Refugee camps are supposed to betemporary domiciles. Unfortunately,temporary can often mean years.Among the oldest of such camps is theone housing the Sahrawi people,located in the Algerian desert just overthe border from Morocco. For threedecades the Sahrawi have lived incanvas tents and mud brick huts.There is no running water and car bat-teries are the only source of electricity.

This patch of the Saharan desert isnot a place that would normally sus-tain human life. Everything, from foodto shelter to medical care, is donatedby international aid agencies. “Theyhave no possibilities, they are depend-ent absolutely on international help”,says Diego Fernández, a Spanishdoctor who heads an NGO that pro-vides medical services to the refugees.

The Sahrawi never expected to behere this long. A formerly nomadicpeople who inhabited a large area ofland in the Western Sahara, theybecame refugees after fleeing thenapalm-spewing Moroccan armywhen the Spanish gave up theircolonies in 1975. The final blow camein the late 1980s, when Morocco builtthe 1600 mile “berm”—an earthenwall 3 m high and longer than theGreat Wall of China—which is pro-tected by 150 000 soldiers and 1 mil-lion landmines. During this drawn-outwar, hundreds of Sahrawi disappearedwithout trace. Even now, AmnestyInternational says Sahrawi humanrights campaigners are routinelyarrested and detained.

With most of the men away fighting,the women and children found shelterin a barren patch of desert on the edgeof Algeria. Three decades later, they arestill here, and now number around180 000. Half the population—every-one under the age of 30 years—was

born in the camps. The average age atdeath is around 50, and child mortalityrates are extremely high.

Everything in the camps is makeshiftand they are totally dependent ondonations. There is one main hospital,which was built in 1992 with dona-tions from Spanish NGOs, and foursmall clinics in each of the refugeeencampments. The main hospital is a45 min desert drive from one of themain camps, Ausserd. The building ispermanent, with both power andwater, and houses 48 beds, but littleelse. The most basic drugs are in shortsupply. The two wings of the hospitalcater for 3000 patients a year. “All ofour tools and equipment are very old”,says Larussi Hadj, assistant director atthe hospital.

Fernández, who twice a year leads ateam of 10 doctors and six nurses towork in the camps for 3 weeks at atime, says the conditions at the hospi-tal are bad. “It’s logical given the situa-tion”, he explains. “They are doing thebest job they can.” Fernández is anemergency physician based inGranada. All of the specialists whocome with him are volunteers, andhave included a gynaecologist, a pae-diatrician, a psychiatrist, and an ear,nose, and throat specialist. He saysthat some of the most common typesof surgeries they are asked to do arefor skin cancer, orthopaedic problems,cataracts, and to treat old war wounds.He estimates they also donate around€24 000 a year in medicines to thecamps.

The Sahrawi have their own doctors,and Fernández says that an importantpart of what his team does is workingwith them. There are eleven localphysicians who all trained in Cuba.They have a lot of theoretical knowl-edge, but almost no practical training,

says Fernández. The Spaniards workalongside the local doctors in sort ofan accelerated residency programme.“They learn in front of the patient”, heexplains.

The maladies of the Sahrawi reflectthe harsh conditions in which theylive. Among the most common prob-lems are diabetes and anaemia, bothcaused by malnutrition, the conse-quence of an entire life spent living ondonated food. While internationalagencies and individual countries pro-vide enough food to live on, the qual-ity is often poor and amounts are verysmall. Pasta, rice, and lentils make upthe majority of food, with little meat,vegetables, or fruit.

Getting enough to eat is a constantbattle for the Sahrawi, as the interna-tional community on which theydepend is increasingly disinterested.“With the lack of international atten-tion to their plight, obtaining regularcontributions of food aid for theWestern Sahara is extremely difficult”,Daly Belgasmi, a director at the WorldFood Programme (WFP) said in thestatement appealing for more aid.According to statistics from the UNHigh Commission for Refugees(UNHCR), 35% of Sahrawi children

World Report

See Editorial page 1280

Exiled from their homelands during a long-running war with Morocco, the Sahrawi people havespent the past 30 years living in refugee camps. But permanent displacement has taken a heavytoll on their health. Samuel Loewenberg travelled to the Western Sahara to find out more.

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Displacement is permanent for the Sahrawi refugees

The Sahrawi refugees depend on international food aid for survival

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suffer chronic malnutrition, and for13% it is so acute that it has led tosevere growth stunting. In 2002, theWFP warned that food donations wereso short that the Sahrawi might bereceiving only 11% of their daily foodrequirements, some 231 kcal a daycompared with the 2100 kcal theyneed. Lack of water is a further chronicproblem. A family of six reported theyhad received only 1000 L a month, lessthan one third of the 3600 L that issupposed to be the UNHCR minimum.

With the Sahrawi in such a depend-ent position, even their donated provi-sions can become a political weaponagainst them. According to theSahrawi government, the Polisario,the quality of international food aidhas declined considerably in recentyears. A Sahrawi doctor told The Lancetthat malnutrition is on the rise, and alocal aid worker recalled that a recentshipment of lentils was of such poorquality that it was still tough after 6 hours of boiling. “We think thatthere is an intention to use thehumanitarian aid issue to put pressureon us”, says Polisario presidentMohamed Abdelaziz. He declined tospeculate whether that pressure wascoming from Morocco or one of itsallies, such as France. The Moroccan

government did not respond to twowritten requests for comment.

The health problems of the refugeesare not only physical. With almost nowork or recreation available to them,despondency is a major problem.Ironically, the factor that adds to therefugees’ isolation is the result of pro-grammes that send young peopleabroad. Schooling stops in the camp atthe age of 14 years, so many childrenare sent to Cuba, and to a lesser extentSpain, Libya, and Syria to study, butmust return home after finishing uni-versity. The returning Sahrawi youthsleave behind new-found freedom, edu-cation, and sometimes lovers, spouses,and children. When they return, there islittle for them to do. This, explainsMohamed-Noh Fadel, a Sahrawi psy-chologist, leads to an overwhelmingsense of depression. “They can’t usetheir knowledge; it’s frustrating and it’slike they are in a psychological war withthemselves”, he says. Often people keeptheir frustration locked inside, and theproblems become clinical, manifestingin depression and even schizophrenia,he adds.

“There is a very high level of depres-sion because of their isolation”, saysJuan Carlos Sánchez, a psychiatrist andneurologist who spent 3 weeks at the

camps last year. He says that during hisvisit he saw more than 70 cases ofschizophrenia—almost all of whichwere untreated. The same goes forepilepsy, which he claims is amongnumerous mental-health conse-quences of the trauma resulting fromdecades of war.

According to UNHCR, there are threeoptions for dealing with long-termrefugee problems: reintegrating therefugees to their homeland, setting uptheir camps as a permanent residence,or resettling them to another country.But numerous attempts to return theSahrawi to their homes have beenblocked by the Moroccans. Anotheroption—integration of the Sahrawi intoAlgeria—is hugely expensive and com-plicated. It’s also an outcome that nei-ther the Algerians nor the Polisario, theSahrawi political leadership, want, saysMarie-Helene Verney, a UNHCR spokes-person. “[Resettlement] is infinitelybetter” than a prolonged stay in refugeecamps, she explains. “We try to push forthis when we have a situation that’sgoing to last a considerable amount oftime, but it’s not always possible.”

Those behind the numerous effortsto make life bearable for the Sahrawiknow that to properly understand thesituation, it is important to considerthe politics behind their predicament.The UN first imposed a ceasefirebetween the Sahrawi and Moroccansin 1991, and since then it has passedresolutions calling for a referendum onself-determination. As UN specialenvoy to the region, former USSecretary of State James Baker tried for7 years to reach an accord to give theSahrawi their land back. But theMoroccans have continually scuttledthe process. Baker has now given up.

“There is a great deal of injusticehere”, says Stephen Paul Hagens, anAmerican teacher who has been run-ning a school in the camps for 2 years.“The Sahrawi are in limbo.” But fornow, at least, there is nothing to sug-gest a change is coming.

Samuel Loewenberg

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Each camp is served by four basic clinics, but equipment is old and all facilities are in dire need of repairs

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