Children are dying from malnutrition at a catastrophic rate in North Darfur camp

Zamzam is a camp of at least 300,000 people near North Darfur's regional capital, El Fasher. It was originally formed by people fleeing ethnically targeted violence in the region in 2003. Ever since war broke out between Sudan's military and paramilitary forces in April 2023, camp residents have been cut off from vital humanitarian aid and medical care. UN agencies and international aid organizations evacuated North Darfur after the war began in April and have maintained only a limited presence since then.

“What we are seeing in Zamzam camp is an absolutely catastrophic situation,” said Claire Nicolet, head of MSF’s emergency response in Sudan. “Our current estimate is that there are around 13 child deaths each day. Those with severe malnutrition who have not yet died are at high risk of dying within three to six weeks if they do not get treatment. Their condition is treatable if they can get to a health facility, but many cannot.”

Rapid nutrition and mortality assessment findings

Conducted in January, MSF's rapid nutrition and mortality assessment of 400 households found a crude mortality rate of 2.5 deaths per 10,000 people per day in the camp, which is more than double the threshold of a humanitarian emergency.  

Nearly 40 percent of children between the ages of six months and two years are acutely malnourished, including 15 percent with severe acute malnutrition. About 40 percent of pregnant and breastfeeding women are also malnourished. 

“Before the start of the conflict in April last year, people in the camp were heavily reliant on international support for food, health care, clean water—everything," Nicolet said. "Now, they have been almost completely abandoned. There have been no food distributions from the World Food Program since May. People are going hungry—and children are dying as a result.”

To prevent further imminent loss of life and to reduce the scale of suffering, MSF will rapidly increase its response in the camp to provide treatment for children in the most critical condition. However, the scale of the disaster requires a far greater response than MSF can provide alone. Food and cash distributions are urgently required. Health care, water, and sanitation are also vital. 

MSF is the only health provider in Zamzam camp, and MSF's small clinic is overwhelmed by the high number of patients and the severity of their conditions. Over the past nine months, North Darfur’s already fragile health system—and the entire humanitarian response—has collapsed, and the clinic is one of the few outpatient health centers in North Darfur that is fully functioning. 

People travel by donkey or by foot from villages up to 30 miles from the camp to access health care, camping outside the clinic overnight. 

Conditions in the camp are atrocious, with no health care apart from the MSF clinic and no clean water supply. People are drinking either from the swamps or the river, which can cause severe diarrhea. For children who are already malnourished, this can be fatal. Likewise, it can lead to malnutrition in healthy children and cause a rapid deterioration in their health. 

Emmanuel Berbain, an MSF medical doctor in El Fasher, provided the following account: 

"The population is surviving in a situation that remains unimaginable for the rest of the world in terms of access to water, to food, to minimal health services. Before the start of the war in April 2023, the population's survival was already precarious, relying a lot on the support of international organizations [such as the UN agencies WFP, UNICEF, IOM and OCHA]. 

"This aid was abruptly halted, with roads and air supply routes severely hampered. The health system has collapsed, and staff no longer receive salaries; equipment and medicines are in short supply, along with fuel for generators, water, and other supplies to keep the health facilities running. 

"To date, MSF is the only major actor to provide free pediatric medical activities in the area. In Zamzam camp, the primary health center is one of the few outpatient centers in Darfur supplied with equipment, and medicines. The number of patients and the severity of [their needs] is very high. 

"For now, we don't have a clear estimation of the population. We [estimate that it is] probably between 300,000 and 500,000 people, but we also have to consider that the catchment area for the health system is much wider."

More action is needed to prevent child deaths

MSF is currently the only large international aid organization providing free pediatric medical care across all five Darfur states—a region the size of France—which is extremely insufficient to respond to the scale of the needs. 

Malnutrition programs that were once present in El Fasher are nonexistent. There is now nowhere in the city that people can go to for primary health care for their children. There is an urgent need for parties to the conflict to open the airport in El Fasher, and to ensure it remains accessible once it is operational so humanitarian organizations can swiftly return and provide support to people not only in Zamzam camp, but across North Darfur. 

"Referrals for patients from Zamzam camp to the pediatric hospital in El Fasher happen on a daily basis to try and save children’s lives,” Nicolet said “But we know from the mortality assessment that there are hundreds of children who do not even reach us. It is possible to prevent the situation from deteriorating further through a massive mobilization of the international community. Without it, even more children will die preventable deaths."