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Sudan’s cemeteries swell with fresh graves as hunger and disease spread

COMMUNITY leaders are keeping handwritten lists of the names of the dead in the Kalma displaced persons camp in Sudan’s Darfur region. The lists are growing longer, and not a day goes by when they don’t include the name of a child, says one of the leaders.

In a two-week period in May alone, 28 children appeared on the lists. The cause of death: malnutrition and disease, say the community leaders.

One of them was Moshtaha, a seven-month-old girl. She suffered severe diarrhoea and vomiting, which led to malnourishment. Her family lacked money to buy medication for her. And food ran short: They were surviving on one meal a day – a plate of Aseeda porridge.

Mariam Adam at the Kalma refugee camp in Darfur. Her seven-month-old baby died of illness and malnourishment last month, during which at least 28 children in the camp succumbed in a two-week span. REUTERS/Handout

Around midnight on May 14, Mariam Adam, Moshtaha’s mother, said she placed her hand on her daughter’s heart but felt no pulse. Then she placed her hand above her mouth. Nothing.

“She stopped breathing,” said the 22-year-old Adam. “Her heart stopped.”

It’s not only children dying in Kalma. In April, Adam’s aunt died of medical complications that required surgery. Moshtaha and the aunt were buried in the same cemetery at the edge of the camp.

Like this burial ground, others around the Kalma camp have been growing rapidly in recent months. One cemetery on the southern edge of Kalma has expanded 2.5 times faster in the first half of 2024 than it did in the second half of 2023, a Reuters analysis of satellite images shows.

One cemetery in Kalma grew 20% faster this year than in the second half of last year.

While a cemetery in the Zamzam camp grew 26% faster during a similar period. Images by Pléiades © CNES 2024, Distribution Airbus DS (Kalma); Planet Labs PBC (Zamzam)

The cemetery in Kalma where Mariam Adam’s baby girl Moshtaha was buried in May. Adam’s aunt was buried in the same cemetery the previous month. REUTERS/Handout

Graveyards are fast expanding elsewhere in the Darfur region, which has been ravaged by the war between the Sudanese military and the paramilitary Rapid Support Forces (RSF) that has engulfed the country. In the teeming Zamzam displaced persons camp, now home to hundreds of thousands of people, a cemetery on that facility’s southern edge expanded about three times faster in the first half of 2024 than in the second half of last year.

In all, Reuters identified 14 burial grounds in five communities across Darfur that have expanded rapidly in recent months. The area of new graves at these burial grounds has grown up to three times faster in the first half of 2024 than in the second half of last year. That increase, moreover, came on top of an already-high base: The region saw weeks of violence in the last six months of 2023 that resulted in many deaths.

These cemeteries are “the canaries in the coal mine,” said Timmo Gaasbeek, the author of a recent report by the Clingendael Institute, a Dutch think tank, that warns of high rates of hunger-related deaths in Sudan. “The longer the war continues, the bigger the problem will get.”

The satellite images – combined with food insecurity data, photos and videos of emaciated children, and interviews with dozens of people from 20 communities across Darfur – reveal how hunger and disease are spreading rapidly in Sudan.

Like Mariam Adam, mothers in these communities described how their children died because they couldn’t feed them, had no access to healthcare and had no money to buy medicine. More than 30 community leaders, medics and health officials spoke of an alarming spike in the number of people dying from malnutrition and illness. The community leaders shared photos and videos showing dozens of fresh graves in the burial grounds that Reuters surveyed with satellite images.

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A severely malnourished 4-year-old girl lies in a hut in a camp in Central Darfur last month. Mothers in communities across Darfur said their children died because they couldn’t feed them, had no access to medical care and couldn’t afford to buy medicine. REUTERS/Handout

An estimated three-quarters of a million people in Sudan could face catastrophic food shortages by September, according to a preliminary projection by the world’s leading famine watchdog, Reuters reported this month. A total of nine million people – almost 20% of the population – are in an emergency food situation or worse, the projection says.

The new analysis was done by the Rome-based Integrated Food Security Phase Classification (IPC), an initiative of U.N. agencies, regional bodies and aid groups. The IPC’s last projection was in December, and the agency hasn’t yet published its latest preliminary projection. In March, the IPC said security threats, roadblocks and telecommunications outages in Sudan were hindering its ability to do assessments.

The IPC didn’t respond to questions for this report. Earlier, a spokeswoman said its Sudan analysis is “ongoing” and that it’s not yet clear when it will be completed.

To obtain an up-to-date picture of Sudan’s food emergency, Reuters employed techniques similar to ones used by health and hunger monitors in inaccessible conflict and disaster zones. In a 2021 manual, the IPC laid out steps that can be taken for establishing the level of mortality in areas with “limited or no humanitarian access.” It included “interviews with key informants” and “counting graves.”

The hunger crisis in Sudan is man-made. The fighting between the Sudanese military and RSF erupted in April last year, uprooting more than nine million people – almost a fifth of the population. War has prevented humanitarian aid from reaching large parts of Sudan. The RSF and its allied militias have looted aid warehouses and stolen harvested crops and agricultural equipment from farmers, Reuters reported in April, making them destitute and forcing them off their land.

Growing graveyards

A Reuters analysis of burial grounds in five communities in Darfur revealed that the area of new graves has grown up to three times faster this year than in the second half of 2023.

Source: OpenStreetMap

Cereal production in Darfur and Kordofan, another region hit hard by the war, was estimated to be up to 80% below average in 2023, according to a March report by the U.N.’s Food and Agriculture Organization. Unable to find food or afford it – prices have skyrocketed, making food prohibitively expensive even when available – people have resorted to skipping meals, eating tree leaves and even dirt, Reuters reported in April.

Tom Perriello, the U.S. special envoy to Sudan, told Reuters this month that the RSF and military are both to blame for the food crisis. While the RSF had burned crops and looted warehouses, the Sudanese army is “right now playing games with border access, cross-line access, and allowing their people to die,” he said.

The army-led government and the RSF didn’t respond to questions for this report. The government has said it is committed to facilitating aid delivery, and accuses the RSF of looting and blocking aid. The RSF has denied looting, saying any rogue actors in its ranks will be held responsible. It has blamed the army for obstructing the delivery of aid.

A man walks while smoke rises above buildings after aerial bombardment, during clashes between the paramilitary Rapid Support Forces and the army in Khartoum North, Sudan, May 1, 2023. REUTERS/Mohamed Nureldin Abdallah
A room in a hospital in Central Darfur that was looted during the war. As of February, up to 80% of Sudan’s health facilities weren’t functioning, according to the U.N. Image via Darfur24 News on Facebook; verified by the Centre for Information Resilience and Reuters.

We are trapped here and we will die of hunger.
A Kalma community leader on residents being too scared to leave the camp for fear of RSF attacks

The war has also devastated a healthcare system already under strain before the fighting began. About two-thirds of Sudanese don’t have access to healthcare, and between 70% and 80% of the country’s health facilities weren’t functioning as of February, according to the U.N. Office for the Coordination of Humanitarian Affairs.

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Desperate to help their sick children, parents are resorting to traditional methods, according to medics and community leaders contacted by phone in Darfur. Some parents, they said, have used the stems of plants to tie their children’s hands in the belief it will stop malnutrition. Others have boiled seeds and thrown them at their children’s buttocks in the hope it will cure them of diarrhea.

In a crisis like Sudan’s, where there is a breakdown of both the food and medical systems, malnutrition and disease go hand in hand, say food security experts and nutritionists. The threat is of a “deadly cocktail” of malnutrition, measles, malaria, cholera and other diseases, said Liesbeth Aelbrecht, a World Health Organization specialist on food insecurity and health for the Greater Horn of Africa.

“Malnutrition and disease reinforce each other, with sick children becoming more easily malnourished and malnourished children becoming sick more easily,” U.N. organizations said in a statement in late May. “Sudan risks a lost generation.”

These pictures of malnourished children in South Darfur were included in a recent internal report compiled by a Sudanese health ministry official on the dire food situation in the region. Reuters reviewed a copy of the report, which covers the April-May period. The children’s faces have been blurred to protect their identities. REUTERS/Handout

The situation is about to get worse. Sudan has entered the lean season between harvests, which runs to September. It is a period when food is less available. The rainy season is also beginning, which will render impassable the dirt roads across Darfur that connect communities with urban centers. That will make it even harder to get aid to the people who need it most.

In charting the spike in mortality in the five Darfur communities, Reuters reviewed hundreds of satellite images of burial grounds over a period of several years. The recent expansion in the area of new graves may in part be due to higher mortality as a result of the influx of people into the camps who have fled violence.

Nevertheless, the Reuters calculation of how much the burial grounds have expanded is likely an underestimate: It doesn’t account for new graves that have been dug in between existing ones in many places, for instance, or for the fact that there are small patches of graves not easily identifiable in satellite images.

Reuters only reviewed communities in which there hasn’t been fighting in the past six months to rule out the possibility that this year’s burial-ground expansion may be due to an increase in the number of people killed in the conflict.

A toddler has her upper arm measured as a test for malnutrition as her mother answers questions in a clinic last month in Rahad Al Bardi, South Darfur. The child placed in the red zone, which signifies acute malnourishment, at risk of death. Her face was blurred by Reuters. REUTERS/Handout

In the town of Nertiti in Central Darfur, no supplies are getting in and the RSF plundered the harvest, a local humanitarian worker told Reuters. Children are dying for lack of food, he said. People are eating the leaves off trees, he added, and digging up ant nests in search of bread crumbs and other food stored in them.

“Famine is already here,” he said.

The RSF and allied militias have been robbing merchants, making the roads unsafe, the humanitarian worker said, and there is no one to protect international aid agencies if they want to return. The town has doubled in size with the arrival of more than 33,000 people fleeing violence, according to data from the U.N.’s International Organization for Migration.

Satellite images taken in March and June show rows of fresh graves on the southern edge of Nertiti. Between Nov. 21 last year and June 6, the area of new graves expanded 13% faster than in the preceding four months.

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In the town of Kas, in South Darfur, the cemeteries are also expanding fast. A health ministry official there said only a fraction of those who become ill make it to hospital because the roads are unsafe. Image: Planet Labs PBC

In Kalma, residents are too scared to leave the camp to look for work because there is no one to protect them from the RSF and its allied militias, said a community leader who spoke on condition of anonymity. The men fear being detained or killed, while the women fear being raped, he said.

The community leader shared pictures of a man who he said was shot dead by gunmen on May 29, when trying to leave the camp to seek work. He was killed on the main road connecting Kalma and Nyala, the capital of South Darfur, the community leader said.

“We are trapped here and we will die of hunger,” he said.

The same is happening in the town of Kas in South Darfur state. People in the Kas district, comprising the town and surrounding villages, are dying of disease and malnutrition, said Mohammed Ali Osman, a nutrition officer at the health ministry there. Only a fraction of the sick make it to hospital because the roads are unsafe and entire villages are isolated, he said.

“We have no idea what is happening in these villages,” he said.

In Kas, too, the cemeteries are swelling. One graveyard on the southeast edge of the town grew 49% faster between Jan. 4 and June 1 than it did in the second half of last year.

Some cemeteries, like this one in the Hamidiya camp in Central Darfur, have been expanding even faster in recent months. Image: Planet Labs PBC

There are indications now that cemeteries are expanding even faster.

Between March 28 and May 3, one large cemetery in the Zamzam camp in North Darfur grew 50% faster than in the preceding three-and-a-half months. A community leader in the camp said in April that many people were surviving on one meal a day. A mass screening conducted by Doctors Without Borders in March and April, including more than 46,000 children under five, found that nearly a third of the children were acutely malnourished.

At the Hamidiya camp in Central Darfur, the burial grounds are showing accelerated growth in recent months. Satellite images reveal dozens of new burial mounds appearing at one site between March 30 and June 4. The pace of expansion of the burial ground was 53% higher than in the previous three months, the images show.

Seif Eddinn Abdullah, a community leader in Hamidiya, shared video footage of cemeteries in the camp. In one segment, a group of people can be seen burying a 40-year-old man who Abdullah said suffered from diabetes.

Abdullah said humanitarian aid isn’t reaching the camp. The help is critical, he said, to “save the children who are dying every day.”