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

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Summary and Comment
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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.

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Health Care for Returning Refugees in Chali Way Station
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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.

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Decentralized Academy for Health Sciences in Baw
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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

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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.

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Alluvial Gold Mining in Aljoro
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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.

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Conclusions and Recommendations
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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

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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