Returning from the violence-ravaged province of the Sudan known as Darfur, a Philadelphia doctor who received his medical training in Israel is holding out little hope that the hundreds of thousands of refugees there will be able to return to their villages and resume a normal life anytime soon.
"The sad thing is that while I was there, things got much, much worse," stressed Patrick O'Connor, 34, who from August through April served as an emergency medical manager for the International Rescue Committee in the city of Nyala in southern Darfur. "The longer they stay, the more dependent they become."
The westernmost portion of Sudan, the largest country on the African continent, is considered by many to be the site of the foremost humanitarian disaster on the globe today. According to news reports, between 180,000 and 200,000 people have died, and as many as 2 million have fled their villages as a result of the conflict between rebel separatists and the government in Khartoum.
O'Connor, who was born in Lancaster, Pa., and has just started a three-year residency in family medicine through the Drexel University College of Medicine, credits his training at an Israeli university in the Negev for preparing him - as much as anything can - for conditions he encountered in the Sudan.
In 2003, he graduated from the Medical School for International Health at Ben-Gurion University, a joint program coordinated between BGU and Columbia University in New York that focuses on international health, cross-cultural medicine, travel and disaster medicine, infectious diseases and environmental health.
While covering the basics of human anatomy, O'Connor and his classmates also studied conversational Hebrew and learned how to serve a diverse population that included Bedouins, along with Russian and Ethiopian Jewish immigrants.
"A lot of the intricacies of the program deal with how to approach a patient," said O'Connor over coffee here in Philadelphia. "They really threw us in, at the beginning of our med school, before we even knew any medicine, into the psycho-social aspects of approaching a patient."
The second intifada had not yet erupted when he first went to Israel in 1999, but didn't his family think he could have chosen a safer location for school?
"My family already thinks I'm a little crazy," he replied.
'Could See the Results'
O'Connor decided on a career in medicine and public health while serving with the military in the Balkans.
In 1996 - first as a transportation engineer with the U.S. Army, and then as an official for the U.N. High Commissioner on Refugees - O'Connor dealt with the maddening logistics of getting humanitarian relief to Bosnia after half a decade of civil war and interethnic violence.
"When I first got there, there was no water, no electricity, and it was really not exactly luxurious accommodations," he recalled. "You did something, and you could see the results of it very, very quickly."
After earning his masters in public health from John Hopkins University in 2004, O'Connor was anxious to get to a part of the world where his skills were needed. In order to even enter Sudan, he had to obtain a second U.S. passport since the country, which doesn't recognize the Jewish state, would never have granted him a visa with Israeli stamps on his papers.
When O'Connor arrived in Nyala last summer, there were roughly 28,000 refugees in and around that city of 1 million.
When he left, there were more than 100,000, greatly increasing the risk of spreading potentially fatal, infectious diseases like malaria, meningitis and measles.
"Most of these people coming are from very rural areas, and probably had never seen a doctor before," explained O'Connor. "The more and more people you put in the camps, the tighter the conditions get, the worse they become."
'Trying to Destroy'
The current crisis began in 2003, according to news reports, when a rebel group comprised largely of black African farmers began targeting sites identified with the Arab-dominated government in the Sudanese capital of Khartoum. International observers have accused the government of launching air assaults against rebel-controlled villages and allowing bands of Arab nomads known as Janjaweed to purge the western part of the country of black Africans, killing men, raping women and stealing whatever they can find.
American officials, including former Secretary of State Colin Powell, have accused the Sudanese government of carrying out genocide, but a U.N. commission stopped short of that declaration, stating only that war crimes had taken place.
O'Connor agrees with the former sentiment.
"I really think that there's a group of people that are systematically trying to destroy another group of people," he said. "The Janjaweed is a militia that is not part of the government of Sudan. So there is deniability; the government can say, 'They don't belong to us, we don't control them.' "
He said the most frustrating part is that if the International Rescue Committee - a more than 60-year-old, nonprofit group that has worked in the Sudan since 1983 - leans too hard on the government on behalf of the refugees, authorities can just throw the organization out of the country.
"People really do have a right to adequate health care. It's a fundamental right. That's the mandate we were working off of," he said.
"My experiences in Bosnia, in Israel and now the Sudan have shown me that the right to health care is extremely complicated. Understanding politics," he affirmed, "becomes almost as important as understanding what causes measles."