News to a situation described by UN Under- care,” said Lee. “These are the realities Humanitarian catastrophe secretary General for Humanitarian of the current crisis in Darfur.” looms in Darfur Affairs, Jan Egeland, as the “biggest At the beginning of June, an early humanitarian crisis in the world today.” warning system for monitoring and The lives of up to one million people In a statement to the UN Security responding to disease outbreaks began affected by the conflict in the Greater Council on 24 May, the international operating throughout the region. The Darfur region, in the west of the Republic nongovernmental organization, Médecins model has already been deployed success- of the Sudan, are at risk unless there is Sans Frontières, described “excessive fully by WHO in Iraq and other chal- an urgent scaling up of the current levels of death and malnutrition among lenging settings. The population under international response, warned WHO a displaced population that is entirely surveillance comprises the 1.2 million following a meeting at the UN in dependent on aid.” It went on to people displaced from their villages and Geneva on 3 June. warn that “relief efforts remain utterly homes as a result of the conflict, 40% The UN estimates that between inadequate and all indicators point to a of whom have no access to health care, 700 000 and 800 000 people in the looming famine.” according to WHO. region are expected to run out of what Adding to the urgency is the ap- The conflict in Darfur began early they need to survive by the end of proaching seasonal monsoon, already last year after rebel groups started at- June. Andrew Natsios, head of the US heading northwards into eastern Chad tacking government targets, claiming Agency of International Development, and Darfur, which could leave 150 000 that the region was being neglected by predicted that the death toll could reach refugees who fled across the western the government. The ensuing conflict one million if humanitarian organiza- border into Chad isolated with no access has affected around two million people tions are unable to deliver aid to the to aid. The rains will bring an increased in total, of which around 1.2 million war-torn province. risk of cholera, dysentery and malaria. are internally displaced persons (IDPs). “We estimate right now if we get WHO Director-General, Dr LEE Located in 124 locations, spread around relief in, we’ll lose a third of a million Jong-wook warned of the dire effects dis- a very wide desert and semi-desert area, people, and if we don’t the death rates ease epidemics could have in an already only about 760 000 of the IDPs were could be dramatically higher, approach- weakened population. “Death and disease accessible at the beginning of June. An ing a million people,” said Natsios, spiral upwards when there is inadequate estimated 10 000 people have been killed following the meeting which brought food, unsafe water, improper sanitation since fighting began in February 2003. together senior officials from donor and shelter, widespread violence, lack The UN warned of an imminent nations, the Sudanese Government and of public health inputs like vaccina- humanitarian crisis in Darfur in October UN agencies to intensify their response tions and insufficient access to medical 2003 when it appealed for extra resources. KEYSTONE Sudanese women and children who have fled the conflict in Darfur, western Sudan, collect water from wells at a makeshift refugee camp at Iridimim, Chad. Bulletin of the World Health Organization | July 2004, 82 (7) 553 News However, it is only recently that funds Khartoum to Darfur will be issued Expanding programmes to prevent have been pledged. At the beginning of within 48 hours and that the movement the spread of HIV infection was ranked June, the UN still faced a funding gap of relief supplies will be facilitated. as the top priority. Distributing micro- of US$ 236 million needed for aid in The latest on the health situation nutrients to combat malnutrition came the region until the end of the year. The in Darfur is available from: http:// second with trade liberalization third and US pledged US$ 188 million and the www.who.int/disasters O malaria prevention and treatment fourth. European Union pledged over US$ 12 Sarah Jane Marshall, Bulletin In selecting HIV/AIDS, the panel agreed million, in addition to the US$ 45 with a paper presented by health econo- million it had already provided. WHO mist Anne Mills of the London School is seeking US$ 7.6 million to assist the of Hygiene and Tropical Medicine. In Sudanese Government in coordinating HIV/AIDS, hunger and malaria her paper, Mills argued that spending the response of the international health are the world’s most urgent US$ 60 billion to promote condom sector and to tackle disease outbreaks, im- problems, say economists use and distribute antiretroviral drugs prove sanitation, respond to public health — particularly in sub-Saharan Africa needs and improve access to medical The top global priority for spending on — would save US$ 3 trillion in health- care. It has so far been promised US$ 3.9 international aid is combating HIV/ care costs and human productivity. The million for its response. AIDS, concluded an international panel panelists’ recommendations focused on “Delivering much-needed aid is an of economists, following the week-long prevention strategies rather than treat- immense challenge in Darfur because Copenhagen Consensus conference ment because of “the rapid change of people are scattered over a vast land area, which took place in Denmark at the end drug prices and the lack of clear data on and communications have been badly of May. The eight economists — three outcome, which make calculating the disrupted,” said Dr Hussein Gezairy, of them Nobel laureates — also placed cost–benefit ratio of treatment difficult.” WHO Regional Director for the Eastern efforts to combat hunger and the eradi- The International AIDS Society, Mediterranean Region. “Accessing those cation of malaria at the top of the list. a professional association of scientists in need requires intense collaboration Their report, commissioned by and health workers, welcomed the by all.” Denmark’s Environmental Assessment Copenhagen Consensus conclusions. The United Nations refugee agency, Institute and the British news journal, But the group — along with other UNHCR, which has been working to The Economist, concluded that 28 public health organizations fighting the provide relief for the Sudanese refugees million cases of HIV/AIDS could be HIV epidemic — was troubled by the in Chad is to launch an appeal in prevented by 2010 and that although lack of focus on the potential benefits mid-June for US$ 55.8 representing an the cost of this would be US$ 27 billion, of treatment for the millions already in- increase of US$ 35 million over their the benefits could be almost forty times fected. “We emphasize that all the tools previous appeal. “The increased budget as high. available to deal with the HIV epidemic takes into account the ongoing arrival “Fighting disease is a good invest- must be made available to all who need of new refugees in Chad and plans to ment,” said expert panelist, Bruno Frey. them,” said Craig McClure, the group’s help 200 000 refugees by the end of the “Disease causes nine out of ten prevent- Executive Director. And that includes year,” said UNHCR spokesperson Kris able deaths in developing countries “antiretroviral drugs for all those people Janowski. among children and adults.” living with HIV/AIDS,” he added. Recent reports have highlighted The panelists were asked to consider Behind HIV/AIDS prevention continuing increases in levels of mal- a list of ten global challenges established strategies came policies to reverse nutrition (doubling each week in some through a cost–benefit analysis: civil micronutrient deficiencies. The econo- settings), diarrhoea, measles and deaths. conflict, climate change, communicable mists identified food fortification to WHO and UNICEF began a measles diseases, education, financial stability, reverse iron-deficiency anaemia as the immunization programme in early June governance, hunger and malnutrition, measure with the highest benefit–cost hoping to reach 2.26 million children migration, trade reform, and water and ratio. “We were delighted with their by the end of the month. sanitation. Their task was to allocate conclusion, which confirmed what we “Almost a quarter of the children a hypothetical US$ 50 billion to solve have been saying for years,” said Ibrahim are already showing signs of malnourish- some of the world’s most important Daibes, Communications Manager for ment, making the threat of the measles challenges. The panelists unanimously the Canadian based non-profit Micro- virus even greater,” said Carol Bellamy, recommended spending US$ 27 billion nutrient Initiative. UNICEF Executive Director. Vaccinators to fight HIV/AIDS, US$ 12 billion to The US$ 13 billion for malaria are also using the opportunity to provide fight malnutrition and US$ 13 billion prevention and treatment was spread life-saving vitamin A supplementation to fight malaria. across three strategies: making insecti- and to immunize at least 90% of children “The starting point of the Copen- cide-treated mosquito nets available to an under five years against poliomyelitis. hagen Consensus is that the world faces additional 60 million children under five The UN and other nongovern- many problems, and we cannot afford years, providing two-stage anti-malarial mental organizations have experienced to solve them all, here and now … treatment to 90% of women in their difficulties in getting aid into Darfur HIV/AIDS, malnutrition, trade barriers, first pregnancy and giving artemisinin- over the past few months. WHO has and malaria — these are problems that based combination therapy (ACT) to welcomed recent assurances from the can be addressed effectively,” said The 280 million infected people annually Government of Sudan that permits for Economist Deputy Editor, Clive Crook, with the objective of halving malaria humanitarian workers to travel from who participated in the experts’ meeting.