I am here with the emergency aid organisation Medicins Sans Frontieres (MSF), who have been working in this camp for over four years now. The humanitarian crisis here has not gone away.

MSF work all over the world in situations where conflict, epidemics or natural disasters threaten the lives of the populations they affect. Uniquely among aid organisations, MSF is funded almost exclusively by private donations, enabling it to work in situations where the need is greatest, independent of the media-driven politics of the international aid ‘business’. In Darfur, ravaged by fighting since 2003, MSF has responded to the needs of those who have fled the conflict, working hard to overcome the difficulties of extending healthcare services into a region with little infrastructure and widespread insecurity and violence, which is occasionally directed against aid workers.

Danny sharing his hat in Sudan. December 2008. Photo by MSF

My own presence here can be traced back to an advert for MSF which I saw five years ago, just as I was finishing my nursing diploma. “Do you believe that everyone is entitled to proper medical care, no matter where they live?”, it asked, “Would you like to make a difference?”. I decided immediately that I did, and I would. Reading more about MSF I was inspired by the principles and bravery of the organisation, and I resolved that I would work towards joining them. Since then I have done just that, taking jobs in Accident and Emergency departments in Sussex and London, completing a Diploma in Tropical Nursing, and gaining experience in expedition medicine with Raleigh International. My assignment to the Darfur mission, after a ten-day training course in Barcelona, was fulfillment of a five-year ambition. And now here I am.

It’s hot and dusty in Sudan, and to be honest, I don’t deal well with heat. In Khartoum (the Capital city) you could have grilled a whale by leaving it outside on the pavement for a few hours. Darfur is a little cooler, and now we’re in winter the top temperatures are dropping down to the mid-30s, which I am nothing but thankful for. The possibility of a White Christmas remains fairly remote, but at least my skin isn’t actively sizzling when I step out of the shade.

My day starts before 7am, woken by a caccophany of donkeys braying, camels honking (I have no better descriptive word for what camels do), and the birds that live in the thatched roof of my “tukkul” (hut) twittering and scrabbling around above my mosquito net. Alarm clocks are not necessary! The diverse expatriate staff (currently a Kenyan Field Coordinator, a Swedish Doctor, a Spanish Logistician, a Canadian Nurse, and me – a British Nurse) all meet for breakfast, and then we crowd into an MSF Land Rover and make the bumpy ten-minute journey from Shangil Tobaya village to Shangil Tobaya IDP camp where our facility is located. The camp itself contains about 16,000 people, and it’s sister camp Shadat (just down the road) houses over 7,000, but adding on the inhabitants of the surrounding villages who also rely on MSF for emergency medical treatment, our total target population is something in the region of 30-35,000. Thankfully, we five expatriates are just a small fraction of the MSF team here in Shangil. There are over a hundred Sudanese staff - nurses, doctors, pharmacists, midwives, community health workers, guards, drivers, cleaners. The list could go on. Getting to work and meeting them all, innumerable smiling faces and handshakes, with cries of “Salaam Alaikum” (peace be with you) and “Sabachalher” (good morning), is a truly lovely part of the day.

Inside the facility we have separate tents for In-Patient and Out-Patient treatment, Nutrition, Maternity, Immunisation, and Mental Health, as well as sterilisation services, a small laboratory which can run basic blood, stool and urine tests, a pharmacy, a canteen, and a waste management area for dealing appropriately with hazardous clinical rubbish. The facility is an impressive tribute to the hard work of MSF staff, but it is important to emphasise that while international staff come and go, many of the national staff have been working here since the project opened, making them both the continuity and the real backbone of MSF’s work here.

Today I accompanied the facility doctors and nurses on the morning patient rounds, but I try to take a backseat role so that the local nurses feel more able to contribute their ideas and suggestions. One female patient seemed tearful and withdrawn, so we agreed to involve the mental health team in her care. Many of the people here are traumatised by their experiences, which can lead to physical symptoms. I visited all the different areas, promising to replace a broken piece of equipment in one, and taking note of a shortage of a certain drug in another. I also try to make as many children laugh as possible along the way, especially in the nutritional program where mental stimulation is crucial to their progress. Back at the Pharmacy, which I am responsible for, I gather up the stock that we need and head back to the facility. A million odd jobs later, it’s lunchtime. In the afternoon, I spent some time on the training program we’re working on for the local staff. Despite being incredibly keen and hardworking, the level of education of most of the staff here is not high, but we all get a lot out of the teaching sessions. This evening a baby was brought in to the facility from a remote village, a four-week old boy suffering from violent seizures who had not fed for three days. His fontanel (the soft spot on the top of a babys head) was bulging, indicating raised inter-cranial pressure, probably meningitis. We did what we could – inserted a naso-gastric tube for feeding and an IV line for antibiotics, and gave drugs to stop the seizures – but I´m not convinced that this little one will survive to see his first Christmas.

Later I read through our latest security briefing, and entered the weekly data for the various different departments into the computer. There are many different sets of statistics to compile so that we can properly assess our impact here and look for ways to improve it. There is always a lot to do, but the people I’m working alongside make it all worthwhile.

Darfur is a predominantly Muslim area, and I’m not aware that any of our staff will be celebrating Christmas. It is a public holiday (to my surprise), so barring emergencies we wont be working in the facility, but because I´m still fairly new at this there is no shortage of jobs for me to do here in the pharmacy, protocols to read and learn, statistics to get my head around. Alcohol is not permitted in Sudan, so there will be no hangovers on Boxing Day. Our evening will be a fairly quiet one. We have patchy mobile phone reception, so I will call my wife before I go to bed. I proposed to her last Christmas Eve, and we’ve been married just six months, so it’s weird being away from her. Her support and understanding is what makes this experience possible, and a few minutes of just the two of us makes my day every time, even at this distance.

Darfur is not a rich place. The people here don’t have much in the way of possessions by Western standards, so we might think it strange, especially in view of how much they have suffered over the last five years, that they seem so happy. Perhaps when people live from day to day, not preoccupied with getting this DVD or that pay-rise, they more readily appreciate the things that are really important – the safety and welfare of their loved ones. That is certainly something that is on my mind this Christmas, being far away from my wife and family. It’s a good wake-up call for my priorities when I get back to life in the UK, and a reminder for all of us that, despite all the barriers of language and culture and distance, we have too much in common with these people to be indifferent to their suffering.

Merry Christmas from Darfur!