Posted December 10, 2006

Darfur is Life or Death for one Portland Doctor

By Sherry Harbert

There is an intimate connection with life in the midst of disaster. Dr. Stephen Boyer of Portland has come face to face with victims in numerous catastrophic events around the world. Boyer went to Sumatra, Indonesia, in the months following the 2004 tsunami. He volunteered with medical teams in Afghanistan, Guatemala, Liberia, Uganda and Peru. Boyer served as a physician with expeditions to the highest mountain peaks in the world and to the remote parts of Antarctica. Boyer surveyed the glaciers on Mt. Hood in Oregon and the Gobi Desert in Mongolia. Boyer has seen the best and worst of nature and humanity—until Darfur.

Shortly after retiring from St. Vincent’s Hospital in Portland last year, Boyer arrived as a field physician in one of the world’s most horrific humanitarian crisis in recent history. He volunteered to go to Darfur on a two-month medical relief response with Northwest Medical Teams (NWMTI), an international relief organization based in Tigard, Ore. It would be NWMTI’s last U.S. team response into Darfur, due to the severe security risks.

There were many more humanitarian organizations in Darfur a year ago, but almost all were forced to leave for their own survival as Janjawid, the government-backed militia, became even more emblazoned with their brutal tactics to scare off any foreign intervention. The Norwegian Refugee Council which operated the largest Internally-Displaced Peoples (IDP) camp in South Sudan was forced to leave last month due to enormous pressures from the Sudanese government. It is even worse for organizations trying to help in Darfur. NWMTI staff is still unable to return to Darfur after more than one year, but the organization continues to ship needed supplies into the region through in-country staff. Sudan’s President Omar al-Bashir threatened all foreign relief agencies and media with expulsion last month, following that of Jan Pronk, the United Nations chief envoy to Sudan.

Boyer worked in Western Darfur’s El Geneina (Al Junaynah) region, located near the border with Chad, where some of the worst atrocities and human suffering continue to occur. Boyer was forced to leave in September 2005, but he did not leave the crisis for others to resolve. Boyer is on a campaign to stop the genocide in Darfur, even if it means coming face to face with every person in Portland.

A Fight to Save Lives

Darfur is a war zone like no other. Though there are wars and fighting in many parts of the world which take innocent life every day, Darfur testifies to a systematic annihilation of a particular people. It is genocide. The U.S. House and Senate reached that conclusion in July 2004, with the Bush Administration following in September, 2004. Two years later, a report issued to Congress in April, said up to 300,000 may have been killed since the Congressional declaration. Though much of the world recognizes the killing as genocide, no real response has yet stopped it.

Boyer returned to the U.S. with a mission to bring a new awareness to the genocide and build support to stop it through speaking engagements throughout the Portland area. Boyer’s soft-spoken nature rises in a crescendo of compassion and commitment when he speaks of Darfur. He sold out an event sponsored by the Portland Committee on Foreign Relations through the World Affairs Council of Oregon in October. He filled the home of Marty Fromer, a member of Amnesty International’s Portland Group 48 and the Portland Coalition for Genocide Awareness, which brought attendees from over one hundred miles away to listen to his plea. Boyer will address students at Lake Oswego High School, Dec. 11, and the Portland City Council, Dec. 13, as he continues his campaign to stop the suffering. “It strikes me that we’re living in a moment where we have the opportunity to intervene,” said Boyer. ”This will be written in history books.”

Boyer matches the intensity of the destruction of human life in Darfur with his will to compel everyone he meets to care about what is happening in the remote villages that are bombed and burned. He talks about what is like to provide basic medical care to men who have been shot because of their ethnicity, women who have been gang-raped for merely leaving a refugee camp in search of firewood and children who are starving and suffering from disease.

Saving life in Darfur goes far beyond writing a prescription or working on an operating table. It is a great risk to those who help. And even the most basic necessities are difficult to obtain. Boyer said he had some idea of what he would face when he arrived in Sudan one week after the death of Dr. John Garang. Garang, first vice-president of the Sudan People’s Liberation Movement (SPLM), was killed in a plane crash in July, 2005. He reached the position through a peace settlement that ended two decades of civil war between North and South Sudan. Two million people died from the results of that war, along with famine and disease. Garang’s death ignited new violence, but it did not last long. There are no real peace talks with the government of Sudan to end the killing in Darfur. And so it continues.

“I’ve spent a considerable time in Africa,” said Boyer. “Of all the countries, I was most struck by Sudan, both culturally and geographically, so I had an inkling of what we were to find.” But the reality on the ground changed Boyer’s concept of Sudan and disaster response. “Of all the trips, this was the most difficult,” said Boyer.

Entering a Genocide

Boyer’s determination to advocate for Darfur encompasses more than a medical prognosis. Darfur is far more complicated. So Boyer made it his mission to understand every facet of the history, people and politics that have allowed the genocide to continue for more than three years. With more than 2 million people displaced in the Darfur region alone, Boyer was shocked to find so many villages completely destroyed by the Sudanese government’s policy to wipe out the black African farmers from the region. In August, 2004, the U.S. Department of State confirmed at least 395 villages destroyed. Boyer said that number has risen to over 1,000, now. “These villages are all gone,” said Boyer. “We drove through and found only rubble.”

The Sudanese government’s response to an uprising in Darfur in February, 2003, culminated in the “Scorched Earth” campaign that continues today. The term refers to the charred remains of villages throughout the region. And, this is no little region inside Sub-Saharan Africa. Darfur is made up of three regions that together are larger than the state of Texas. With such a large area, the campaigns of mass destruction are not simply tribal riffs for local territory. The attacks come in deliberate waves of violence at the behest of the government.

Darfur’s atrocities begin with attacks by the government-supported Janjawid militia armed with planes, helicopters and assault rifles for bombing raids over the villages before the Janjawid ride on camels and in trucks to finish off anything left. Burning a village is the final stage that forces any survivor to flea into camps. The Janjawid then surround the camps and kill any male survivors and gang-rape the women and girls if they venture out to seek firewood. There are over two million internally-displaced people (IDPs) inside the Darfur region. “Forty-six percent of the IDPs are within two hours walking distance from their homes,” said Boyer. “But it is not safe to return.” And, in most cases, there is nothing left.

Villagers must grow food to survive, but it is one of the ways the Janjawid target them. Wheat, millet and sorghum are the main crops in the region, though harvesting has become a life and death situation. Boyer said the most dangerous time was during the millet harvest. “That’s when the Janjawid would come on camels and take it.” Boyer said there are more camels in Darfur than in any other part of Africa, with the exception of Somalia.

“As a policy, we were not to use the term ‘angered’,” said Boyer, noting that the term means “devils on horses” though the Angered ride camels. Boyer said the team was well aware that photographs of the Janjawid were forbidden, but took one when a Janjawid asked him. “He was heavily armed,” said Boyer. “So, I obliged.”

Working inside a Genocide

Boyer’s two months in Darfur reinforced how systematic the killing campaign is carried out in the region. Though humanitarian organizations have combined their operations to better respond in the region, the Sudanese government continues to step up efforts to hinder their operations. Boyer said NWMTI, World Relief and several other relief organizations merged their efforts to form the Darfur Relief Consortium (DRC) to better meet the needs on the ground, especially with many groups being forced out. The DRC focused on health, water, food security and nutrition. NWMTI was awarded federal grant money last month to provide funds for in-country medical training and supplies. The funds will be funneled through the DRC to access in-country medical personnel who are the only ones able to access some of the areas.

Travel into the region is highly controlled. The International Crisis Group, an independent nonprofit research organization, pointed to September, 2005 as a turning point for the increased violence. According to a Crisis Group report issued in March, humanitarian organizations could only access 45 percent of the population. Boyer worked directly in the epicenter. His team worked at the DRC’s operational base in El Geneina then traveled to the Sanidadi District to offer healthcare, training and setting up local supplies. Every two weeks, Boyer was forced to apply for a new permit and give an account for what he did just to travel between Um Tagouk and Kereruk.

Since he left, the Sudanese government has increased travel restrictions for anyone entering the region. The government has also jailed journalists and relief workers who did not possess the necessary documents. Getting those documents are near to impossible, leaving many to risk the consequences to get a glimpse into what is happening inside the region.

The roads leading to El Geneina were heavily armed. A UN report documented an increase in the government soldiers traveling in land cruiser pick-ups with mounted 12.7mm machine guns to reinforce troops in El Geneina. The Crisis Group reports the Chadian rebel group, the RDL, made up of Arabs, Tama and Gimr, is aiding the government troops in the region through reports from the African Union (AU), the only peacekeeping force in the region. AU troops are stationed along the same route from Nyala to Zalingei and El Geneina. It is duly noted that the AU does not have a mandate to fight against the government-backed troops and militias, leaving the villagers with little means of protection. It also meant little protection for Boyer and his team.

Boyer volunteered with a self-selected group willing to enter the Western Darfur region near the border. The region has seen increased hostility as more people pour across the border to Chad to seek refuge. The Janjawid follow close behind and are increasing their forces on both sides of the border, with the help of the RDL and others. Even the most hearty relief workers traveled in escorted groups to avoid being targeted by the Janjawid, the most overt force in the region. Boyer said it was dangerous, but a necessary risk to offer aid. He said they had to rely on transportation through a rented driver and vehicle. With only one translator for the group, the team stuck to the basics.

Boyer’s team worked in two different cities with the Ministry of Health clinics, as part of World Relief. The group had to rely on one Congolese doctor for all their translations. Limitations forced the group to focus on training local Sudanese, rather than seeing a maximum number of patients. “They didn’t understand at first,” said Boyer. “So I talked with the medical assistant and explained that training would have a greater impact long after I left, so we made the best of it.”

When aid is reduced to a triage response, the human touch is lost. Boyer said the medical staff appreciated the help, but remained cold as they watched volunteers come and go while the killing continued. But Boyer experienced a turning point after a split decision. The conditions in Darfur are remote, at best. A clinic may be little more than a hut with dirt floors. Such conditions are bad enough for those in minimal health. But for the very sick, it is far worse. Boyer had just persuaded a local doctor of the meaning behind his focus on training, rather than seeing patients to better equip him once the team left Darfur. The relationship was cordial, but limited. But things began to change when they were confronted with a very sick girl. “One day, the doctor asked for beds,” said Boyer. “At first I said no, it wasn’t in the budget.” Boyer said it took him 30 seconds to say change his mind, after realizing he had some personal money from NWMTI. “It was a turning point,” said Boyer. “Then they signed onto our program.”

But the healthcare program in Darfur is daunting. “All the people are malnourished,” he said. Boyer said even the simple healthcare problems can be exasperated under the conditions of the ongoing genocide. “There was an old man who came in with leg pain. The medical assistant would hear that and automatically prescribe antibiotics.” Boyer said the long lines and extreme conditions worked against treating people properly. “There was no exam done on the old man,” said Boyer, noting that there is prevalence of diseases that need antibiotics. “When I examined him, I found he had arthritis.” Boyer said the automatic assumption that each patient needs antibiotics is dangerous, as doctors have found in the U.S. In time, patients develop a resistance to antibiotics, creating stronger strains of the virus. Boyer showed photos of the victims of disease made far worse from the genocide, along with the lack of water and food.

It was not the only problem faced by Boyer and the team. The language barrier made it difficult to work. Donated medicine would arrive with English or French labels and had to be translated into Arabic for proper use. “We tried to organize the drugs,” said Boyer. “especially since many of the containers looked the same.” Boyer said the translator eventually created a dictionary to help. Boyer spent much of his time outside of training putting together labels and medical kits for mobile clinics.

Boyer also worked with the tribal structure in the region to gain acceptance and help. He said his team worked to get them to sign a contract to assist patients and build a structure for a clinic. “They were very interested in this because of the contract,” said Boyer.

It is stunning that AIDS is not as prevalent in the Darfur region as it is in most of Africa, until the reason is presented. Boyer said it takes about eight years for HIV to activate. In Darfur, many people don’t get that time. What is making the dire situation worse is malaria, meningitis and other infections. Boyer’s shared photos of his patients and the effects of the diseases with audiences to show them the reality faced by so many in the region.

A Reality Short-lived

“It was working well, then we had to pull out because of the political situation,” said Boyer. “Anytime you see a straight line on a map, it’s not for geographical reasons.” The politics of Darfur are complex. Boyer attributes the main reasons for the continuation of the genocide in Darfur with regional politics, oil and international law.

Boyer said the five permanent members of the UN Security Council were putting constraints on any response. The U.S. called for a response in Darfur in 2004 when former Secretary of State Colin Powell first declared the situation in Darfur a genocide. But a subsequent finding from the UN would prolong any comprehensive response as nations argued over what constituted genocide. By the time the UN declared a genocide in the region a year later, thousands, if not hundreds of thousands of people were killed. Now the UN is desperately pushing for a peacekeeping mission inside Darfur and trying to maintain dozens of refugee camps along the border with Chad.

There are deep interconnected economic and political implications for Darfur and the world that only worsens the genocide in the region. Boyer said it is rooted in the colonial past of the region. “Any time you see straight lines on a map, it is not for geographical reasons.” Boyer makes a point of informing his audiences about the past to bring a better understanding of the consequences of foreign acts and neglect in Africa.

Like many countries in Africa, different tribes were forced to merge into nation-states that pitted nomads and farmers over meager resources and land. Sudan’s conflict began in the 1980s between the Arab nomads and the Black African farmers. Boyer said the camel migration routes almost thirty years ago helped form what the Janjawid are today.

Foreign Intentions, Local Consequences

Boyer is quick to point out that situation in Darfur grew out the political unrest in Sudan over the last two decades. What changed between the Arab nomads fighting for their camel migration routes and the Black Africans fighting to farm the fertile soil was the government support of the Bashir administration.  When Bashir backed the Arabs, he created a division that grew into a genocidal strategy within a decade.

As most Americans wonder why they should ever care about Darfur, the implications of what the U.S. and other governments do in Sudan matters. Although the U.S. has declared the situation in Darfur a genocide, it is wrapped around the economic and security issues that allow the killing to continue.

Boyer pointed to China and its economic ties to the U.S., as one example. “China is a good part of our economic debt,” Boyer said. “This has to influence the Security Council.” Boyer pointed to the U.S. economic entanglement with China as one of the reasons for not pushing China more. “Darfur is paying the price for our economic ties with China,” said Boyer. “We’re not participating in some of the negative techniques as China, but we are involved.”

“I also feel the current Administration has little moral compass,” said Boyer. “People in the Administration say genocide, but are not willing to act on it.” Boyer sees the War on Terrorism trumping all else, especially concerning Darfur. The U.S. worked closely with the Sudanese government to help negotiate the peace treaty for the North-South war, and more recently in the War on Terror. (Sudan officials were flown to Washington, D.C., for talks.) “They are so distracted by Iran, Iraq and Afghanistan,” said Boyer. “They claim they want information on terrorism.” Boyer said the Bush Administration’s aversion to the International Criminal Court also plays a role in lessening any impact the government could have in resolving the situation in Darfur.

Boyer said oil also plays a role in Darfur. The Sudanese government is one the wealthiest because of its oil deposits. “Chevron was there first in the Abu Gabra region in 1975,” said Boyer. “But they pulled out in 1991 due to the conflicts.” He said other U.S. oil companies pulled out in 1997. The void left allowed China to enter. Sudan now supplies China with 85 percent of its oil. As long as China gets the oil it needs to increase its economic boom, the Sudanese government will get the funds it needs to continue its campaign in Darfur.

China, along with the U.S. is among the five key members of the UN Security Council which could press the Sudanese government to stop the situation in Darfur. “My feeling is the permanent members maintain the status quo,” said Boyer.  “The five permanent members are all nuclear powers and are all ranked in the arms trade.”

Boyer said the International Criminal Court (ICC) could play a vital role in prosecuting those guilty of carrying out the genocide, but lacks the support of the U.S. to push for any justice. Boyer said the ICC can prosecute the perpetrators of genocide but cannot intervene. “It can threaten, but it needs muscle,” said Boyer.

The only muscle available in the region is the AU. But without any direct mandate to protect, it can do little to stop the government-supported Janjawid. It is why the Sudanese government has allowed them to stay in the region, while it adamantly opposes any foreign intervention, including UN troops.

Any increased mandate for the AU has drawn opposition by China and Russia in the UN Security Council. Boyer said the original mandate language for the Security Council Resolution 1706 called for protection, but was softened by the two members. Such increases in the AU’s ability to provide protection in the region are not without support. Boyer points to a long list of African leaders, human rights’ organizations and even factions within Sudan that are pushing for a stronger AU mandate. It may be the only way of helping in lieu of any outside forces. But with China, Russia and Egypt bulking at any increased AU power, the chances for peace are slim.

Boyer’s List for Hope

Boyer doesn’t leave any of his audiences without hope. He offers a list of solutions that would help end the genocide and bring those guilty of it to justice. Boyer begins with a no-fly zone imposed by a strong mandate for protection in the region to stop the initial bombing of villages. He said support for the UN Human Rights’ Council and the International Criminal Court is crucial, along with the U.S. paying its debt to the UN. “And we must remove the state’s right to consent to ICC prosecution,” said Boyer, referring to each country’s ability to accept or refuse ICC prosecution.

Boyer also wants the Geneva Convention amended to include protection for IDPs. But it is the last item on his list that could do the most good, but be the most difficult to achieve. “We need to exclude the nuclear powers and arms exporters from the UN Security Council,” said Boyer.

All of the items on his list are more feasible than the one obstacle that both infuriates him and challenges him to continue his mission. “What is most shocking to me is the world’s indifference.” If Boyer has his way, that will also change and hopefully before there is no one left for the change to matter.

© 2006, Foreign Interest

For more information:

Northwest Medical Teams: www.nwmedicalteams.org

International Crisis Group: www.crisisgroup.org

Contact the author: sharbert@foreigninterest.com