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Министр здравоохранения Западной Сахары СидАхмед Тайеб

Western Sahara is administrated by Morocco.

According to Sid'Ahmed Tayeb, minister of health in Western Sahara's government in exile, health problems among the refugees result from poor conditions in the camps combined with the desert climate. “The very hot weather causes diarrhoea and dehydration whilst the cold weather causes respiratory problems, especially among children”, he explains. Indeed, in the summer months, temperatures on the hammada desert plain regularly top 120°F, whereas night temperatures during the winter fall below zero. With sandstorms, little vegetation, and no sources of food or water, it is little wonder that the area is known locally as the Devil's Garden.

More than 160 000 Saharawi refugees reside in camps in the Algerian desert, where poor living conditions and extreme climates pose challenges to their health. Stefan Simanowitz reports. Exactly 1 year ago, 19-year-old Ibrahim Hussein Leibeit was carried into a Red Cross mobile orthopaedic treatment centre, deep in the desert in southwest Algeria. His leg had been blown off below the knee by a landmine. Leibeit, a refugee from Western Sahara, had been taking part in a demonstration to the 1550 mile fortified barrier known as the berm built in the desert by the Moroccans to stop Saharawi refugees from returning to their native land. In a symbolic gesture, he had attempted to get close enough to the wall to throw a pebble to the other side when he trod on the device. Didier Coorman, a Belgian who heads the orthopaedicc project of the Red Cross in Tindouf, Algeria, was the one who treated Ibrahim. Despite the fact that the strip of desert beside the berm is protected by around 7 million explosive devices—the most densely mined area in the world—injuries are very rare. “Over the past 2 years we have provided assistance to over 50 victims of anti-personnel mines and cluster munitions but most of these are pre-existing injuries from the 1980s and 1990s”, Coorman explains. “I have only treated two people for new landmine injuries and one of those was Ibrahim.” The older injuries to which Coorman refers are ones sustained during the 16-year war fought between the Polisario Front—Western Sahara's liberation movement—and the Moroccans who annexed much of the territory following the departure of the Spanish colonisers in 1976. During that time, tens of thousands of Saharawis fled across the border to refugee camps in Algeria and despite a ceasefire in 1991 under whose terms a referendum on self-determination was promised, around 165 000 Saharawi refugees have remained in refugee camps ever since. Living conditions in the camps are extremely harsh.

Widespread health problems in the camps include hepatitis B, anaemia, meningitis, and various forms of malnutrition: severe acute, moderate acute, and chronic. A 2008 study, commissioned by Norwegian Church Aid and the Spanish organisation Medicos del Mundo, found that one in five children in the camps had acute malnutrition. These findings were supported by a WHO survey that showed that rates of malnutrition had increased from 8% in 2005 to 19% in 2008. Alan Fenwick, professor of Tropical Parasitology at Imperial College London and an executive board member of the International Education Foundation, which recently delivered medical supplies to the camps, believes that problems of health and poverty are inextricably linked and that a holistic approach is required in tackling them. “Health issues in these camps are tied in with wider social issues: poverty, overcrowding, poor sanitation, and bad diet”, he says. The diseases in the camps are diseases of poverty. As the medical director of the hospital in Dakhla, the most remote of the four refugee camps, Laedaf Abid agrees. His small clean hospital serves a refugee population of nearly 30 000 but can only offer basic treatment. The hospital does some basic surgery, but patients needing more complex operations must board a rickety ambulance and drive to the national hospital in a neighbouring camp more than 100 miles away. Dakhla is a sprawling single-storey town, with wide sandy streets lined with rectangular houses and tents forming neat family compounds. Despite efforts to keep themselves active there is an air of listlessness that hangs over the camps and people there are entirely dependent on international non-governmental organisations (NGOs) for their supplies of food, water, and medicine.

According to Abid, shortages in hospitals are a constant problem. “We do not have enough equipment, enough medicines, or enough doctors.” The shortage of doctors is compounded by the fact that many Saharawi doctors, often trained in Cuba, have been lured to work in Spain where there is a huge demand for Arabic-speaking doctors. In the camps, doctors are paid around €1500 per month, a fraction of what they can earn in Spain. Dakhla hospital also endures frequent power cuts because of a lack of petrol for the generator and the fact that the old batteries attached to solar panels are unable to store much power. “About a month ago, a woman went into labour at night and before we could deliver the baby the midwife had to go looking for petrol for the generator”, Abid says. “The main challenges faced by women in the camps involve nutrition”, says Maria Fenandez, coordinator of a women's health care project in the camps run by Medico dos Mundo. International NGOs provide food but do not provide a balanced diet, she explains, pointing out how the diet is carbohydrate heavy—pasta, rice, and bread with little fresh fruit and vegetables. Fenandez is particularly concerned about the effect that the lack of vitamins and micronutrients has on children, pregnant women, and lactating mothers. “There are high levels of anaemia and epilepsy”, she says. The infant mortality rate is not alarming, but it is high. According to the minister of health Sid'Ahmed Tayeb, 80% of births arise at home and despite the harsh conditions, birth rates are on the increase. “This is a positive thing”, he says. “It would be easy for the Saharawi refugees, living as they do between existence and non-existence, to slowly disappear but this is not happening.” The Saharawi have their own rich nomadic culture and traditions and their own distinct Arabic language, Hassaniya, and living in the camps the they have had to strive to sustain their culture. Traditional medicine still has an important role in the camps, and, according to Sid'Ahmed Tayeb, sick people often try local remedies first before they go to the hospital. But, generally, traditional healing sits comfortably beside modern medicine. The ministry of health and NGOs have worked hard to promote preventive medicine through public outreach programmes stressing the importance of hygiene and nutrition. There is a generalised immunisation programme and primary health care starts at the lowest level with nurse practitioners and dispensaries spread across the camps. This strategy has been particularly effective in achieving a substantial reduction in rates of the debilitating eye disease trachoma. In addition to raising awareness about nutrition, efforts have been made to reduce dependency on foreign food aid by creating fruit and vegetable gardens. Dakhla for example boasts a 12 hectare garden which produces onions, tomatoes, pumpkins, papayas, avocados, pomegranates, figs, dates, and even watermelons. The project is, however, on a very small scale and tending gardens is both resource and labour intensive, requiring large amounts of water and fertiliser to keep the sandy desert soil sufficiently moist and fecund. Abdul Karim Ghoul, from the UN High Commissioner for Refugees (UNHCR), has been in the camps for an annual 3-day donor mission to assess the effect of their projects and the needs of the refugees. He believes the lack of profile of the crisis in the camps within the international community is a major problem. “It is easy to raise funds when there is an emergency like a drought or an earthquake but when a crisis has been going on for decades it becomes harder”, he says. Ghoul argues that it is not possible to continue a relief programme on emergency mode for 35 years but is hopeful that attitudes are changing largely because of the 2009 visit to the camps by the UN Commissioner for Refugees, Antonio Guterres. Guterres urged the international community to “wake up” and committed the UNHCR to improving conditions for the camps' inhabitants, citing health and education as priorities. Since 2007, the total budget for the Saharawi refugees has more than trebled from US$2·5 million to $9 million last year. There has also been an important shift away from emergency relief towards solution-orientated assistance. “This means a strategy which is looking to support future generations with things like health, education, water and sanitation projects, rather than just dealing with immediate issues”, says Ghoul. Ultimately, the problem of health care in the camps cannot be separated from the wider political crisis that has remained unresolved for over three decades. In a situation where Polisario will not negotiate away their right to self-determination, Morocco will not countenance any proposal that contains even the possibility of independence, and the Security Council is unwilling to enforce the resolutions to resolve the dispute, it is difficult to see how the deadlocked peace process could be revived. Nevertheless, the Saharawi refugees remain confident that the tide of history is on their side. Back in Dakhla, Ibrahim Leibeit has now been fitted with a prosthesis and has no regrets. “I would gladly lose my other leg if it would mean that my country could be free”, he says.


Health in the camps is run by local health committees. I was fortunate to be able to visit the national hospital run by POLISARIO. The hospital is for civilians, and wounded soldiers are treated elsewhere. The hospital seemed well organized and was divided into sections, including maternity, general and intensive care, with 400 beds. Staff includes both nurses and para-medics. Some staff have many years of experience and some have been trained at the hospital. A nurse remains in all occupied rooms at all times.
Mothers will often stay in the hospital with their children. In this way the mothers learn something about their child's illness, the medication given, and prevention techniques. Proven traditional methods are also used.
Many of the illnesses treated are those associated with refugee situations. However, things have greatly improved in the past couple of years, Salek Babeith, Minister of Health explained when we met him at the hospital.
Each refugee camp has a clinic run by the local health committee. These are three regional hospitals and the national hospital.
Much of the equipment in the national hospital has been donated, including an x-ray machine by Oxfam-Belgium. Among current needs, besides medicines, are more beds, stethoscopes, and more ambulances. The need for ambulances was stressed, as transport of people who are ill to the national hospital from the refugee camps is a serious problem. Report on a Visit to the Democratic Arab Saharawi Republic and Algeria By Richard Knight American Committee on Africa 1979.

карта регионов Западной Сахары

Three Moroccan regions overlap the territory of Western Sahara:

* Guelmim-Es Semara – also includes Moroccan territory outside of Western Sahara
* Laayoune-Boujdour-Sakia El Hamra
* Oued Ed-Dahab-Lagouira

Morocco controls territory to the west of the berm (border wall) while the Polisario Front controls territory to the east (see map on right).

Последнее обновление: 31 июля 2010
Страница создана: 08 июня 2010
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