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In the context of the civil war being waged in Darfur, Sudan, this paper seeks to convey what has happened to the health of people in Darfur based on data emerging from MSF clinics and surveys. The objective of the report is to create some understanding of the magnitude and depth of the suffering and the failure to address these problems. The authors combine technical health statistics with a human perspective gathered from the conversations and laments of the thousands who came to MSF clinics for assistance but who themselves were unable to remain silent about the atrocities committed against them and their families.

This report is based on a series of cross-sectional nutrition and mortality surveys3 carried out in conjunction with Epicentre4 in 6 locations of Darfur - as well as face-to-face encounters with displaced people and patients, reported by the teams working in West, South, and North Darfur since the beginning of the year 2004.

The paper traces various stages in the experience of refugees, from fleeing their homes, to the search for refuge, to going home again, all with a health perspective. This includes examination of access to food, water and sanitation, shelter, rape and violence.

The authors ultimately conclude that aid has been delayed and inadequate. Whilst the increased numbers of actors and volumes of aid now present in Darfur have stabilized the public health crisis in the major camps and around the main towns, many gaps remain in shelter, water and sanitation, nutrition and health. Assistance programming is not effectively meeting the needs of those in camps, let alone being rolled out to these many pockets of victims, host and displaced alike, suffering deprivation. And conditions of life are still so treacherous that even daily tasks like gathering wood and water still mean serious threats of violence.The climate of fear that still exists in Darfur is all-pervasive. Camps of refuge are anything but; displaced Darfurians tell MSF that they are living under the guard of some of the same armed men that burned their villages and killed their families. The situation in Darfur perverts the very idea of refuge.

MSF concludes with three recommendations to begin redressing the situation of civilias in Darfur:

• expand assistance in terms of quality and quantity
• deliver aid wherever civilians have chosen to seek refuge
• strive to freed individuals from the threat of violence, the fundamental cause of this crisis

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