By Emily Wax
Washington Post Foreign Service
Monday, April 25, 2005
NYALA, Sudan -- Julius Lanya, a nurse in mud-caked work boots, rushed out of his office, leaned over Haja Hamid and began gently examining the gaunt 12-year-old girl, limb by limb, as she rested on a straw mat under a tree.
Haja's skin was flaking badly, the sign of a chronic vitamin A deficiency, Lanya explained to her worried parents. He needed more time to examine her, but night was falling. The family of six, with no place to stay, would have to risk walking across the Darfur desert to their temporary home in a refugee camp.
Haja's father, his hands clasped in a pleading gesture, begged Lanya to let the family sleep in the compound, local headquarters of Merlin, a British medical aid group. Lanya, a welcoming, easygoing man of 40, was tempted to agree. But he faced a difficult choice.
If he sheltered the African family for the night, Sudanese authorities might see him as siding with the rebels who have been fighting against government troops and their allied militias in Darfur for two years. If he refused, the family could be attacked while walking home and the girl's condition could worsen.
Haja began crying and pointing to her peeling arms and bleeding feet.
"Please ease my pain," she pleaded.
Lanya tapped his chin, and small beads of sweat formed on his forehead. He fell silent for a moment, then suddenly pointed to his small concrete bedroom.
"This is not a political issue," he said. "You will sleep here tonight."
Lanya is one of more than 10,000 humanitarian workers operating under the auspices of the United Nations in this region of western Sudan. Their tasks range from monitoring tubes at infant feeding centers to digging sanitation ditches and boreholes for water outside one of the dozens of squalid refugee camps that dot Darfur's war-shattered landscape. Like Lanya, a Kenyan, the vast majority are from the continent -- Africans trying to help fellow Africans.
In failed states or countries devastated by war, humanitarian workers become a de facto government, building schools and health clinics and helping with water and trash collection, at times even constructing roads and providing security.
But as relations among the United Nations, the rebels and the government grow increasingly tense, aid workers in western Sudan say they have been shot at, arrested by local government officials and repeatedly robbed by rebels as well as bandits, according to a report released this month by Human Rights Watch.
The impact has been dramatic, both on the workers and on those they seek to help. Roads have been closed; aid organizations are withdrawing staff. Drivers for the World Food Program have refused to transport food because of frequent muggings. After a worker for the U.S. Agency for International Development was shot and wounded last month near the Kass camp, home to more than 80,000 people in South Darfur, the United Nations closed the road to the site, saying it was too dangerous. The rutted desert track has been closed dozens of times because of the lack of security, leaving the displaced people in the village without food and medical supplies.
The conflict in Darfur began two years ago, when rebels protesting discrimination against African tribes by the Arab-led government attacked police stations and military outposts. The government fought back, and allied Arab militiamen known as the Janjaweed attacked villages repeatedly, causing more than 1 million people to flee.
Human rights groups and U.N. officials have reported war crimes in the region, including rapes by militiamen and government bombings of villages, while U.S. officials have said the crisis amounts to genocide.
In recent weeks, aid groups said, relations have worsened following a U.N. resolution that authorizes sending Darfur war crimes suspects, including government officials and rebel leaders, to the International Criminal Court in The Hague. Although grateful for the humanitarian help, some Sudanese officials accuse aid agencies of giving the United Nations wrong information, a charge aid workers deny.
Lanya said he had little time to think about politics. He laughs easily and dresses like a college student, in wrinkled cotton shirts and khakis, but his daily struggles are typical of those facing aid workers in Darfur.
His facility has been severely understaffed since two other Merlin nurses and the medical coordinator quit, citing emotional stress. One day, Lanya said, he found himself alone in the hospital with hundreds of patients. He had so many IV drips to start that he felt like crying.
"But when the heat is really on you, you have no choice but to carry on," he said. Leaning over Haja again, he examined her emaciated back. It was peeling so badly that her dark brown skin looked as if it had been shredded with razors.A 'Pull to Help'
In the early 1990s, Lanya was working in Kenya for the Ministry of Health when human tragedy first found him. His post was in a town near the border with Somalia, where civil war was erupting. Thousands of injured and terrified people began pouring across, and Kenyan security forces fired shots to push them back, according to Lanya and U.N. accounts.
"I saw so many people dead or injured," he recounted. "That was when I realized that in war the majority of people who died were not soldiers but civilians."
There were no camps set up, so people just spread out on the streets -- sleeping, cooking, nursing children. Desperate men sent their wives door to door, seeking work as prostitutes or selling their clothes for pennies.
"What they wanted was food and water, nothing else," Lanya recalled. "I sometimes cried at what I saw. It was really heartbreaking."
Then fighting broke out between rebels and the communist government in neighboring Ethiopia, pushing 18,000 more refugees into Kenya. Many had gunshot wounds, Lanya said.
"I had to do an amputation with no anesthesia. I was shaking, but I did it. I cut off a leg so someone could have life," he said. "All of this . . . they were the worst things I ever saw, and it really hurt me. I guess in a way, I wasn't the same person after that."
Lanya's experiences led him to the field of humanitarian aid, which has taken him all over East Africa in the last decade as a nurse with such groups as Doctors Without Borders and Save the Children. He said it was important for educated Africans from peaceful countries to help those at war.
"After the amputations I just felt it deeply, this pull to help," he said. "As a nurse, I was needed. At least it was doing something. I couldn't just let the nightmares of the realities on the ground haunt me. It was better to stay active."
During his travels, Lanya met his wife, a Kenyan nurse who lives there with their two daughters. Often he works intensively for 12 to 15 months, then takes several months off.
"I really missed my Tuskers and used to join the others in complaining nonstop about that," he said, referring to a popular Kenyan beer. "But then, watching those who were suffering, I realized that those extracurricular activities were not mandatory for every day. There were other things that were of importance."
Lanya also said he learned to be careful to stay out of politics, especially during a recent posting to southern Sudan, where African rebel groups fighting the Arab government were believed to be backed by Kenya. Some African aid workers were even accused of running guns for the rebels and giving them extra food.
Lanya said he was warned by his employers not to take sides, because he could be deported or even killed. But soon after he arrived, rebels from the Sudan People's Liberation Army stole two cars from his aid group -- then came back and threatened him with guns.
"They told me to restore medical care to certain areas that they themselves had cut off," he said, laughing as he recalled protesting that he had lost his transportation. "Then they returned a car."
The incident reinforced his belief that there are no good or bad parties in a war, and that he should just focus on the victims.
"I didn't know at first being a nurse could be so complicated," he said. "But I kept thinking of the Somalis fighting and weeping to get over the border. I thought, I will really sweat in this job. But it will be worth it."'Emotions Aren't Helpful'
Five months ago, Lanya arrived in Darfur, in the city of El Fasher. On his first night, he saw a village on fire. He remembers the smell of straw huts burning, along with teapots, sandals and blankets. He remembers the women with babies on their backs, screaming and running.
The government said its troops were fighting rebels who were using civilians as human shields; the rebels claimed to be defending the local populace. Witnesses said government forces burned the villages in retaliation for a rebel attack. But neither side came to help the women, Lanya recalled.
"I thought I had really seen a lot. But at this, I really felt trauma," he said, referring to the sight of people being displaced from their homes and land. "As an African, I also really understood the value of their animals being taken. To me that was like robbing their bank."
Every morning after that, Lanya said, he rose with the sun and went from camp to camp, starting IV drips for dehydrated people who had walked miles through the desert. As a medical coordinator, he also managed other nurses, helped arrange the shipping of medicines from the Sudanese capital, Khartoum, gathered lists of patients and trained midwives to help with births in the camps.
At night, exhausted, he fell asleep in seconds.
"My entire self is utilized 100 percent of the day," he said. "When I wake up in the morning it's so hard. I just want 10 minutes more of sleep."
A few months ago, Lanya was moved to Nyala. He noticed that although attacks on villages had decreased, everyone now seemed to own a gun. In addition to government troops, militiamen and rebels, there were bandits and civilians who said they had to protect their families.
"People now have guns around here like they have walking sticks," he said.
The environment had become both unpredictable and dangerous. One recent day, he was trying to help colleagues from a church aid group who had been detained and robbed by a rebel group. A day later, gunmen shot two African Union monitors just northwest of Nyala, severely injuring one. Then more roads were closed, making it harder to get to some of the camps.
"It's really frustrating," Lanya said. "You travel away from your friends and family and then the people you are trying to offer a service to, well, sometimes people in that country attack you." Lanya laughed and joked about his "African coping skills," but his eyes looked red with stress.
He had been up all night with the panic-stricken parents of a little girl with diphtheria, a bacterial throat infection. An operation was attempted, but the girl died during the night.
"It was good to stay with the parents," he said, rubbing his eyes. "But I need to plug up my emotions. I learned that emotions aren't helpful. Just finding solutions are."
For now, he guzzles sodas to stay awake and jokes to keep his spirits up. He said he felt good about helping Haja Hamid, who had left with skin lotions and a four-month supply of vitamins. But more patients were coming. A board on the wall listed 11 more names.
When he reaches Kenya on his next break, Lanya vowed: "I am just going to sleep and sleep. That's when I will really feel the impact of this war."