Once their remoteness and inaccessibility made the Nuba Mountains a refuge in Sudan, offering sanctuary and protection to people fleeing persecution. Today, a lack of access has made the same mountains a deadly prison to hundreds of thousands trapped in a bitter struggle between the Sudanese military and rebel forces, with reports that the government is cluster-bombing its own people.
If the cluster bomb reports are true, it is an outrage that must end. But we shouldn’t have to wait until the bombs drop, or until a U.S. president visits the region, to be prompted into action. Ever since South Sudan’s independence, this disputed border territory around the South Kordofan region has struggled to see vital humanitarian aid that is quite literally a lifeline. The moment supplies of vaccines and medicines stop flowing, lives are as good as lost. With that in mind, we need to start reading the signs and sound the alarm as soon as children are denied access to immunization, rather than waiting for the inevitable consequences.
With the largest measles outbreak in years currently sweeping its way across Sudan, we may soon see why.
So far this year, according to UNICEF, Sudan has already seen some 2,700 cases of measles, considerably more than the 600 cases in a typical year. Of these roughly one in 10 will die. The fear now is that, with around 150,000 children under 5 in the Nuba Mountains who have had no reliable access to immunization since 2011, the situation could explode. As a result, there is real potential for more lives to be lost than in the recent Ebola outbreak in West Africa, except here the vast majority will be children.
The priority must be to enable immediate humanitarian access to South Kordofan — and other regions such as Eastern Jebel Marra and several Blue Niles states where a further 45,000 children under 5 are believed to be cut off — to ensure that food and medical supplies are made available and mass immunizations carried out. Since 2011, when access was first denied, there have been a wide range of diplomatic efforts to negotiate at the very least a temporary ceasefire, all of which have foundered.
For the partners of Gavi, the Vaccine Alliance, and others, that leaves few options. One is continued diplomacy. The front line may be impenetrable, but it is quite flexible, with brief periods where the government forces gain control over an area before losing it again days later. During these periods there are fleeting opportunities to gain access, and operational plans are indeed prepared to carry out vaccination campaigns and provide vital health interventions, as well as food, to the people of that area.
Nothing is guaranteed, and this involves partners such as UNICEF and the World Health Organization supporting intense efforts by the Ministry of Health — including Minister Bahar Idriss Abu Garda, who is a Gavi Board member and committed to childhood immunization — in negotiating with the military to gain access during these times. It is a quite perverse situation, with the government of Sudan paying toward the cost of hundreds of thousands of vaccine doses for children in this region, only to allow its military to deny them, although the rebels must take responsibility for this, too. And even when negotiations are successful, the difficult terrain can severely limit the numbers of children reached during these excursions.
Option two is to try to get vaccines in through partner organizations still working in this area, such as Doctors Without Borders and faith-based organizations such as Caritas, which have had at least some success in finding less conventional ways to gain access, such as via the South Sudan border. However, while forces seem to turn a blind eye to their presence, they are by no means afforded immunity, and earlier this year a Doctors Without Borders hospital in South Kordofan was bombed. Meanwhile, with the situation getting more desperate, the capacity of these organizations is becoming increasingly limited as conflicts on the South Sudan side of the border make it more difficult for supplies to enter the area and for people to flee.
It is not naïve to believe that it shouldn’t have to be this way.
Even at the height of Sri Lanka’s long and ferocious civil war, vital medicines and vaccines continued to flow across the front line, thanks to an agreement between the Sri Lankan government and Tamil Tiger leaders. Today, political leaders need to put more pressure on both the Sudanese government and the rebels to negotiate a similar ongoing agreement and to demand an immediate ceasefire.
But in all conflicts we also need to be more proactive about not just responding to humanitarian disasters but also preventing them, by recognizing the warning signs, the most obvious being a child’s right to vaccination. After all, for any country to have a future it must protect its children.
Dr. Seth Berkley is CEO of Gavi, the Vaccine Alliance, an international organization that aims to bring together the public and private sectors. The views expressed are his own.