Alexander Tsai and colleagues review medical records from the Amel Centre, Sudan, to assess consistency between recorded medical evidence and patient reports of human rights violations by the Government of Sudan and Janjaweed forces.
Ongoing conflict in the Darfur region of Sudan has resulted in a severe humanitarian crisis. We sought to characterize the nature and geographic scope of allegations of human rights violations perpetrated against civilians in Darfur and to evaluate their consistency with medical examinations documented in patients' medical records.
Methods and Findings
This was a retrospective review and analysis of medical records from all 325 patients seen for treatment from September 28, 2004, through December 31, 2006, at the Nyala-based Amel Centre for Treatment and Rehabilitation of Victims of Torture, the only dedicated local provider of free clinical and legal services to civilian victims of torture and other human rights violations in Darfur during this time period. Among 325 medical records identified and examined, 292 (89.8%) patients from 12 different non-Arabic-speaking tribes disclosed in the medical notes that they had been attacked by Government of Sudan (GoS) and/or Janjaweed forces. Attacks were reported in 23 different rural council areas throughout Darfur. Nearly all attacks (321 [98.8%]) were described as having occurred in the absence of active armed conflict between Janjaweed/GoS forces and rebel groups. The most common alleged abuses were beatings (161 [49.5%]), gunshot wounds (140 [43.1%]), destruction or theft of property (121 [37.2%]), involuntary detainment (97 [29.9%]), and being bound (64 [19.7%]). Approximately one-half (36 [49.3%]) of all women disclosed that they had been sexually assaulted, and one-half of sexual assaults were described as having occurred in close proximity to a camp for internally displaced persons. Among the 198 (60.9%) medical records that contained sufficient detail to enable the forensic medical reviewers to render an informed judgment, the signs and symptoms in all of the medical records were assessed to be consistent with, highly consistent with, or virtually diagnostic of the alleged abuses.
Allegations of widespread and sustained torture and other human rights violations by GoS and/or Janjaweed forces against non-Arabic-speaking civilians were corroborated by medical forensic review of medical records of patients seen at a local non-governmental provider of free clinical and legal services in Darfur. Limitations of this study were that patients seen in this clinic may not have been a representative sample of persons alleging abuse by Janjaweed/GoS forces, and that most delayed presenting for care. The quality of documentation was similar to that available in other conflict/post-conflict, resource-limited settings.
Please see later in the article for the Editors' Summary
Conflict in the Darfur region of Sudan between Arabic- and non-Arabic-speaking tribes over the past decade has resulted in a severe humanitarian crisis. According to the United Nations, more than 2.7 million people have fled from their homes to camps for internally displaced persons (IDPs) or to refugee camps in neighboring Chad, and up to 300,000 people have died from war, hunger, and disease since the conflict started. The origins of this conflict go back many years, but in 2003, organized rebel forces began attacking government targets, accusing the Government of Sudan (GoS) of oppressing black Africans in favor of Arabs. In response, the GoS attacked the rebel forces, but some observers allege it also targeted non-Arabic-speaking civilians, in contravention of international laws of war. Observers have also accused the GoS of having links with the Janjaweed militias, nomadic Arabs who attack settled black farmers, although the GoS denies any such links. Indeed, reports of systematic, targeted assaults on non-Arabic-speaking civilians, of large-scale disruption of rural livelihoods, and of deliberate consignment to living conditions likely to cause death have prompted some observers to accuse the GoS of genocide (violent crimes committed against a national, ethnical, racial, or religious group with the intention of destroying that group) and the International Criminal Court to issue arrest warrants for the allegedly responsible authorities.
Why Was This Study Done?
Most investigations of claims of violence against civilians in Darfur have relied on self-reported data gathered from people living in refugee camps outside Sudan. Because these data could be biased, in this cross-sectional study (a study that characterizes a population at a single point in time), the researchers investigate the nature and geographic scope of alleged abuses against civilians in Darfur and endeavor to substantiate these allegations by analyzing the medical records of patients attending the Amel Centre for Treatment and Rehabilitation of Victims of Torture in Nyala, South Darfur. Opened in 2004, this center provided free clinical and legal services to civilians affected by human rights violations. Its staff fled in 2009 because of increasingly dangerous working conditions; the medical records used in this study were sent out of Sudan before the staff fled.
What Did the Researchers Do and Find?
Between September 28, 2004, and December 31, 2006, 325 patients were seen at the Amel Centre. According to their medical records, 292 patients from 12 different non-Arabic-speaking tribes alleged that they had been attacked by GoS or Janjaweed forces in rural areas across Darfur. Nearly all the patients reported that they had been attacked in the absence of active armed conflict between GoS/Janjaweed forces and rebel groups. Half of them claimed that they had been beaten, two-fifths reported gunshot wounds, a third reported destruction or theft of property, and nearly a third reported involuntary detainment. Half of the 73 women seen at the center disclosed that they had been sexually assaulted, often near IDP camps. Only 198 medical records contained sufficient detail to enable the researchers to determine whether the documented medical evidence was consistent with the alleged abuses. However, in all these cases, the researchers judged that the medical evidence was consistent with, highly consistent with, or virtually diagnostic of the alleged abuses.
What Do These Findings Mean?
These findings provide credible medical evidence that is consistent with torture and other human rights violations being inflicted on non-Arabic-speaking civilians in Darfur from 2004 to 2006. These findings cannot be used to estimate the population incidence of attacks on civilians or to corroborate claims of assailants' identities or of genocidal intent. Moreover, their accuracy may be affected by several limitations of this study. For example, during the study period, only patients who obtained a medical evidence form from the police were permitted to receive treatment from an authorized medical officer; obtaining such a form likely represented a considerable hurdle to accessing health care services. Nevertheless, the widespread, organized, and sustained pattern of attacks documented in this study is consistent with the possibility that the actions of Janjaweed and GoS forces during the conflict in Darfur may constitute war crimes, crimes against humanity, and/or acts of genocide. Importantly, these findings also highlight the need to provide adequate protection for health professionals working in countries affected by internal conflicts.
Please access these web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001198.
The African UnionUnited Nations Mission in Darfur (UNAMID) provides background information and up-to-date news about the ongoing conflict in Darfur Amnesty International, which campaigns for human rights, provides background information and news about the current situation in Darfur
The Save Dafur Coalition also provides detailed information about the situation in Darfur Physicians for Human Rights, a non-profit organization that mobilizes health professionals to advance health, dignity, and justice, is calling for security in Darfur and compensation and restitution for survivors of the conflict
Wikipedia has pages on Darfur and on genocide (note that Wikipedia is a free online encyclopedia that anyone can edit; available in several languages)
Details on warrants of arrest issued by the International Criminal Court in response to the situation in Dafur are available