Q&A about Jamam

I'm going back to Jamam next week. I'm a bit apprehensive about it to be honest; there are now 88 staff there working as part of the Oxfam 'scale up' for the Category 2  Emergency; in Jamam refugee camp there are around 32,000 people, and over 100,000 Sudanese refugees in Upper Nile state. 

It's been 4 months since I was there, and a lot has changed since then. There are permanent structures in our compound instead of tents, three more refugee camps in the area, and a bucketload more people fleeing fighting in Sudan. The place is under water from the rain, there's mud everywhere, emergency latrines are overflowing and there has been a suspected cholera outbreak. We are now awaiting the test results from Nairobi (which are, relievingly, likely to be negative).

A new site has been designated for the refugees from Jamam, called Gendrassa. Oxfam are currently drilling boreholes there in preparation for moving the people. Our focus is now on this new site and making sure everything is in order for the first arrivals.

I cam across the article below on the Oxfam website. It is now 3 weeks since it was written, so it's a bit out of date, and it is very Oxfam-centric - there are many other organisations working there such as UNHCR, ACTED, Goal, MSF etc - but I think it gives a good basic overview of the situation on the ground. It's helping me to get up to speed on what's happening there, given I've been out of the loop for a few months while working with the team in Rumbek. Gendrassa is a new addition to the 'new' camp of Batil described below.

Options running out for 32,000 refugees in Jamam Camp – July 4, 2012

by Janna Hamilton, Oxfam GB journalist

The situation in Jamam was already fragile, and is now critical. Conditions in the camp are the perfect storm for an outbreak of cholera or other water-borne diseases. There is simply not enough safe drinking water in the camp, and now the rainy season has begun, families’ tents are flooded and pit latrines overflowing, causing a dire health risk. As the rains get heavier disease is likely to spread. Oxfam delivers water and sanitation all over the world and conditions here are as difficult as it gets. 

Every effort must be made by the local government in Upper Nile, with strong leadership from UNHCR, to evacuate the 32,000 refugees from Jamam to new sites, which are safe from flooding and where adequate safe drinking water is available. The window is shrinking with which to relocate refugees before the rains make roads impassable and flooding overwhelms Jamam camp.

More than 35,000 new refugees crossed the border in May, fleeing conflict and bombing in Blue Nile in Sudan, and more than 10,000 are also expected to be on their way. A new site in Batil, 60kms from Jamam, is being prepared to accommodate Oxfam has supported the drilling for water in the new site. 

While we are doing all we can to prevent a cholera outbreak, continued coordination between humanitarian organizations is vital to ensure we are all ready with prepositioned stocks to respond as effectively as possible if an outbreak does occur. 

Oxfam has 88 staff (68 national and 20 international) now in Jamam responding to the refugee crisis.

Despite the challenges, Oxfam is:

o   Continuing to drill for new water sources in Jamam camp, as well as in the new site in Batil.

o   Building latrines to prevent open defecation and spread of disease.

o   Spreading vital hygiene messages to the refugee and host community on how to identify, treat and prevent the spread of cholera and other waterborne diseases.

o   Stock-piling emergency supplies of water purification equipment, rehydration salts and soap to help contain the spread of cholera if an outbreak happens.

 The critical situation people are facing in the refugee camps is the human face of conflict – although they may have fled the fighting, they continue to have to suffer living in very desperate conditions. What these refugees need and deserve is for the conflict in Blue Nile to immediately end and long-term peace to be established, so they can go home in safety Refugees in Jamam want to go home, but they need security to do so.

Overview – Jamam Camp 

Jamam camp lies about 60 kilometres south-west of the Sudan-South Sudan border.  About 32,000 refugees currently live in the camp.  These refugees are from Blue Nile State in Sudan where conflict broke out last year between the SPLM-N rebels and the government of Sudan. Most of the refugees arrived in South Sudan in December 2011 – though most moved to Jamam in Jan/Feb 2012.

The refugees in Jamam face extreme challenges. The area faces critical water shortages, with very little groundwater available – not enough to support the influx of people. With the arrival of the rains, the camp is flooding, inundating tents and latrines, but this water is very unsafe to use is not treated.

In May, around 20,000 refugees were moved within Jamam camp away from their initial place of spontaneous settlement on a flood plain. Areas that have not flooded completely have been become extremely muddy and very difficult to live in during the rains, as water tends to sit on the surface of the ground, a high risk for both waterborne disease and malaria.  It is also now difficult to access inside the camp by vehicle and even on the roads, water trucking will eventually become impossible.

As a result, Oxfam has been calling for people to be relocated to a completely new site where more water is available. Relocation started late and slowly in May, however, so far only 4,000 of the original 37,000 in the camp have been moved to Doro refugee camp. Further relocations stalled due to resources being diverted to deal with new influx of refugees. Oxfam welcomes the latest commitment from UNHCR to relocate the 32,000 refugees from Jamam refugee camp to a second site in Batil and possibly a third new site. Every effort must be made by UNHCR to honour this and to urgently prepare a realistic contingency plan for what to do if cholera breaks, out or impassable roads, due to rains, prevent relocation.

There are about 5,000 people living in Jamam village who also need access to the same water sources. They have faced severe competition for resources, including water, that were already rare, since the arrival of the refugees. Oxfam is concerned tensions over competition for water is growing between the refugee community and permanent residents. 

Oxfam has four operational boreholes that are located between one and 30 kilometers away from the camp currently trucking into seven water tanks attached to tap stands mostly positioned close to the road that runs through the camp. These boreholes have been fitted with submersible pumps that pump almost 24 hours a day so Oxfam can try to keep up with demand.  But with water being extracted at a very fast rate, the water they provide is decreasing as ground water levels drop. 

Oxfam and other partners in the camp have been trying to drill for new boreholes to supplement the existing ones.  However eleven new boreholes have not produced a significant new source of water: only two produced any water at all and this was too little to make a meaningful contribution to Jamam’s water needs, with one source no longer even providing enough water for the hand pump initially installed. 

Humanitarian agencies have been trying to get larger rigs into the camp to try to drill deeper but their arrival has faced many delays. One additional rig has arrived and is in the process of drilling, but it is not as large a rig as initially hoped for and may not be able to drill as deep as needed to find water. There’s also a good chance that water deeper in the ground will be saline. 

In order to get the best chance of hitting water Oxfam has done a geological survey of the area and has reviewed this survey again. The area is known to be an especially difficult area to find good sources of ground water because there’s little rock and below the surface is mostly clay that does not allow water to flow through it. 

However, progress has been made with an additional borehole now available, increasing the average amount of water available from 6 litres in April to 8 litres per person per day.

Questions and answers

        Why are there such shortages? Why isn’t Oxfam providing more?

Water has always been problematic in the Jamam area: Oxfam has been working with the host community for three years and finding productive groundwater sources has always been a challenge. 

The influx of tens of thousands of refugees into the area has put enormous pressure on what little water there is available. Refugees continue to arrive and water sources continue to be put under more pressure. The situation is now critical. Oxfam and other NGOs have had teams of engineers and drilling rigs trying to find more water, and carried out geological surveys, but there is simply not enough available to meet the enormous needs.

Currently the refugees receive between 7-9 litres per person per day – far below international humanitarian standards of 15 litres per person per day.  This is only achieved by the use of trucking water into the camp from existing boreholes between 10-30 miles away, but rain is now making the dirt roads very difficult and slow to navigate. Trucks are getting stuck, delaying the urgent delivery of the limited water available to the camp. Even using the trucks, only about 16,500 people could get 15 litres per day, while there are around 37,000 people in Jamam in need of water, 5,000 host population and 32,000 refugees. 

This water has to be carefully managed and is only enough for cooking and drinking.  In surveys performed by Oxfam, refugees report having to make hard decisions, such as whether to use water for cooking or bathing, a choice no one should have to make. Illness is common in the camp because of a lack of water and the risk that this will get worse now the rains have arrived is very high, especially in children and other vulnerable populations.  

2.    If there is so much rain, why is there still not enough water for the refugees?

Dues to the rains, there is now a lot of surface water in the Jamam area, but when this water pools on the muddy ground it becomes very unsafe for people to use for cooking and drinking.  Hafirs (large ponds) in the camp have been a source of water for refugees – although this water is very unsafe if not treated and is likely to contain pathogens as cattle and goats also use the haffirs. Oxfam has setup pumps, tanks and operators to treat this water as a safe additional source of water for the population.

Oxfam is also providing rain water harvesting - where people use plastic sheeting to collect rain water, and they then treat the water with water purification tabs to make it safe for drinking.

3.    How likely is a cholera outbreak in the refugee camp?

The situation in Jamam is the perfect storm for a cholera outbreak. Extremely limited groundwater means people can only access between 7-9 litres of safe, clean water each day, but still only enough for cooking and drinking. While within emergency indicators, this is far below the international humanitarian standard indicator of at least 15 litres per person per day. 

The threat of cholera and other water borne diseases such as diarrhea and malaria is very real during the rainy season when people have a much higher risk of being infected by contaminated water sources. In Jamam, however, there are simply not enough safe water sources available to provide the recommended quantity to the 32,000 refugees to lower the risk of a cholera outbreak. Over one and a half Olympic sized swimming pools would be required every week for just the basic needs of the refugees. Moreover, if an outbreak does occur, 40 litres of safe, clean water per person is recommended to contain the spread of cholera within a family with a cholera patient – which is simply not possible given the limited water available.

4.    What is Oxfam doing to prevent a cholera outbreak?

In Jamam there is simply not enough water available to adequately reduce the risk of a cholera outbreak amongst the refugee population, particularly in the rainy season when people will live close to pools of contaminated water. 

To help limit a cholera outbreak, Oxfam has started chlorinating the water where possible it is delivering to the refugee community, and will increase chlorination if an outbreak does occur.

Preventing the spread of cholera, if an outbreak does occur, is straightforward: it requires good basic hygiene, like hand-washing and only drinking clean water, but this becomes more difficult if access to water and basic sanitation is limited. Oxfam is diffusing hygiene messages to the Jamam refugee community and the host community nearby on how to identify, treat and prevent the spread of the disease, especially dangerous to children and other vulnerable members of the population.  In addition Oxfam is rapidly constructing adequate communal latrine facilities.

This involves hygiene messages on the importance of hand-washing, and using the safe clean water they do have available for drinking and preparing food. Most of the refugees have fled from rural areas and are not used to living in crowded camp conditions where diseases can easily spread.

Oxfam, in partnership with the other agencies, also has contingency plans in place for a cholera outbreak, which includes:

·         Stock piling water treatment equipment and chemicals for emergency treatment of surface water such as ponds and dams in case the borehole and pipeline system breaks down.

·         Contingency stock for emergency sanitation infrastructure - in the event that we have to build elevated latrines in a flooded area.

·         Contingency stocks of chlorine and PUR (water purification) for emergency water treatment, plus soap for hand-washing.

·         Designated areas reserved in the camp for oral rehydration points. These are places where people know that they can go for rehydration when suffering from diarrhoea. 

5.    Are people showing signs of waterborne disease yet?

Forty per cent of all patients treated in Jamam’s health clinic were reported to be suffering from diarrhoea in June. (PLEASE NOTE this is not the same as 40 per cent of the population having diarrhoea) As a comparison, the population size in Doro and Jamam refugee camps are similar, and the number of cases of Acute Respiratory Infection seen at both are about the same, however, the number of diarrhoea cases is much higher in Jamam – a strong indicator of the impacts of limited access to water and sanitation in Jamam camp. 

Oxfam is disseminating hygiene messages to the Jamam refugee community and the host community nearby on the importance of hand-washing, and using the safe clean water they do have available for drinking and preparing food to prevent waterborne diseases. In addition, Oxfam has constructed nearly 1,000 communal latrine facilities – however, the recent flooding has led to the collapse of more than 100 of these, as no higher ground was available to construct the latrines in large parts of the camps. Oxfam is extremely concerned with the increased heath risk this brings.

6.     Why was the camp established in a place with too little water to sustain a refugee camp?

Refugees fleeing the conflict in Blue Nile initially settled close to the Sudan – South Sudan border, but moved to the Jamam area in December 2011 deeper into the South in order to get them away from the conflict. The area was partially selected because of the willingness of local chiefs and authorities to host the refugees, but Oxfam has been warning for months of the urgent need to find a more suitable site with better access to safe water.

However, as more refugees have arrived in Jamam, Oxfam and other agencies have not been able to source enough water to sustain them. The level of flooding that hit Jamam after several days of heavy rain at the end of June has also exceeded our previous expectations.

7.    Oxfam warned that 23,000 refugees needed to be relocated from Jamam to a new site with a more reliable water supply before the rainy season, did this happen?

In February and again in April, Oxfam sounded the warning that 23,000 refugees needed to be urgently moved from Jamam to another location with a more reliable water source, which would leave the remaining 16,500 refugees in Jamam with the recommended 15 litres of water per person, per day. Unfortunately, just as the relocation operation began in May, a new influx of 35,000 refugees arrived from Blue Nile state to transit sites close to Jamam.  As a result only 4000 people have been moved from Jamam since resources were diverted to the urgent needs of the newly arrived refugees.

We support UNHCR’s decision, in light of flooding and limitations in safe water supplies, to evacuate the entire population of Jamam, as soon as possible before further flooding and disease outbreaks put the population at grave risk. Oxfam urges that sufficient support, funding and expertise are deployed by all agencies involved to a successful evacuation this takes place.

8.    Why have refugees not been relocated in time?

Setting up a new camp, especially in a short timeframe is very challenging and expensive. Government needs to allocate a site, and UNHCR needed to move the refugees, and identify and fund partners to operate the camp. 

It takes time to identify an accessible site with adequate access to water in a secure location. This needs to be approved by the Govt. authorities and supported by the local community.  Site planning and setting up basic infrastructure also takes time. Moving up to two thousand refugees a day is an enormous challenge – trucks, way stations, security, food and water for the journey all need to be planned and pre-positioned. Given that Upper Nile is caught between conflict zones in Blue Nile and South Kordofan, it is also a challenge to identify a site that is a safe distance from a border and in a secure location. 

9.    Why has Oxfam been critical of the UNHCR response?

We feel strongly that aid and UN agencies should work together to address the huge challenges in Jamam. We have a firm commitment from the local government in Upper Nile, with strong leadership from UNHCR, that the immediate evacuation will begin of the 32,000 refugees from Jamam to new sites. Under incredibly challenging conditions, thousands of men, women and children must be evacuated as quickly and efficiently as possible, and this will require a focused coordination and collaboration from all agencies.

10.  Where are the refugees now going to go?

Batil has already received some 30,000 new arrivals from Blue Nile in the past month and is close to capacity. A new camp called Batil 2 has been identified by UNHCR as a suitable site for up to 15,000 people from Jamam – this is under development now, and we hope that people can start moving there within the next few weeks. There are variables outside of anyone’s control at this stage – how much rain will affect the roads and how many new refugees may arrive. Even if this is accomplished, it leaves nearly 20,000 refugees still in Jamam – and a third site will need to be urgently identified and developed for this population.  

11.  What is Oxfam's concerns, if any, with Batil?

Borehole drilling in Batil has been successful over the last month, and at this stage offers an viable location to resettle the ten of thousands in Jamam who are in desperate need of safe drinking water.  Batil 1 camp is close to capacity with the new influx having settled there. Batil 2 is going to be developed as a matter of priority and could take up to 15,000 refugees currently living in the flood plane in Jamam. 

Oxfam is still concerned about the need to prepare a third site for the remaining 18,000 people in Jamam and support UNHCR in its efforts to find such a site urgently. 

12.  Does Batil have enough water to meet international standards of 15 litres per day, per person?

At this early stage, borehole drilling in Batil is showing very positive signs of good ground water supply. 

13.  What will Oxfam be doing in Batil?

Oxfam has supported the drilling of boreholes in Batil with drilling rigs, staff, borehole consumables and supplies for water distribution. We will continue to support, as much as we can, the development of new water sources in Batil 2 and any other site identified. 

14.  UNHCR said they would relocate 16,000 in April, but didn't. Will this time be any better?

The recent flooding in Jamam has convinced all actors, including UNHCR, that Jamam 1 needs an "evacuation" rather than a "relocation". The risks of a major health disaster have become obvious to all - and the response has been unanimous and quick. We believe, and hope there is no going back on this decision. 

15.  In the event there's a cholera outbreak before a significant number of refugees are relocated, will relocation stop?

Yes - if there is a confirmed case of cholera in Jamam, it would be impossible and unethical to continue moving refugees (who possibly carry the disease with them) into another, unaffected population. Stock-piling emergency supplies of water purification equipment, rehydration salts and soap to help contain the spread of cholera if an outbreak happens is underway. 

16.  What is the current situation in Blue Nile?

The conflict in Blue Nile continues to force people to flee their homes. The latest UN report indicated fighting in Blue Nile escalated during June, with the most recent bombing reported on July 2. According to the FEWSNET early warning system there is currently a food crisis in Blue Nile, caused in large part by the conflict, displacement and poor harvest. Many of the refugees were farmers who had to flee their villages in the middle of the planting and harvest seasons. The price of staple foods such as sorghum has risen by 75 per cent from this time last year. Ultimately the only sustainable solution to the crisis is for a cessation of hostilities and a peace agreement in Blue Nile so that people can go home.

* * *

So there it is. Gulp.