Independent Appeal: A cold wind of death in Darfur

A heavy yellow-brown fog hung over Gereida in the remote western reaches of Darfur yesterday, a place that a year ago was empty desert scrub and which is today the largest refugee camp in the world. It was cold, somewhere about 5C. The air was charged with particles of choking sand.

This is not what you expect in Sudan, where most of the year the baking heat of a relentless sun turns the hard, unyielding plain into a giant griddle.

The 120,000 people who have fled to this barren place from the fighting between rebel groups and the Sudanese army with its Janjaweed militia, today huddle together for warmth beneath a cold cloudy sky. The weather has been this cold for weeks.

There is something else which comes as a shock. To reach the camp, any visitor must traverse a vast moonscape whose unending horizon is broken only by the occasional scrubby thorn bush. All around, for hundreds of miles, the landscape is marked by empty villages, some burnt-out, others abandoned to the dust devils that whip across the bare soil.

But when you arrive in Gereida you find it is not the guns and bombs of the constant fighting in Darfur that are the greatest evil. Few here perish from wounds of war. "Some 95 or 96 per cent of people die from infection, pneumonia or malaria are the big killers," says Joanna Kotcher, the medical co-ordinator of the health centre set up four months ago in the camp by the medical agency Merlin, one of the three charities being supported by The Independent Christmas Appeal this year. "The biggest killer is the environment. The camp is a place of refuge but also a place of infection."

Merlin has been working in Darfur since 2004, running 15 health centres and mobile clinics in a region where Sudan's Ministry of Health has ceased to function. This year, Merlin's teams, funded by the EU and US government, have provided medical care to approximately 150,000 people. But it was only in September that they were able to set up in Gereida.

It is a delicate operation. Many aid agencies have pulled out of the region because of the deteriorating security. Just weeks after setting up in Gereida, the Merlin team had to be airlifted to safety by UN helicopters when rebels seized the camp. The medics returned a few weeks later.

Merlin's clinics provide primary health care services, such as vaccinations, pre- and post-natal care, and screening for malnutrition. Pregnant mothers are given food supplements, mosquito nets and anti-malarials. "At present, we can treat about 400 patients a day," says Ms Kotcher. "But we're about to start a programme to go out to the edge of the camp which will reach a further 4,000 people."

The charity meets only a fraction of the need in a camp so large it takes two hours to walk from the furthest edges of the camps to the Merlin clinic, a lot longer for a woman carrying a sick child.

The diseases they treat change with the weather. In the heat, malaria was the big killer, particularly cerebral malaria which can progress from first symptoms to death can take just 15 hours. Now, with the cold and extreme levels of dust in the air it is pneumonia.

But the underlying problem is that nearly every child in the camp is under-nourished. They are living off cereals and a little oil. With no fruit or vegetables, they suffer vitamin deficiencies which Merlin tries to rectify with supplements. But when children become severely malnourished they can die from ailments as simple as diarrhoea.

Such illnesses thrive in camp environments where clean water and sanitation are poor. International agencies are doing their best to address the problem. Oxfam has sunk deep wells which are providing good-quality water.

Each family has been asked to dig a latrine and agencies have supplied plastic or concrete covers for them. "That way, we can try to avoid the use of open land for defecation which causes diseases," says Ms Kotcher, a health worker for 13 years in hotspots including Kosovo and Afghan-istan. "And Merlin does health education to make sure families understand the importance of latrines and washing."

It is an uphill task. Camp life is arduous. Women spend five hours a day collecting firewood to cook. Children queue for four hours a day for water which they collect in five- or 10-litre cans and struggle back to their flimsy shelters

"If you look at the sheer numbers you can feel overwhelmed," Ms Kotcher says. "But the patients we see every day very much appreciate our presence. We can't help everybody but every child with malaria that we do help is someone saved from needless death. I feel we're making a big difference."

What is needed now, she says, is more personnel. "It's difficult to recruit people for Darfur. With such a very harsh environment, there's a high turnover in aid workers. And from the international community we need money, food and medicines. "The situation is very critical. Day-to-day life is so stark and the needs so great. We need not let these people fall between the cracks."

The greatest need now, she says, is for more blankets. "Children lose body heat rapidly. There are no hills, trees or barriers to the wind, no shelter, no proper buildings or tents, just structures of branches, cloth and bits of blue plastic. There is no warm place to put the children in thin clothing."

Aid agencies have distributed one blanket per family. Most families have five children. "The aim now," Joanna Kotcher says, "is to get two blankets per family." In a world of plenty, it seems a modest aspiration.