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Wells of Life Run Dry for Sudanese

Trauma, Malnutrition Leave Many Refugee Mothers Unable to Breast-Feed

By Emily Wax
Washington Post Foreign Service
Sunday, August 22, 2004; Page A01

BAHAI, Chad -- As she had done every morning for a week, Mecka Ibrahim brought the lips of her howling infant to her breast, hoping the milk would flow again. She shifted the 1-year-old boy's frail little body and adjusted her position, folding and unfolding her legs. She tried again, with lithe arms cradling the boy, Issa. He was hungry and reached for her, but her breast was still dry.

She recognized what health workers had told her, that stress and malnutrition were blocking her ability to produce milk. "I am too sad," Ibrahim said as she rocked the baby, shielding his eyes from a swirling sandstorm approaching Oure Cassoni, a refugee camp on the border with Sudan.

(Photos Jahi Chikwendiu -- The Washington Post)

_____Photo Gallery_____
Malnutrition Plagues Sudanese Refugees
_____Crisis in Sudan_____
Q&A: Darfur A brief explanation of the issues and current humanitarian situation in Western Sudan.
Photos: Sudan's Rebels
Sudanese Decry U.N. Threat of Sanctions (The Washington Post, Sep 20, 2004)
U.N. Puts Sudan Sanctions Into Play (The Washington Post, Sep 19, 2004)
Death Rates in Darfur Rising, WHO Says (The Washington Post, Sep 15, 2004)
U.S. Calls Killings In Sudan Genocide (The Washington Post, Sep 10, 2004)
U.S. Drafts Resolution On Sudan Sanctions (The Washington Post, Sep 9, 2004)

Ibrahim came to this labyrinth of sand-covered tents after her village in the Darfur region of Sudan was attacked 16 months ago and her husband was killed. Five months pregnant, she fled across the desert to Chad. She found herself in the company of women, who make up 90 percent of the adult population of the refugee camp and carry the burdens of a conflict that has displaced 1.5 million people and killed as many as 50,000.

Other new mothers at the camp have discovered, like Ibrahim, that they can no longer produce breast milk for their babies. The condition is caused not only by trauma but also by dehydration and malnourishment. Ibrahim said she often feels too weak to wait in line for her rations: heavy bags of cornmeal, peas and salt.

"All night, I'm awake thinking of what happened in my village," she said. "I want to be stronger. I keep trying. But I am tired."

Ibrahim is a member of the African Zaghawa tribe, whose members, along with those of the Fur and Masalit tribes, were driven off their land in Darfur by Arab militias backed by government forces that are fighting two rebel groups. Many African men and boys of fighting age were killed. Some escaped and became fighters for the rebel movements. Others simply left looking for work.

Even during peaceful times in Africa, women are responsible for most of the work on a continent where female muscle rather than the modern machine is the force behind survival. Fetching buckets of water and hauling bundles of firewood, cooking and cleaning, farming and planting are among a long list of tasks that men shrug off as women's work.

But women from Darfur bear an even heavier load. Children and the elderly depend entirely on the health and strength of the women. More and more cases of lost breast milk, aggravated by trauma and illness from rapes, have been reported in the last few months, and doctors warn about the additional calamity.

"This is very dangerous. And it's extremely important to note because the burden will now be greater on the already stressed feeding centers," said Jennifer Leaning, a professor of public health at Harvard University. Leaning toured Chad's camps in June as a board member of Physicians for Human Rights, a Boston-based organization.

"Normally, you can count on breast milk to be 100 percent complete food," Leaning said. "This is a situation where anxiety and stress is far greater for women, and it adds a particular layer of stress to an already stressed population and stressed humanitarian operation. If breast-feeding is blunted, small infants risk malnourishment and even death."

Ibrahim's baby, Issa, is now at the camp feeding center with many other malnourished children. Only one doctor serves the camp of 17,000. Ibrahim prays her son will live and gain the weight he seems to keep losing.

Four out of 10 Sudanese refugee children younger than 5 in Chadian camps are acutely malnourished, according to a survey by the U.S. Centers for Disease Control and Prevention.

The survey said that the mortality rate for children "is above the emergency threshold" and that there is a "very high risk for serious illness and death." Representatives of the U.N. High Commissioner for Refugees, the agency that is running the camp, said they were aware of the problems and were scrambling to bring in more aid.

But relief has been slow to reach one of the world's most remote and impoverished regions. Recently, fierce rains filled seasonal riverbeds, or wadis, with dirty brown water, creating miles of fast-moving rivers. The water slowly evaporates under the scorching sun, leaving quicksand-like mud in the gullies that is nearly impossible to pass even with four-wheel-drive vehicles.

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