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The Microbes of Mayhem

Author: Laurie Garrett, Senior Fellow for Global Health
May 10, 2004
Los Angeles Times


As the horrors of Sudan's ethnic conflict mount, opportunities for pathogenic microbes -- germs that could threaten people all over the world -- rise in tandem. War and disease are often a matched set in Africa, with terrifying results: If the fighting doesn't kill you, disease very well could. And without outside help to stop the cycle, the devastating results will only spread.

In the Darfur region of western Sudan, an estimated 1 million ethnic-African Sudanese are refugees, the targets of government troops and horseback janjaweed militia -- ethnic Arabs -- who are torching and raping their way across hundreds of miles of poor farmland.

It is almost impossible to overstate how remote this region is. Permission to legally visit the area is rarely granted by the Sudanese government. So scientists know very little about the area's plants and animals, much less its microbes. But what they can surmise is frightening.

Darfur is just 500 miles north of N'zara, where scientists believe the often lethal West Nile virus (which has now spread to nearly every state in the United States) resides. In 1976, N'zara also was the site of a major outbreak of the deadly Ebola virus. And across Sudan's southern border, Uganda is believed to be ground zero for the global AIDS epidemic. The circumstances of West Nile's spread remain a mystery, but the Ebola outbreak and the AIDS epidemic owe a great deal to the treacherous mixing of war, refugees and microbes.

In 1976, an international team of scientists was in Yambuku, Zaire, doing battle with the world's first known epidemic of Ebola, a virus that causes uncontrollable bleeding. Ebola was rare, to say the least, so the scientists were stunned to hear rumors of another outbreak in N'zara.

American disease detective Dr. Joe McCormick drove a Land Rover across more than 400 miles of unmarked terrain to confirm the outbreak. To this day, however, scientists have no idea exactly how Ebola emerged in N'zara, or whether the virus normally inhabits the area. But they do know that ethnic warfare was underway in the region.

Most likely, infected animals -- bats, perhaps -- had taken up residence inside buildings in the area, probably as a result of human encroachment into the animals' normal habitat and changes in local weather patterns. It is believed that starving local residents hunted and ate infected animals, and once humans were infected, Ebola spread swiftly, thanks to the dire conditions in the region's war-torn hospitals and clinics, where needles were reused and sterile techniques were virtually unheard of.

As for HIV, it also can be traced to the 1970s and another ethnic-cleansing campaign in the same region of Africa. Ugandan strongman Idi Amin set his soldiers against tribes in the Rakai district, with rape as a primary weapon. When the conflict spilled over into Tanzania, so did the rape, and when Tanzania's army repulsed Amin's forces, it carried out its own campaign of rape in turn. As it happened, however, another form of revenge spread along with the rape: HIV.

The genetic history of HIV shows that the virus made its first leap to our species from a primate -- probably a chimpanzee -- some seven decades ago. But in traditional village settings across Africa, the virus did not readily spread, and less than 1% of any society is thought to have been infected before the mid-1970s. It took a catastrophic event, like Amin's brutal campaign, to amplify the rare virus into a pandemic.

Today, as then, a chief horror of the Darfur campaign is the militias' raping of women and girls. They brand their victims' foreheads so that all will know that the women and their potential offspring are tainted. Nobody knows how prevalent HIV is in the Darfur region (Khartoum has never allowed surveys of the area). In the Muslim north, surveys of pregnant women four years ago revealed that 3% of them were HIV-positive; a N'zara-area survey found infection rates twice as high. It isn't unreasonable to suspect that the current Darfur "ethnic cleansing" campaign is spreading the disease, not only among the people of Darfur and their janjaweed rapists but also among refugees in camps in neighboring Chad. It is equally reasonable to posit that some other previously obscure sexually transmitted disease could be amplified to epidemic proportions via the bodies of the women of Darfur.

And there is yet another chapter in the region's disease history that has a bearing on what's happening in Darfur. Ten years ago, the world stood by as hundreds of thousands were murdered in Rwanda and thousands more died in the refugee camps. Initially, overwhelmed local medical workers believed that the disease causing many of the deaths was cholera. But it wasn't chiefly cholera that ravaged the refugee camps; it was shigella, bacteria that cause dysentery. Amid the ongoing violence and the chaos of the camps, black market antibiotics were taken indiscriminately. Instead of curing the bacteria, the uncontrolled use of antibiotics created a brand new fully drug-resistant strain that still plagues Africa.

Surely it is in our collective interest, in light of this sorry history, to pay heed to those who implore us to save Darfur, to stop the rape, to resettle the refugees, to end the chaos that breeds disease. Even if we cannot find Sudan on a map or have no room left in our hearts to bear witness to another war, we surely understand that deadly microbes are our problem, as well as theirs.

Laurie Garrett, a former Pulitzer Prize-winning reporter for Newsday, is now senior fellow for global health at the Council on Foreign Relations.

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