NAIROBI, Kenya — On her last day in the war-torn Darfur region of western Sudan, Gemma Davies, a 29-year-old British staffer with Doctors Without Borders, helped arrange for a gunshot victim to be transferred from the charity group's remote mountain clinic to a faraway state hospital. She watched as doctors discharged a young mother a day after a difficult delivery.
Then she and about a dozen colleagues lifted off in a helicopter, leaving behind a small local staff, a few weeks' worth of supplies and a promise to make radio contact twice a day. Their departure, three days before the International Criminal Court was due to issue an arrest warrant for Sudanese President Omar al Bashir in connection with atrocities in Darfur, was a security precaution, and Davies figured she'd return to the clinic in a couple of weeks.
Now, however, Davies and her team, part of the Dutch arm of Doctors Without Borders, are banned from Darfur after Sudan expelled 13 international humanitarian agencies and three domestic groups last week who were working in the troubled region. Soon after the warrant was announced, Bashir accused the foreign agencies of collaborating with the court — which they deny — and Sudanese authorities began freezing their bank accounts and confiscating computers, telephones and radios.
The future of the clinic where Davies worked — and that of scores of programs throughout Darfur that provided clean drinking water, sturdy latrines, prenatal care, vaccinations, schooling and emergency food for malnourished children — is in doubt. The clinic and many other sites are cut off from communication and supply lines, reduced to islands in a harsh, sprawling scrubland the size of Texas.
Relief groups are scrambling to shutter their offices, pay off local staff members and vacate the country, with no idea how — or whether — their programs will continue. The United Nations estimates that the expulsions will affect 1.1 million people.
"We're very concerned that we've left patients behind," Davies said in an interview in Nairobi, in neighboring Kenya, where many expelled aid workers are beginning to arrive.
A day before flying home to London, Davies sat in a plush banquette at a sleek new Nairobi coffee shop, 1,500 miles and a universe removed from the craggy Jebel Mara mountains in southern Darfur, where she'd worked for the previous six months in a village called Feina. She had three months remaining on her contract.
The free clinic in Feina, established two years ago, is the only health facility serving some 90,000 people who've been displaced by fighting and are scattered throughout the mountains. The nearest decent hospital, in the city of Nyala, is an eight-hour drive away, if rains haven't washed out the road. In an average month the clinic saw about 3,000 patients.
"The population is scattered all over and access is a huge problem," said Davies, who previously worked for Doctors Without Borders in Turkmenistan. "With us gone, they have no one."
Among the simple farmers and livestock herders in the area, rates of hunger and maternal mortality are high even by Darfur's grim health standards, Davies said. On March 1, the day her team left, seven children younger than 5 were being treated in the clinic's emergency feeding center, with stiff doses of heavily fortified milk formula being pumped into their limp bodies.
The clinic has enough formula for several weeks, Davies said, as long as there's a steady water supply. When the team left, a diesel truck was pumping water. If the pump breaks down, residents will have to bring potable water up the mountainside on the backs of donkeys.
With the international staff gone, only a local midwife remains to offer prenatal care, an unprecedented service in an area in which poor nutrition and traditional birthing methods often leave women with grave post-delivery injuries.
In the month before Davies left, three women required emergency cesarean sections and the team arranged for each of them to be transported to Nyala. None of the babies lived, but two of the women managed to survive the complications.
"Those women aren't going to have help anymore. They're going to be in trouble," Davies said.
The agency also was forced to end services in Kalma, a camp that houses 90,000 displaced people, and in the town of Muhajariya, where it helped to operate the only hospital in an area, which has 70,000 residents.
Darfur has been a killing field since 2003, when rebel groups launched an uprising and the Sudanese government responded with a brutal scorched-earth campaign. Perhaps the only bright spot has been the response by humanitarian agencies, which braved the tough terrain and byzantine government bureaucracy to build from scratch the world's most complex relief operation, dramatically curbing deaths from malaria, cholera and other treatable illnesses.
"The immediate future for Darfurians is a sharp decline in the remarkable humanitarian work that has reduced mortality rates to near-normal levels in the aftermath of the massacre years of 2003-04," Julie Flint, a leading expert on Darfur, recently wrote on the Web site of the Social Science Research Council, a New York-based research center.
The expelled U.S.- and Europe-based groups provided about half the relief services in Darfur, says the U.N., which has warned of catastrophe if the groups aren't reinstated. There are no signs that Sudan will reverse the decision, however, and ousted aid workers aren't optimistic that the Sudanese government or the remaining relief groups will be able to fill the gap quickly.
"There are no NGOs" — nongovernmental organizations — "with the capacity to do it," said David Clatworthy, a water and sanitation coordinator in Darfur for the International Rescue Committee, a U.S.-based group that also was expelled.
Clatworthy helped run projects in three sites in Darfur, pumping some 1.5 million gallons of drinking water daily into camps that house 167,000 displaced people. When diesel fuel for the pumps runs out and the water taps need replacing — 250 taps wear out every month from overuse — no one will be around to do it, he fears.
Aid groups long have complained about the strictures of operating in Darfur, including lengthy delays to obtain travel permits and authorizations for deliveries. Once, Davies' team's monthly shipment of food to Feina was delayed for several days because authorities objected to one item: canned peaches.
"You face barriers to what you're doing," Davies said. "You can have all the will and capacity, but you still need permission to get food, logistical support, medical supplies."
In the end, the team in Feina never numbered more than 12 foreigners. That was the maximum that could be carried out by helicopter in an evacuation.
More than 50 local staff members remain, but on the other end of the radio — where Davies and her team were supposed to check in twice daily — there's only silence.
"I would think they would keep running as long as they could," Davies said. "But we have no way of knowing. To know you have more than 50 staff there, totally unsupported, their level of knowledge not great — it's very difficult to imagine what will happen."
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