VZCZCXRO6702
OO RUEHGI RUEHMA RUEHROV RUEHTRO
DE RUEHKH #0405/01 0820624
ZNR UUUUU ZZH
O 230624Z MAR 09
FM AMEMBASSY KHARTOUM
TO RUEHC/SECSTATE WASHDC IMMEDIATE 3330
INFO RUCNFUR/DARFUR COLLECTIVE
RUEHGG/UN SECURITY COUNCIL COLLECTIVE
RHMFISS/CJTF HOA

UNCLAS SECTION 01 OF 03 KHARTOUM 000405 
 
SENSITIVE 
AIDAC 
SIPDIS 
 
DEPT FOR AF A A/S CARTER, AF/SPG, AF/C 
NSC FOR MGAVIN AND CHUDSON 
DEPT PLS PASS USAID FOR AFR/SUDAN, USAID/W DCHA SUDAN 
ADDIS ABABA ALSO FOR USAU 
 
E.O. 12958: N/A 
TAGS: EAID ASEC PGOV PREL KPKO SOCI AU UNSC SU
SUBJECT: COMBATTING THE MENINGITIS OUTBREAK IN DARFUR 
 
REF: A) KHARTOUM 318 
B) KHARTOUM 313 
C) KHARTOUM 311 
D) KHARTOUM 306 
E) KHARTOUM 299 
 
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SUMMARY 
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¶1. (U) SUMMARY. As international donors and humanitarian agencies 
continue to seek ways to address the humanitarian gaps created by 
the Sudanese government's March 4 and 5 expulsions of 13 
international organizations and dissolution of three Sudanese 
organizations, cases of meningitis are increasing throughout Darfur, 
particularly in South Darfur and West Darfur.  On March 18 and 19, 
USAID's Office of US Foreign Disaster Assistance (USAID/OFDA) staff 
met with members of the UN World Health Organization (WHO) to 
discuss the current situation, the impact of gaps due to the 
expelled health partners, and alternative measures that the 
international community and Government of National Unity (GNU) can 
implement to prevent the spread of the deadly disease and treat the 
cases already diagnosed. END SUMMARY. 
 
--------------------------------------------- ---------- 
THE LAST SIX WEEKS IN DARFUR'S DEADLY MENINGITIS SEASON 
--------------------------------------------- ---------- 
 
¶2. (U) The meningitis season in Sudan typically occurs between 
January and April, and health officials generally observe an 
increase in the number of reported isolated meningitis cases rather 
than a widespread outbreak of disease. Meningitis is highly 
contagious, particularly for populations living in overcrowded IDP 
camps during the January to April dry season.  In addition, 
according to Mdecins Sans Frontihres (MSF), a meningitis patient 
receiving rapid and appropriate treatment has a mortality rate of 5 
to 10 percent, whereas an untreated meningitis patient has a 50 
percent mortality rate.  According to WHO, this year's first cases 
of meningitis appeared in South Darfur during the week of February 
¶7.  During the week of February 15, the South Darfur State Ministry 
of Health (MOH) requested that rural hospitals form committees to 
combat a potential meningitis outbreak through conducting active 
case finding, case management, and immediate reporting to the MOH. 
In addition, WHO made efforts to increase disease surveillance, 
pre-position supplies, and train national staff, and the Federal MOH 
prepared to conduct a vaccination campaign. 
 
¶3. (U) On March 1, the UN Office for the Coordination of 
Humanitarian Affairs (OCHA) reported suspected meningitis cases in 
West Darfur and South Darfur, including 14 suspected cases and one 
confirmed case in Thur and Kutrum towns in Jebel Marra, West Darfur, 
and 14 suspected cases in the teeming Kalma IDP camp, near Nyala, 
South Darfur. 
 
¶4. (U) On March 2, the South Darfur MOH declared a meningitis 
outbreak in Kalma camp. According to federal health guidelines, the 
threshold for a meningitis outbreak in a population living in a camp 
is two confirmed meningitis cases, or more than 10 cases in a 
population of 100,000 individuals, or a doubling of cases over a 
period of three continuous weeks.  (NOTE:  Kalma met all three 
criteria at the end of February.  END NOTE). 
 
¶5. (U) During the planning phase for the substantial preemptive 
measures against the meningitis spread, health partners did not 
anticipate the GNU's immediate expulsion and dissolution of key 
implementing health partners in Darfur.  In the last 20 days, 
without the necessary humanitarian staff, many of the pre-planned 
activities, campaigns, and surveillance exercises have gone 
unimplemented and the residents of Darfur have suffered.  According 
to WHO, the expulsion denied health care to 1.5 million people in 
Darfur, including individuals in the IDP camps most dramatically 
impacted by the current meningitis season, Kalma camp and Bielel 
camp in South Darfur, and Thur camp in West Darfur. Kalma, a 
stronghold of Paris-based rebel leader Abdul Wahid Nur, has long 
been a target of particular ire by the Sudanese authorities, which 
culminated in a massacre there in August 2008. 
 
¶6. (SBU) On March 10, OCHA reported two incidents of internally 
displaced persons (IDPs) rejecting government officials entry into 
Kalma camp, including IDPs declining to allow Sudanese government 
medical staff and Sudanese non-governmental organization (NGO) staff 
entry to commence the planned meningitis vaccination campaign. IDPs 
did however permit staff from the UN Children's Fund (UNICEF) to 
enter the camp. According to local reports, the IDPs do not trust 
 
KHARTOUM 00000405  002 OF 003 
 
 
government authorities and fear that the Sudanese staff will inject 
IDPs with 'bad things'. 
 
¶7.  (SBU) As of March 13, WHO reported 47 cases of meningitis in 
South Darfur, including four fatalities.  Due to the lack of health 
partners conducting disease surveillance in Kalma IDP camp, any 
South Darfur case counts after March 3 exclude data from Kalma camp. 
 This, due to the camp's significant size and caseload potential, is 
not a small omission and as a result, the number of meningitis cases 
in South Darfur could be significantly higher than current reports. 
Prior to their expulsion on March 4, health partners in Kalma camp 
had reported 32 cases of meningitis and two deaths.  Following 
laboratory tests on two cases from Kalma camp, health officials 
confirmed cases of neisseria meningitides serotype A, the strain 
that the routine vaccination prevents. Although no data is available 
from Kalma camp after March 3, WHO and the South Darfur MOH have 
been monitoring the arrival of meningitis cases to Nyala's teaching 
hospital and note that no cases from Kalma have been admitted and/or 
treated since March 3.  WHO and the MOH have also been monitoring 
the health clinics in Bileil locality, near Kalma camp, and report 
no admitted cases from Bileil either.  (NOTE: Although this is 
indirect evidence, it suggests that people are not traveling from 
Kalma camp to seek outside medical care, and perhaps the situation 
within the camp is not as severe as believed. END NOTE).  As of 
March 20, the number of meningitis cases in Kalma camp remained 
unknown because health partners were not seeing or treating patients 
in the camp and the IDP leaders had no idea which camp residents had 
undiagnosed or untreated meningitis. 
 
¶8. (SBU) As of March 18, IDPs in Kalma camp forbade Sudanese health 
staff from entering the camp to commence the vaccination campaign. 
However, in Bielel camp Sudanese MOH staff initiated the meningitis 
vaccination campaign with technical support and supplies from WHO. 
As of March 18, more than 6,000 of the 25,000 camp residents had 
received the vaccine.  (NOTE:  Typically those under 2 or over 
forty-five do not get immunized. END NOTE). Because sector 1 of 
Kalma camp is contiguous with Bileil camp, humanitarian staff hope 
that some Kalma camp residents may seek vaccinations at Bileil camp. 
 MSF/Netherlands (MSF/H) had planned to conduct a vaccination 
campaign targeting 130,000 individuals in Kalma and Bileil camps in 
early March, the expulsion of MSF/H staff left the IDP population of 
these camps vulnerable to meningitis and without health care. 
Following the NGO expulsion and IDP prohibition of Sudanese 
organizations to enter the camp to provide services, WHO, UNICEF, 
and OCHA have attempted daily negotiations with highly politicized 
IDP leaders in hopes of reaching an agreement.  Although the 
negotiations remain unresolved, according to OCHA, IDP leaders 
reported plans to provide their decision on the alternate health 
partners who would be permitted to conduct a vaccination soon. On 
March 18, IDP leaders summoned health partner Merlin to a meeting in 
the camp; however, when Merlin staff arrived, the youth group 
members prohibited the health staff from meeting with the IDP 
leaders, so the issue remains unresolved.  As of March 22, Merlin 
had still not been allowed into Kalma to conduct an immunization 
campaign. CDA Fernandez is seeking to contact Kalma IDP Camp elders 
to urge them to allow the vaccinations to proceed. 
 
¶9. (SBU) West Darfur's Nertiti area is also experiencing increased 
caseloads of meningitis.  Prior to their expulsion, MSF/France 
(MSF/F) had planned a vaccination campaign for 40,000 individuals in 
Jebel Marra, West Darfur, particularly near Nertiti town and Thur 
camp, where MSF/F staff registered 17 cases of meningitis since 
early February. In addition, USAID staff noted unconfirmed reports 
of cases of meningitis in the rural area approximately 1km outside 
Nertiti town, Thur town, and Golo IDP camp during the first week in 
March.  On March 12, community members in Thur town and Kutrum town 
reported four cases of meningitis each.  As of March 18, WHO 
reported 18 cases of meningitis in Nertiti and Thur, including two 
deaths and one confirmed specimen of neisseria meningitides serotype 
¶A.  On March 18, the International Committee of the Red Cross 
reported 13 cases of meningitis in the Golo area of Jebel Marra, 
West Darfur.  WHO plans to conduct an assessment to the affected 
areas on March 21 to verify the information. 
 
¶10. (U) On March 18, WHO staff in North Darfur reported 13 suspected 
cases of meningitis.  Although laboratory confirmation is pending, 
health staff note that the cases have appeared during the last five 
weeks without any particular geographic cluster or origin.  Although 
the cases remain limited, WHO staff encourage further surveillance 
and preparedness for all area health partners. 
 
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NEXT STEPS, SUGGESTIONS, AND ACTIONS 
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KHARTOUM 00000405  003 OF 003 
 
 
 
¶11. (U) During the March 18 meeting with USAID/OFDA staff, WHO 
officials outlined continuing measures to address the unfolding 
situation.  In addition to advocating for continuous monitoring of 
the situation on the ground, WHO plans to pay salaries of Sudanese 
health clinic staff of expelled partners in gap areas through the 
end of March in order to facilitate the continued collection of 
surveillance data.  As health sector lead, WHO is organizing 
meetings twice a week to coordinate with the MOH and remaining NGO 
partners on the best ways to fill the existing health care gaps and 
maintaining the health care gap map. 
 
¶12. (SBU) By all accounts, the water situation in the most affected 
areas appears to be sufficient, as IDPs are permitting the entry of 
some supplies (i.e. fuel) and local staff of expelled NGOs are still 
working.  GNU authorities have requested that World Vision 
International (WVI) assist in Kalma camp with water, sanitation, and 
hygiene (WASH) issues, and WVI reported that local authorities have 
pressured WVI field staff to assume some WASH services in some of 
the camps surrounding Nyala as well as in Kass IDP camp.  Currently, 
WVI staff remain in "a wait and see mode".  (NOTE: This report of 
the GNU targeting specific agencies to work in designated areas 
despite lack of technical agreements, or results of the UN 
assessment, or specific mandates is consistent with what USAID is 
hearing from many of its partners remaining in Darfur. END NOTE) 
 
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COMMENT 
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¶13. (SBU) If negotiations between the sheiks in Kalma and OCHA do 
not result in greater access by NGOs to the IDPs to conduct an 
immunization campaign, we risk having the potential for widespread 
disease and possible increased mortality which in the case of Kalma 
could be prevented.  NGOs and donors are concerned that the 
government may use the stalemate in negotiations as an excuse to 
force their way into the camp, or cut Kalma off completely. For now 
the government is content with standing by and watching the 
negotiations between the sheikhs and the international community 
because a dragging out of the situation only undermines the sheikhs' 
authority and creates internal chaos in the camp.  Recognizing what 
a tinderbox Kalma is, government engagement at this time will only 
result in further bloodshed in Kalma the likes of what we saw in 
August of last year.  Additionally, with significant humanitarian 
gaps existing, Post is concerned that the international community 
will see further manipulation of humanitarian assistance and NGOs by 
the GNU in the coming weeks and months.  GNU pressure on NGOs to 
work in specific areas and address certain sectoral needs leaves the 
humanitarian response vulnerable to significant government 
manipulation of services.  The current operating environment, for 
both humanitarian staff and the millions of beneficiaries they 
serve, can only be characterized as one of tension, fear, and 
looming uncertainty whereby all parties involved are subject to the 
whims and wishes of an erratic and hostile Sudanese government. 
Post will continue to closely monitor the meningitis situation in 
country and encourage all stakeholders, especially the government, 
to take an active role in combating a meningitis outbreak. 
 
FERNANDEZ