According to UN estimates, Sudan hosts the highest number of internally displaced persons (IDPs) in the world. In 1998, there were more than 6.8 million IDPs, almost a quarter of  the total population. Three groups of civilian population affected by the war can be distinguished:

• Refugees in neighbouring countries: at the beginning of 2000, a total of nearly 500,000 Sudanese refugees had been registered in neighbouring countries with often high HIV/AIDS prevalence rates.
• Internally displaced persons (IDPs) in war zones: 1994 estimates of IDPs in the southern region enumerated 1.5 million displaced at 112 sites. Renewed fighting in 1998, especially in the east, has increased these numbers.
• Other IDPs: besides some two million IDPs in Khartoum, 72 so-called ‘peace villages' in South Kordofan State host 173,000 displaced Nuba people. An additional 60,000 became displaced in 1998-1999. The urgency has motivated several UN agencies to launch a multi-sectoral programme for the Nuba Mountains, targeting a population of 454,000 living in both areas controlled by rebels and by government. A recent UN mission reported prevalence of HIV/STIs and a low level of HIV awareness among these populations.

Khartoum State is the main destination of the displaced, who constitute 40% of its population of five million. Invariably, displacement disrupts family ties and living conditions, exposes people to hardships and creates large-scale rural-to-urban migration. In the new urban environment, the displaced mostly lack training, basic education, skills and assets to compete for urban jobs. Therefore, most of them are forced to pursue trivial jobs and many women turn to sex work. There is also an increasing number of orphaned and street children, who are exposed to drug abuse, child prostitution and child labour. The lack of awareness of reproductive health (RH) problems, including HIV/STIs, makes them highly vulnerable.

Reproductive health and HIV/AIDS - Civilian population is deliberately targeted by the warring parties to deny opponents supplies and civilian support. Women and children are particularly vulnerable to personal violence, including rape, abduction, forced enrolment in armed forces and bondage labour. The testimonies of abducted women cite rape and forced marriages amounting to sexual slavery, as common practices, resulting in high levels of unwanted pregnancies and abortion. There are an estimated 80.000 street children in Khartoum alone. 10,000 out of a total of 52,000 children assisted by the Catholic Church in Khartoum are HIV-positive.

HIV/AIDS has been reported in all States. The Sudan National AIDS Control Programme (SNAP) estimates the HIV prevalence rate at around 1.0% of the total population of 30 million, although it is acknowledged that the actual prevalence rate is much higher. Recent data from sentinel surveillance conducted among antenatal women show infection rates of 0.5%, 2.7% and 8.0% at different sites in the country, with Khartoum and war zones topping the list due to the high population mobility. STI prevalence rates are high and escalating.

Responses to reproductive health needs and HIV/AIDS - The national response to the health needs of the displaced has been minimal, and international organisations primarily focus on curative measures. Reproductive health and human rights of  refugees and IDPs are still a second priority, although some NGOs have paid particular attention to HIV/STI prevention.

SNAP has been ineffective in addressing HIV/AIDS among the IDPs, mainly due to a lack of political support and a severe lack of human and financial resources; this is exacerbated by the international sanctions restricting external assistance to emergency support. Religious and cultural conservatism prevents openness about HIV/AIDS, while illiteracy, language and cultural barriers hinder effective information and education on HIV/AIDS.

In 1989, a consortium of UN agencies, NGOs and donors launched Operation Lifeline Sudan (OLS) to bring assistance to the population affected by war. OLS operates in two sectors: a southern sector co-ordinated by UNICEF from Kenya provides assistance to rebel-controlled areas. A northern sector is co-ordinated from Khartoum by UNDP in co-operation with the Sudanese government. As OLS prioritises food security and other relief assistance, it does little about HIV/STIs and other reproductive health problems.

Successful programmes - Save the Children Fund (SCF-UK) implemented an HIV/STI project for IDPs in two of the displaced camps in Khartoum in collaboration with SNAP. This project included:

• community activities, drama and songs on HIV/STIs for 9000 IDPs, addressing issues like the role of religion and communities in AIDS control, as well as harmful traditional practices (e.g. female genital mutilation, skin piercing, widow inheritance and tribal markings);
• production of educational material on HIV/STIs in English, Arabic and --for the first time-- in Dinka, the language of the majority of the IDPs in Khartoum State;
• training workshops for NGO and other health workers, community health promoters, camp co-ordinators and community leaders on health education, counselling and HIV/STI-prevention and management.

This and other successful programmes show that it is possible to provide quality programmes for refugees and IDPs. Examples from neighbouring countries show the major role political, religious and traditional leaders can play in strengthening national responses. But most importantly, it is the Sudanese government that should assume its responsibility of protecting the reproductive and human rights of its vulnerable populations in particular, by strengthening national programmes and allowing international organisations to provide reproductive health and other services. The final solution, however, lies in a peaceful settlement of the conflict in Sudan.