April 4, 2008
EMERGENCY DESK: CHAD
Chad 2008 © Benedicte Kurzen
During the week of January 27, reports surfaced of rebel forces advancing on the Chadian capital, N’Djamena, to oust President Idriss Déby. In preparation to support local health workers in treating any wounded, Doctors Without Borders/Médecins Sans Frontières (MSF) quickly transferred its surgical team from Goré, in southern Chad, where it had been assisting residents and refugees from the Central Africa Republic, to N’Djamena.
By Saturday, February 2, intense combat had erupted in N’Djamena, as rebel and government forces clashed. Lasting for two days, the fighting in N’Djamena took a heavy toll: more than 270 deaths and nearly 1,000 war-wounded. In the Bon Samaritan Hospital in the Walia District, the MSF surgical team treated more than 120 wounded over the course of one week.
“I was heading for my mother-in-law’s home when a mortar hit the building,” said Ahmed K., the father of a 6-year-old girl who was hit by shrapnel. “When I went in, I saw three bodies. There were three wounded: my daughter and two other children. One of them had lost an arm. The nearest clinic was shut and the General Hospital was completely overloaded. In the end, we stopped a motorcyclist and while I buried the dead, he took the wounded to Walia, because we knew the hospital there was still running.”
The rest of the family took refuge in a village further to the south. It’s the fourth time that Ahmed and his family have fled N’Djamena. “This time was the worst,” he said. “It’s the first time there’s been fighting in the capital. Everyone wants to rule, but if there are no people left, who are they going to rule?”
The General Hospital found itself in the middle of the fighting. The few doctors and nurses who remained had to cope with an influx of more than 250 wounded. The MSF teams could only reach it on Monday, February 4.
“The hospital was too close to the fighting, it even had to shut for a few hours,” said Dr. Meinhard Kritzinger, an MSF anesthetist who came with a surgeon to reinforce the emergency room. “They had to deal with the most urgent cases. They were often unable to operate, just stopping the hemorrhages, applying bandages, and sending the patients home.” MSF donated medicine and surgical supplies for dealing with the most urgent needs.
Refugees flee into Cameroon
Chad 2008 © Alois Hug/MSF
According to UN High Commissioner for Refugees (UNHCR), some 30,000 people fled N’Djamena, crossing into northern Cameroon and settling in Kousseri, a small border town. A surgical team was dispatched to the area as well as other medical teams to provide assistance. MSF set up an emergency surgical facility inside Kousseri hospital to tend to people with injuries stemming from the fighting in N’Djamena. Many of whom could not reach hospitals for treatment during the worst of the fighting or who were only given first aid and developed serious infections.
Within a week of the cessation of fighting, refugees began to return to Chad. However, those remaining had little in the way of supplies to cope with their hostile living conditions. “Children and adults were found to be suffering from dehydration, diarrhea, and respiratory infections. Nights in northern Cameroon are cold at this time of year and the refugees lacked any protection,” said Dr. Véronique Urbaniale, the MSF emergency coordinator in Kousseri, just days after the refugees had fled their homes.
By February 13, MSF had vaccinated 5,600 children against measles. More than 3,600 families received relief supplies, such as blankets, plastic sheeting, jerry cans, soap, and mosquito nets. Medical teams were providing assistance in three clinics in town and in the outpatient department of Kousseri’s central hospital, performing an average of 400 consultations per day in these structures. “There were bodies everywhere, even at our doorstep”
Two weeks after the heavy fighting in N’Djamena, thousands of refugees were being forced to make a difficult choice: return to Chad or be transferred to a refugee camp 20 miles away from Kousseri. By March 4, UNHCR had transferred 10,000 people to the newly established Maltam camp in Cameroon.
Insecurity is the main reason given by refugees hesitant to go back to Chad. Some are still too frightened after the extremely violent clashes that shook the capital. “The rebels entered and broke down the city,” remembered Fatima, a widow who sought refuge in Kousseri with two of her grandchildren. “There were bodies everywhere, even at our doorstep.”
Safety is an important factor but not the only one for a Chadian refugee to consider when deciding whether or not to return home. For the poorest, there is also a question of finding the basics that will keep them going. “I don’t know yet if I will go to Maltam,” said Narcisse, a man in his 50s living in Kousseri with the five members of his family. Their food reserves have run out and they sleep in the open. “I am a carpenter and all economic activities have been stopped. If I go back and everything is still stopped, what will I do? In Maltam, at least, I will get food. I could stay there and see what happens in N’Djamena.”
Even if many refugees want to reach Maltam, most only see the camp as part of a transition phase. Most of the refugees who were interviewed said they want to return to N’Djamena in the coming months, after the dust settles. “I can’t go back now. If I go, I’ll remember what happened. I’ll stay until I feel rested. Once the dust has settled in N’Djamena, I’ll go back,” said Fatima.
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)