarian Action Plan for Darfur"] commits to a figure of 2 million for food aid only in October 2004; this implies a highly dramatic shortfall in current response by the WFP.)

But even the figure of 2.2 million speaks to conditions six weeks ago.  In the interim there have been numerous reports of continued violence and displacement (though diminished from the levels of spring 2004), and surviving food reserves have been fully depleted for more and more of Darfur's population.  Moreover, there is growing evidence that the UN Resident and Humanitarian Coordinator report considerably understates the number of people in critical need in areas to which there is no humanitarian access.

In this present context, it has seemed most reasonable to use an estimate, very likely conservative, of 2.3 million to 2.5 million, in determining the population that must figure in any calculation of mortality on the basis of US AID's "Projected Mortality Rates in Darfur, 2004-2005."  This decision is justified in the views of several senior aid officials.