SUDAN - BLUE NILE STATE - HEALTH CARE FOR RETURNING

UNCLAS SECTION 01 OF 03 KHARTOUM 000251 SIPDIS AIDAC SIPDIS STATE FOR AF/SPG, PRM, AND ALSO PASS USAID/W USAID FOR DCHA SUDAN TEAM, AFR/SP NAIROBI FOR USAID/DCHA/OFDA, USAID/REDSO, AND FAS GENEVA FOR NKYLOH NAIROBI FOR SFO NSC FOR PMARCHAM, MMAGAN, AND TSHORTLEY ADDIS ABABA FOR USAU AND FOR REFCOORD USUN FOR TMALY BRUSSELS FOR PLERNER E.O. 12958: N/A TAGS: EAID PREF PGOV PHUM SOCI SU SUBJECT: SUDAN - BLUE NILE STATE - HEALTH CARE FOR RETURNING REFUGEES AND GOLD MINING ISSUES KHARTOUM 00000251 001.2 OF 003 -------------- Summary and Comment -------------- ¶1. The USAID Senior Humanitarian Advisor (SHA),accompanied by the Blue Nile State Minister of Health and the Dean of the Academy for Health Sciences, visited the Chali Way Station to consider options to improve working and living conditions for health care providers. The group also visited the ruins of three buildings on the hospital grounds in Baw that will house the first class of health science students after renovation. A UN Mission in Sudan (UNMIS) military observer reported a dispute in a Blue Nile State community over the exploitation of gold deposits by internally displaced persons (IDPs) living in the community. End summary and comment. -------------- -------------- Health Care for Returning Refugees in Chali Way Station -------------- -------------- ¶2. From January 6 to 10, 2007, the SHA, the Blue Nile State Minister of Health--a member of the Sudan People's Liberation Movement (SPLM)--and the Dean of the Academy for Health Services, assessed existing arrangements for health services delivery at the Chali Way Station. The site serves as the main reception area for Sudanese refugees returning from Ethiopia. Returning IDPs from the northern part of the state also re-group in Chali before traveling to their respective villages in the southern county of Kurmuk. ¶3. Chali lies 53 km southwest of Kurmuk town in southern Blue Nile State and is one of four administrative centers in Kurmuk County. The dirt track leading to Chali offers only enough space for one vehicle to travel at a time. The way station is located next to the ruins of the former residential buildings for health staff, a church, a mosque, and an elementary and secondary school. All buildings except for the mosque are severely damaged and are reportedly not worthy of rehabilitation. The Uduqh ethnic group is dominant in Chali; they suffered great losses when Sudanese Armed Forces attacked Chali in April 1987 in retaliation for suspected Sudan People's Liberation Army support !Qd4er the attack,!Th*comi5nity flEd!Do EwhiopmA(a~d {qEn vHe vk,lngmw 1 Yezq@mQQjvrmms~d~w'ae@eamtC(ens| bgel4l98iN,@hy,$4Qj4&Asw h&QQQJaaunQe.j5N biflqjbTul swtom*qgymQmp5rQ+taUQGxump>b&&MjQHB4Q^JEl Qxdc!Qyi+WCQxQOd4 kw substantial, which would allow water harvesting with hafirs, according to the UN World Food Program (WFP) and World Vision field staff. ¶5. Beginning in February, refugee returns will resume with convoys of more than 500 persons each arriving every eight days. A total of 14,500 refugees and 15,000 returning in-state IDPs will be processed through this way station. ¶6. The State Minister of Health wants to improve the operational and working conditions for the refugee repatriation period. According to the minister, immediate needs include several prefabricated buildings and equipment to establish a proper pharmacy, administration, consultation, inpatient wards, and staff quarters. The State Ministry of Health (SMOH) has identified and selected staff and placed them on the SMOH payroll. The total catchment area is currently between 3,000 and 4,000 persons and is expected to increase to between 7,000 and 10,000 persons. -------------- --- Decentralized Academy for Health Sciences in Baw -------------- --- ¶7. Baw County lies between Ed Damazin and Geissan localities and is dominated by the Ingessena ethnic group, considered the most disadvantaged and under-educated group in the state. The SMOH plans to establish the Academy for Health Sciences at a hospital complex in Baw that has several buildings. Students will follow their academic course while working part-time in the hospital for practical experience. They will be considered state employees under training and will receive a stipend, in addition to room and board at the hospital. Two dilapidated buildings need rehabilitation to KHARTOUM 00000251 002.2 OF 003 serve as student accommodations. A third similar building could serve as accommodation for teachers after rehabilitation. ¶8. The main purpose of setting up a Health Sciences Academy in Baw County is to avoid a concentration of opportunities in Ed Damazin, the state capital, where graduates tend to remain and avoid returning to their home communities. Students must be residents of Baw County, secondary school graduates, younger than 30 years old, and have no severe handicaps. Tribal affiliation is not a determining factor in the admission process. The academy has selected the first 90 students, who will begin their programs in March 2007. -------------- Alluvial Gold Mining in Aljoro -------------- ¶9. UNMIS military observers report that tension has developed around the gold deposit in Aljoro, Baw County. The resident population is aware of the gold and its value but does not have the technical expertise to extract it. In contrast, IDPs from Kurmuk, who are temporarily living in Aljoro, possess the technical skills but do not own the land containing the precious metal. The residents objected to the IDPs' attempted extraction of gold. The land owners maintain their rights, while the IDPs argue that the gold is worthless to the residents if they remain unable to extract it. The situation could possibly be resolved through a negotiated settlement, based on an agreement outlining how income generated from gold extraction would be shared between the residents and the IDPs. This agreement assumes that the Comprehensive Peace Agreement (CPA) allows for such wealth sharing. Alternatively, residents could compensate IDPs for transferring their skills to the community. -------------- Conclusions and Recommendations -------------- ¶10. The recommendations below are offered with the understanding that there are neither legal prohibitions nor policy considerations opposing such interventions. USAID will obtain a legal opinion and clearance from a policy perspective as part of considering any interventions: A) Chali Way Station: USAID should consider possibilities to support the Blue Nile State Government in its effort to take on its basic responsibility of rendering health services. A temporary facility to provide a space for consultations and in-patient wards, and to adequately house health staff on three-month rotations are needed in Chali. The World Bank has included Blue Nile State in its Decentralized Health System Development Project valued at USD 23 million; however, contracting for the first phase alone will not be complete until July 2007. By this time, the Office of the UN High Commissioner for Refugees (UNHCR) hopes to have repatriated the majority of the refugees from Ethiopia. The USAID Three Areas Program Manager and UNHCR are aware of the SMOH's interest and suggested that the SHA investigate the situation in Chali. B) Chali: USAID should encourage WFP and World Vision to assess the food security situation in Chali now, approximately six months after the resettlement rations have been consumed. In addition, USAID should encourage these agencies to consider building hafirs for water harvesting under a food-for-work scheme. Representatives of both agencies in Ed Damazin showed interest in the concept during a debriefing by the SHA. C) Baw: USAID should assess the SMOH plan, in conjunction with their implementing contractor. By supporting this plan, USAID can encourage the decentralization of health training and the provision of underserved localities with a functioning hospital as a practical training ground. Currently, the SMOH is supporting the start of classes and providing temporary accommodations for the employee-students. Assistance with the rehabilitation of the housing units would be a significant contribution to the academy. D) Aljoro: USAID should assess the situation in Aljoro and determine options available to the community, based on the provisions of the CPA and the interest of the community. With outside help, this community may obtain a solution to their conflict by either sharing the wealth from alluvial gold mining or by KHARTOUM 00000251 003.2 OF 003 compensating the IDPs for skills transfer to the community. In addition, all parties to the discussion should consider the environmental impact of any project. HUME