Tackling meningitis amidst the many challenges of Darfur
By Steinar Sveinsson, UNICEF Sudan.
El Geneina, West Darfur, June 2009. The Darfur states in Sudan, already confronted by conflict and the displacement of millions of people, face another lesser-known challenge – their membership of the “meningitis belt” that stretches across sub-Saharan Africa, from Senegal to Ethiopia.
During the dry season the meningitis bacteria thrives as the population becomes weaker and more vulnerable due to sandstorms, cold nights, and lack of water and food as the life-threatening “hunger gap” approaches. In Darfur, the dense populations synonymous with displacement assist transmission.
In 1996, Africa experienced the largest recorded meningitis epidemic, with over 250,000 cases registered – one in ten proved fatal. And yet this terrible disease is easily preventable, and treatable.
“Although meningitis is life-threatening it is curable if detected in its early stages and it’s preventable with vaccination which lasts up to five years,” explains UNICEF’s Dr. Ali Dowelbait Ali, based in the West Darfur city of El Geneina. Dr. Ali has worked on health programme in West Darfur for the past five years and fought meningitis many times.
Around mid-March 2009 meningitis cases were confirmed in the Western Jebel Marra area of West Darfur – just days after 16 aid agencies were forced to suspend operations and in most cases leave the country on the instruction of the government.Around mid-March 2009 meningitis cases were confirmed in the Western Jebel Marra area of West Darfur – just days after 16 aid agencies were forced to suspend operations and in most cases leave the country on the instruction of the government.
“The sudden change in the humanitarian landscape meant UNICEF had to re-examine its own role in Darfur,” recalls Dr. Ali. “Normally, UNICEF coordinates programmes and provides technical and financial support to specific projects – with the expulsion of key partners, UNICEF had to rapidly take on additional responsibilities to help fill the gaps left by the NGOs.”
For the meningitis campaign, UNICEF supplied 70,000 doses of vaccine to the International Committee of the Red Cross (ICRC), with ICRC providing the necessary logistics to get vaccines into the target areas. ICRC and the World Health Organization (WHO) also assisted with the training of vaccinators themselves.
Bringing services to areas beyond official government controlIn Western Jebel Marra more than 31,000 people were vaccinated against meningitis during the first eight days of the campaign alone, with a total of 74,000 people reached by the end of May. Coverage extended into areas that were not under the control of the Government of Sudan, requiring UNICEF and the ICRC to work with rebel movements and local communities to guarantee safe access for vaccinators and respect for the neutrality of those working on the campaign.
“This was a complicated and challenging project in every respect – UNICEF became actively involved in leadership on coordination, logistics, technical support, implementation and monitoring of the campaign in the absence of its usual partners. The role of the ICRC, with its reputation as a neutral humanitarian organization, was equally critical in ensuring that vaccinators were able to enter areas safely,” explains Dr. Ali.
But gaining access to these areas was also a physical challenge, requiring coordinated efforts of a number of agencies including UNICEF, WHO, ICRC and international NGOs still operating in the Jebel Marrah region.
“Western Jebel Marra is isolated and difficult to access because of security and conditions of the roads. Therefore, UNICEF chartered a helicopter to take vaccines to one central village, from where vaccinators fanned out to other villages in the area,” says Dr. Ali. “Because of the remoteness of the area the vaccinators used donkeys equipped with special vaccine carriers to transport the vaccine, again supported by the ICRC. The vaccine needs to be kept cool to retain its potency so the vaccine carriers were filled with icepacks. For storage of the vaccine we used solar fridges that we have already installed in some of the villages to support routine vaccination campaigns.”
Using local resources, with additional support
Despite the difficult terrain and expense of using air assets – which can cost several thousands dollars per hour to keep airborne – the large coverage made the overall exercise highly cost-effective. A total of 60 vaccinators participated in the campaign, all coming from villages in the region. While many had taken part in vaccination campaigns before, the specialist nature of meningitis vaccination required additional training to be provided. The vaccinators worked in teams of four, travelling to different villages every day, with a target of reaching 500 people per team every day.
The highest risk group of the population are those aged between 2 and 30 years of age – about 65 per cent of the local population.
“Having gone through the complicated and expensive preparation phase and transported the vaccination material to the area it was important that the implementation was successful. We had to vaccinate as many of the target population as possible,” Dr. Ali explains.
“Every village has different market days and vaccination teams planned to be in the villages on these days to reach as many people as possible,” Dr. Ali explains. “UNICEF also worked with community leaders to get messages out to the people about the vaccination. And once the people know about the vaccination they come – they know that it is necessary for them and tell others as well. We also sent messages to nomadic groups, so they too would come into villages on the fixed dates to be vaccinated.”
Initial results appear promising – there have been no new cases reported in the target areas since the immunization campaign was rolled out. Delivering results that save lives
In total, there were just 124 cases of meningitis registered in Western Jebel Marra during the current outbreak, with 15 per cent proving fatal. Without the rapid vaccination effort, it is highly probable that the outbreak would have been much worse.
Despite the success, Dr. Ali remains cautious. “If one thing is sure, meningitis will reappear and when it does UNICEF will have to be ready,” he warns. “If the gaps left by the expelled NGOs are not adequately filled in the long-term, there will be a need to review the way immunization campaigns such as these are undertaken. We cannot afford not to take meningitis – and the response to outbreaks – seriously.”