This, she explains, is the result of education.
Every month in the camps near El Fasher town, a team of health workers—elected by their community and trained by Oxfam—fans out to bring messages about health and hygiene to thousands of residents. The workers go house to house, teaching newcomers about disease vectors, hand washing, and the use of latrines, and they organize community-wide campaigns to clean everything from streets to latrines to household water cans.
You might think people would resent unsolicited advice about their personal habits, but the health workers generally get a warm welcome. Women, who have the primary responsibility for the care of children and homes, are happy to receive this information, say the workers. And for the most part they take the advice.
"If they don’t want to accept what we are saying, we don't go harsh on them," says health worker Halima Nasur "We just communicate the information peacefully." But the cost of not heeding hygiene messages could be outbreaks of deadly disease, so the health workers sometimes ask community leaders to intervene. "They nicely teach a woman the importance of our work to her family. Then she listens."
For the health workers, their job is a labor of love. "I believe that all the people in the camp are my sisters and brothers," says Nasur. "We are never going to let our people down."
When it came to guarding the health of her family and community, Gado needed no coaxing. "From the public health women, I learned to cover food to keep away flies because they transmit diseases. I also learned about keeping things clean—our jerry cans, kitchen utensils, latrines, and my children's hands," she says. "Previously, my children didn’t wash their hands before they ate. They were often weak and not healthy. Now, they wash their hands before eating. They don't suffer from diarrhea, and if they happen to get sick, it isn't something serious."
Once learned, it is hard to forget the life-and-death importance of good hygiene practices, and according to Gado, the work of Oxfam and the community health workers is likely to have a lasting impact. "I learned these values, and I'm going to apply them throughout my life," she says. "I would like to thank all of the people who have supported us," says Gado, "and I wish them good health."
]]>A crowded camp sheltering 25,000 people from the horrific violence of Darfur's five-year-old conflict may seem an unlikely venue, but this is no ordinary pop concert. The tunes are traditional, but the lyrics talk of hygiene and explain how people can avoid fatal diseases. Kaltoum is one of a dozen women who have teamed up with Oxfam to hold weekly music festivals in Shangil Tobai in North Darfur. The concerts bring an afternoon of fun to people who have had fled attacks on nearby villages—but they educate as well as entertain.
"Singing is a part of our lives and we like to sing whenever and wherever we can," says Omer, sipping a small glass of extra sweet tea after the concert ends. "We enjoy it, and the people listening enjoy it, but most importantly our singing now helps change people's lives for the better."
"We take Oxfam's advice about good health and sanitation and put it to our own music," she continues. "You can see the songs changing listeners' behavior. The camp is much cleaner now and there are far fewer cases of malaria and diarrhea. Children wash their hands now without being told. When you tell young children to wash they don't always do as they're asked—but when we sing it to them they join in and have fun, and they really pay attention."
The songs change over time to reflect the needs in the camp, adds Zaharisa, another member of the group. "We used to sing about the need to clean the latrines regularly, but now people are doing this well so we no longer have to sing about it. At the moment my favourite song tells people how to safely and hygienically dispose of waste and get rid of rubbish."
Zainab Basher, an Oxfam health promoter in Shangil Tobai, helps the women organize the concerts. She says the impact has been enormous.
"We hear women and children singing the songs at home and work, and the communities keep asking us when the next performance will be," says Basher. "Now the women perform at weddings and religious festivals, as well as the weekly concerts. Each community has its favorite singers, and keeping latrines and water points clean has become a source of pride. Everyone wants to keep their area of the camp the cleanest. Participation in regular clean-up campaigns has increased greatly."
As the conflict has dragged on five long years, Basher says she and the Oxfam team have had to adapt their work. "We held committee meetings, we visited people's homes, and we trained individuals to become community health mobilizers, but the longer people are here in the camp, the more these methods become routine and ineffective. We needed something new and exciting, so we approached the women singers and they were very keen to help."
The concerts are held in different areas of the camp each week, attracting an audience of hundreds each time.
"We want as many people to hear the songs as possible," says Omer. "Oxfam gives us megaphones for the concerts, to make them louder. The next step is to get cassette recorders to tape the concerts, which we can hand out as gifts to neighbours and relatives so people can listen to the messages at home. Not everyone can sing but we still want to involve them somehow. Some of the women who can't sing are good at playing drums, while others help us write the lyrics."
All over the world, children like to imitate their favourite pop stars. Darfur is no different, and Kaltoum and the women have inspired a new generation of singers who meet every week at the Oxfam health centers in the camp. One popular chorus goes:
"Let us go to school to read,
Let us learn to be healthy,
Let us clean ourselves,
All children, let us do this."
Manahir, a 15-year-old girl from the camp, leads a group of children aged 5 to 16. Some sing, some bang on small drums, and others just clap and cheer. A chant of "clean the jerry can, clean the latrine" gradually gets faster and the drums louder, until the children lose their breath and burst into applause.
"We have great fun, and we learn at the same time," says Manahir. "My friends and I come to the center every day from all over the camp."
Nearby, as the women's concert reaches its finale, another singer named Mahasa takes the megaphone and leads a chorus in praise of Basher and the Oxfam team's recent distribution of blankets and jerry cans for carrying water.
"We thank the aid agencies and the people around the world who send us these things when we have nothing," she says. "If they didn't help us we wouldn't be able to stay here in the camp. We'd have to go home and be attacked all over again."
]]>This is where Asewe stays when she's in Goz Beida, a small town in eastern Chad whose outskirts are now flooded with about 52,000 people forced from their villages by factional fighting. But when it's safe, her home is a tent at Kerfi, one of several sites in the area that the displaced Chadians have temporarily settled.
"That's what my beneficiaries are using," says Asewe about her tent. "It's good to use what my beneficiaries are using."
It's there, at Kerfi, that Asewe likes to be best—in the midst of the people she has come to help. A registered nurse and trained midwife, she is a public health promoter for Oxfam, leading a team of three staffers and a committee of 15. Her job is to work closely with families, showing them how to prevent the spread of waterborne diseases. A musical voice, a warm smile, and an untempered passion are her tools.
Asewe came to this region of Chad in mid-July 2007—at the height of the rainy season—her second posting to the country in a long humanitarian career that has carried her around the world from the tsunami-ravaged coast of Indonesia to Afghanistan, Pakistan, Sierra Leone, Ethiopia and back to Chad. It was raining that first time here, too, back in 2004 when refugees from the Darfur region of Sudan were streaming across the border, many of them having walked for days to reach safety.
She was assigned to Bredjing, a camp that now has a population of close to 30,000 people. But back then, it was just beginning to grow, a chaotic sprawl of families, ragged and tired, desperate for food, water, and shelter.
"It was a very difficult situation. Every morning we would come and we would find at least 100 people, towards the wadi, just squatting around," recalls Asewe. "Some would come with small plastic sheets. Some would have traditional mats, but some would have literally nothing. It would be raining the whole night. The children would have literally nothing on top of their heads."
Many of them didn't survive.
"They put in their own graveyard. Every morning organizations like Doctors Without Borders had outreach people just to count how many graves. Yes. So it was very very painful when they first came."
For nine months, Asewe worked with Oxfam, and alongside other organizations, to bring some order to the camp.
"I left happy, though," she says, "because I had seen the beginning and I saw all the changes—everybody putting in a lot of effort." Besides getting water and sanitation services in place, aid groups had even managed to set up activities for children. And the overcrowding was relieved a bit when some of the refugees moved to a new camp—one that was planned for them in advance, so water systems and latrines were already in place.
For the first few weeks of her posting to Kerfi, about 45 kilometers south of Goz Beida, Asewe couldn't even get there. The heavy seasonal rain had swollen the seasonal river, or wadi, swamping parts of the village, and making it impossible for trucks to cross. The short drive from Goz Beida to Kerfi took six or seven hours through the rain, as drivers struggled to negotiate the mud and gushing streams.
Doctors Without Borders was the only aid organization working in Kerfi at the time, said Asewe and it had managed to get there before the rains began to fall. It had parked two of its trucks on the far side of the wadi rushing by the village.
Eventually, workers built a small raft from old drums. An Oxfam driver would deliver Asew to the wadi's edge, and she would float across, her feet dangling in the water, to catch a ride on the other side in a Doctors Without Borders truck.
"We did that until September," Asewe said. "We were not able to get a driver across until October so that delayed all the possibilities."
But once she was able to set foot in Kerfi, Asewe wasted no time in laying the groundwork for her program.
In crowded situations, where there is little room for people and their animals to live as they are accustomed, the spread of waterborne diseases poses a major threat. In December Kerfi was home home to more than 3,000 displaced people—on top of the 4,200 who were already living there.
"The major issue was there was a lot of wadi water, but no clean water," said Asewe, noting that Doctors Without Borders was treating numerous cases of diarrhea. "It was pathetic. The host community, having been completely surrounded, also lost the area they would use for extra space. Their main complaint was they hardly had any place to get their animals to graze." Nor did they have any place left to use as a bathroom.
"Hence the demand for latrines and water," says Asewe.
In convincing people to adopt new ways of doing things, it's important to make them part of the process—so they own it, too. But first, Asewe has to find out what they know, and in this case, it quickly became clear that people were not making the link between the dirty wadi water they were relying on the diarrhea they were suffering from.
"That gives you a key basis where to start," says Asewe.
She organized a development committee of nine women and eight men from Kerfi who would eventually help her with the big task of public education. After some training, together they settled on three main messages they needed to convey to the community.
The messages may sound simple to western ears, but for the residents and displaced people of Kerfi, they could mean the difference between life and death.
Here is what the health promotion committee and Asewe want the people of Kerfi to do:
Part of Asewe's public education program also includes granting families ownership of community latrines—along with cleaning and maintenance duties. About 20 people share each latrine. When a cluster of three or four have been built for people who are under the care of one chief, Asewe arranges for a handover ceremony, with plans made for who's going to keep the latrines clean and how they'll close them down when they're full. And with each latrine, Oxfam provides a latrine kit—a brush and bucket for cleaning.
Some people get the messages very quickly; others are slower to change.
"The best people to target are the children," says Asewe. They learn quickly and adapt readily. "For adults, they may be able to understand, but changing habits may not be so easy."
But whatever the frustrations may be—wadis overflowing with water, insecurity that keeps her tied to Goz Beida, the slow pace of people's adaptation—Asewe says none of that is enough to snuff out the enthusiasm she has for this work.
"I'm still so happy to be the public health promoter who goes to that little house and finds the child and plays around with them and see how you could improve their little lives," says Asewe. "That makes me more happy. It's quite an opportunity and a blessing."
]]>I like to sleep. But by six o'clock the first rays of the sun are coming through the holes in the wall of my family's shelter, the cocks and donkeys start their shouting, and the camp starts to come to life. The first thing I do when I get up is pray. I ask God to look after my family, and bring peace to Darfur. Then I get on with the household chores... so many chores! I boil the water on the fire to make tea, I wash my brothers' and sisters' clothes, and then I clean the cooking pans. I don't enjoy cleaning and sometimes I'm tempted to do it very quickly, but Oxfam is always telling us to clean the pans thoroughly and I'm scared of getting sick if I don't!
By 8 a.m. I'm on my way to the community center. It's a short walk from my house and it's run by Oxfam. At the center I take lessons in hygiene and English. I like the hygiene class because I can see how to make changes in our house that keep my brothers and sisters healthy. Now whenever I see a woman not taking proper care of her latrine, or not cleaning her jerry can (for carrying water) I get very upset with her. I like the English class, too, but it's very difficult. Maybe next time we can speak in English, but I don't think so!
I am not married yet. Insha'allah—God willing—I will be soon. But there are few men my age in the camp. Most people here are women, old men, and children. Many younger men are away fighting. Or dead. There was a boy in my village who my friends used to tease me that I would marry, but now I don't know where he is. So for now I live with my mother, two little brothers aged 8 and 9, and two sisters aged 11 and 13. My father is no longer with us. I'm the oldest, which means I get to be in charge, but also that I have to do most of the work while my brothers get to play soccer.
At 10 a.m. it's time to go home and make breakfast. We have two meals a day—breakfast at about 11 a.m., and then dinner in the evening. I like to eat goat meat but here in the camp it is too expensive. My mother taught me long ago to make stew from vegetables, but it would be so much nicer with some chicken in it. I also like assida, which is one of our famous Darfur dishes. It's like a thick porridge made from sorghum. Back in my village, every time there was a celebration—a wedding, a birth, a new visitor—we would have roasted meat to eat and a big party in the village.
After breakfast I head to the Oxfam water point. I do this at least once every day. At the moment there are big queues. Today I had to wait for more than one hour and it was very hot. But the other women have to wait, too, so I get to catch up on all the news while I'm waiting. I usually take one of my little sisters with me to help carry the water home as it can be too heavy for one person.
We use water for everything. I can't even imagine what it would be like to be without it. Every time I eat I need water—to boil the food, to wash the vegetables, to get rid of the dirt and germs. Everything I drink is either normal water or boiled water for tea. I use the water to wash the clothes of the whole family. We don't have any animals but some of my friends' families have donkeys and the water also keeps them alive and healthy.
The afternoon is more of the same. Living in the camp I really notice how life feels very repetitive. I go to school, I cook and do chores, and then I do it all over again. In the afternoon I go back to study at the community center for an hour or so, and then I go home to prepare the evening meal. Even the food is usually the same.
I very rarely leave the camp. Why would I? Here there's a water point, a market, a community center. Outside there's danger—soldiers and guns. My mother goes out of the camp maybe twice a week to collect firewood, which we can use at home and sell what's left over. This is the only money we get. I feel guilty: It's so dangerous for my mother to do this. The women often get attacked or shouted at or shot at. They won't let me go with her. They say only older women should go as young girls are more likely to be attacked. Secretly I'm glad: I don't want her to go alone, but I don't want to go with her because I'm scared of the men.
When I first came here we saw the camp and the aid agencies and felt safe. Unhappy, but safe. Now even the camp is dangerous. At night nobody really goes outside their shelters. When I'm done cooking I stay home and study. I would like to do my English work but I have nobody to practice with. I study until it gets dark after eight o'clock, and then we go to bed and start the day again.
It's difficult for us here. Look at our shelter—it's very basic. This is not home. Soon the rains will come and then some of the shelters will be destroyed. What will happen to those people? I know the aid agencies are doing their best, but there are so many people here and everybody always needs something. I think the only way our lives will really improve is if we go home. But we can't go home because people are still being attacked. I will stay in Kalma until peace comes. I just hope it won't take too long.
]]>The achievements of Oxfam and other aid agencies in Darfur have been truly incredible. Jan Egeland, the former UN Humanitarian Coordinator, described the humanitarian response in Darfur as among the most successful in the world, and he was right. The high levels of mortality and malnutrition that we saw at the start of the crisis have been greatly reduced. Many people now have better access to water, sanitation, and education than they did before the conflict. However, other things have not improved. People in Darfur still live in daily fear of violence. Those living in camps cannot go outside without risking attack. The number of people in need of help keeps rising. There are now four million people in Darfur who rely on aid.
What are the biggest challenges Oxfam faces now in Darfur?
Safety and security is by far the biggest concern for both civilians and our staff. Our ability to reach people in need is decreasing due to hijackings and attacks on aid workers. Early in my time here I drove for hours through North Darfur, from El Fasher to our programs in Kebkabiya, through quite stunning scenery. Now this road is far too dangerous for us to use and we rely almost entirely on UN flights. In terms of security, we are operating at the very limit of what we can tolerate as an organization, and if the situation continues to deteriorate then we may be left with no option but to withdraw from Darfur. The humanitarian impact of this could be catastrophic. It's vital that the world leaders do more to ensure an end to the violence so that aid agencies can continue our life-saving work.
The crisis is now in its fifth year. Is there any sign that Darfur will move on from being a humanitarian emergency and into a development and recovery stage?
Oxfam has been working in Darfur for more than 20 years, carrying out development work with local communities. We all hope that we can resume this as soon as possible. But at the moment Darfur is still an enormous humanitarian crisis and we cannot resume large-scale development work until there is a sustainable political solution to the conflict. People continue to be attacked and displaced by the thousands. We are still seeing people arrive in the camps where we work. The situation in Darfur is incredibly complex and we have to be very careful. For example, many of the villages that people have fled from are now inhabited by other communities, and if we were to provide development assistance to them we would risk legitimizing this.
What has been your proudest achievement in your time here?
The relationship between non-governmental organizations and the Sudanese government has been complicated and at times difficult. Back in early 2004 we just could not get our staff members the necessary visas and permits to get to Darfur and respond to the urgent needs there. It was very frustrating. Our staffers have since done a wonderful job in building a working relationship with the authorities—both in Khartoum and at the field level—and as a result these problems have now been eased considerably. Without this success, we would not have been able to have such an impact on the ground and provide water and assistance to half a million people.
And your biggest frustration?
When I took up the post of country program manager, Darfur was one of the world's largest humanitarian crises. Today the security situation for people there is perhaps even worse, and the prospect of peace seems as far away as ever. It has been incredibly frustrating to see the hard work of our staff thwarted by insecurity in so many places. In Gereida in South Darfur, for example, the team did a magnificent job to set up water supply to 130,000 displaced people. But since then we have had to withdraw from the area because of insecurity. Across Sudan there are still many challenges. Marginalization and poverty are still endemic, and there are increasing threats to the nationwide Comprehensive Peace Agreement.
Finally, what personal memories will you take from working in Africa's largest country?
Outside Sudan, very little is known about the country, its people, and culture. What does get attention is mostly war and human suffering. Despite the enormous problems in the country, the Sudanese people are incredibly friendly and welcoming. I can honestly say that in my years of working around the world, my job in Sudan has probably been the most satisfying and enjoyable. The Sudanese are also extremely resilient people. It is incredible to go to the camps in Darfur or to the harsh deserts of the east and see how people cope in the face of adversity. It makes me feel confident for the future that Oxfam can work closely with local communities to help build a better Sudan.
]]>One of the remarkable things about Darfur is the number of people who are still volunteering with health committees after three years of living in Abu Shouk and Al Salaam camps outside of North Darfur's capital of El Fasher.
About 60 percent of the original committee volunteers at Abu Shouk have continued with their work. At nearby Al Salaam camp, the number is 80 percent. Their help is pivotal to the success of Oxfam's public health work in the camps. Every week they spend several hours visiting households in their allocated blocks and inspecting the surrounding areas.
They go shelter to shelter talking with families and sharing information on good hygiene. They check latrines for cleanliness and wear. And they instruct families on how to keep their water clean by making sure the jerry cans in which they store it are scrubbed with powdered soap and chlorine.
"We wanted to serve our people and to raise the awareness of the population so that everyone's at the same level," says Kaltoum Ali Asad, a volunteer at Abu Shouk.
"If we don't volunteer to do something the people would suffer and there'd be outbreaks of diseases and illnesses," adds Namma Saed Haroun at Al Salaam camp. "If we didn't volunteer it would be us who would eventually suffer, so we will continue to volunteer."
Their efforts win high praise from the agency.
"The volunteers work really hard," says Hussaam Eddin Mirghani, Oxfam's team leader at Abu Shouk. "They volunteer because they're afraid of diseases, especially diarrheal diseases, spreading throughout the camp. The volunteers really feel the necessity to support their communities and their people, who are really suffering in this dreadful situation."
Camp life is bleak. Ahmed Eysa, who has lived at Abu Shouk for three years with is family, makes that clear.
"Life here is horrible," he says. "It's full of difficulties, and we don't have any solutions in our hands. There are no choices for the people living here in the camp."
But Eysa has made one choice—an important one that will make a difference to others in the camp. He chose to volunteer, and he has continued giving his time for three years.
"We have to adapt to our situation and we really need to respond," he says. "There's no way we could give up."
Soon, the rains will come and fall heavily. Living conditions in the camps will deteriorate, and the threat of diseases like cholera, malaria, and diarrhea will rise. Then, the job of the health committee workers will be even more vital.
]]>But, he adds proudly, he does know how to wash his hands properly after going to the latrine—something he rarely did just a few weeks ago. And he proceeds to demonstrate to the group of children, who—like Osman—have started attending Oxfam's child-to-child educational programs that aim to equip the children of Kalma camp with knowledge that could save their lives.
Football matches, songs, volleyball tournaments, and playground games are just some of the innovative ways in which the Oxfam Public Health Promotion (PHP) team here is teaching children how to stay healthy.
Kalma is one of the largest camps in Darfur—mile after mile of tightly packed shelters and rapidly constructed sanitation systems currently home to around 89,000 displaced people. As in most camps, the vast majority of residents are women and children. Two years ago there were just 19,000 people here, but rapid growth since then has created an abundance of health risks, to which children are the most vulnerable.
"Children everywhere need to be taught to wash their hands and keep clean," says Khaled Suleiman, one of Oxfam's PHP officers in the camp. "But here especially so, as the consequences can easily be fatal."
To make sure the messages sink in, Khaled and the team try to make them as fun as possible. Oxfam has built a series of community shelters where child-to-child interactive classes and activities are held.
Songs are enthusiastically sung about how to prevent malaria and diarrhea ("Our food should be washed, our water should be covered," the children sing, accompanied by stomping of feet and clapping of hands).
Other songs encourage children to participate in community clean-up campaigns, and explain how to set up mosquito nets and use the latrines properly. Oxfam has installed around 9,000 family latrines and 1,500 communal latrines in Kalma.
The children in Kalma love to make noise. The merest glimpse of a new Oxfam worker elicits a chorus of hundreds of voices shouting in unison, "OK, OK"—the nickname the children of Kalma have given to foreign visitors and the first English word every child in the camp learns. The welcome is followed by mischievous smiles and laughter all round, and the children's enthusiasm for loud, energetic fun extends into the classroom.
"My favorite is the singing and dancing," says Osman of the child-to-child activities, his arms waving frantically about his head as he mimes the actions to a song about swatting away flies. "And I like to learn new things." He has spent most of his short life in the camp after arriving here with just his mother. Nobody is sure what happened to his father and brothers.
Nine-year-old Hawa also likes to sing. "I enjoy the classes as I can make friends with lots of other children and learn at the same time. We sing the songs when we go home as well. I would like to go to school but so far I have not been able to," said Hawa, who has been in the camp for two-and-a-half years since her family fled their village of Shataya, nearly 100 miles to the west.
The PHP team works with community volunteers to come up with new songs that they think the children will find both educational and entertaining. "Kalma is as big as a city, so it is divided into eight 'sectors,'" says Khaled. "Recently we heard children from sectors 7 and 8—the only parts of the camp where Oxfam does not work—singing our songs! The children at our classes had been singing at home and gradually the songs spread around the entire camp."
The programs have proved extremely popular—almost too popular. The teachers—themselves displaced people living in the camp—say they often have 400 children trying to cram into a single room at the community shelter. "Every time we open the door, another dozen or so burst in," says Khadija, who teaches children in Sector 3 of the camp.
"Having such large classes can make it very hard for us to get the message across successfully," she says. "So we have split them into groups. Group 1 comes between 8:30 and 10:30 and Group 2 between 11 and 1 pm. Of course, some children try and come to both!"
"We are trying to ensure that the children are exposed to our messages at every possible opportunity," says Khaled. "The songs are just a part of our activities and it is clear that children's health has improved since the programs began."
Cartoon drawings explaining how food can breed germs, and how failing to clean latrines will spread disease and attract rodents, are pinned to the walls of the community shelters. Football matches and other events are organized for children to attend, where health-related information is disseminated.
The PHP team is also coordinating its efforts with the four primary schools in Kalma camp. A number of children from each class are chosen as supervisors and join teachers for training in hygiene promotion. The skills and facts they learn are then passed on to their classmates and pupils.
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