Helping desperate refugees
In 2002-2003, Chad was the destination
for waves of refugees
fleeing conflict in neighboring
Central African Republic. During
2003-4, Chad was again inundated
with refugees, this time
people fleeing atrocities in the
Darfur region of western Sudan.
The exhausted, malnourished and often ill
people who have been arriving in Chad
have little hope of receiving the care that
they need. The country has a chronic
shortage of qualified staff and even many
of its residents do not obtain basic health
care. Treatment for tuberculosis and
malaria is hard to come by, and HIV/AIDS
care is practically non-existent. Epidemics
including cholera, measles and meningitis
often sweep through parts of the country,
and food can be scarce depending on the
success of harvests. Moreover, the country's
medical system which includes user fees,
excludes many in dire need of care for lack
of ability to pay.
Malaria is the most lethal disease in Chad.
In January 2004, MSF started a malaria
project in Bongor district, which aims to
reduce levels of illness and death in the
area. MSF is also working to improve treatment
by introducing a new protocol that
includes artemisinin-based combination
therapy (ACT). The project will include a
prevention component targeting pregnant
women and children under five. MSF also
runs a surgical training program at Bongor
Hospital.
In August 2004, more than 1,500 people
were infected with cholera around the
town of N'Djamena. When nearby health
facilities became overwhelmed by the outbreak,
MSF, in collaboration with the ministry
of health, built a cholera-treatment
center able to accommodate 100 patients.
MSF also flew in cholera kits containing
supplies and needed medicines. An MSF
medical coordinator, nurse and water-andsanitation
specialist were also brought in
to oversee patient care and the construction
of the treatment center.
MSF has worked in Chad since 1981.
Fleeing from Darfur
| " I arrived here about two months and ten days ago. I came here by
foot. I came here without anything. I only have my clothes that I am
wearing. I asked for food from the Chad people and they gave me
something but it is not enough. Here it is very difficult. There is not
enough food and we are cold during the night."
– Female refugee, 45, in Birak, Chad |
Since July 2003, refugees from the Darfur region of Sudan have been setting up makeshift
shelters along a 600-kilometer stretch of border between Chad and Sudan. MSF teams
have followed them there, starting projects to help the exhausted, hungry civilians who
make it across the border. Thousands more remain trapped by violence in Darfur.
MSF set up health posts in the border towns of Tine and Birak in September 2003 to provide
medical care and food. More than 10,000 medical consultations were completed by
MSF staff in these two towns between September and December 2003. Although the first
refugees to arrive were taken in by the local communities, their numbers soon ballooned,
exhausting the region's resources. Since December 2003, thousands of refugees have
been arriving each month in eastern Chad. By the end of August 2004, an estimated
180,000 refugees had arrived. The conditions they face upon arrival are harsh. Most have
walked for days, and when they arrive, there is no shelter or food for them. The region's
extreme weather conditions only worsen the problems. Many of the refugees are in a
deplorable state, with young children the most vulnerable. A large number of these
families have already lost relatives during attacks on their villages.
In the first part of 2004, MSF teams launched a meningitis-vaccination campaign and
immunized almost 83,000 children in the Iriba area, a coverage rate of 82 percent. An
immunization campaign against measles was also conducted. An MSF team runs the hospital
in the town of Adre where 30 to 60 surgical interventions are performed each
month. The number of referrals to the hospital has increased since an ambulance service
was started in August 2004. Admissions now average between 130 and 150 each month.
A nutritional unit has been opened to treat children suffering from severe malnutrition.
In August, in Breidjing camp, where 100 to 300 people continued to arrive each day, an
MSF team provided food and medical care to an estimated 42,000 refugees. Most of the
patients were suffering from diarrhea, malaria, malnutrition or respiratory infections. In
the northern Toulum and Iridimi refugee camps near Iriba, and in refugee areas near the
towns of Tine and Birak, there were few malaria cases at first, although they began to
appear with the onset of the rainy season. This region of Chad has also been hit by a hepatitis
E epidemic which is plaguing Darfur, Sudan as well. By mid-August, Goz Amer camp
reported 875 hepatitis E patients and 24 deaths, including 8 pregnant women, who are
extremely vulnerable to the illness.
Additional MSF teams have spread out along the border area to provide prenatal services,
more nutritional activities and desperately needed water. As refugees are moved by UN
agencies away from border towns to safer locations deeper within Chad, MSF moves its
activities to areas where new refugees are arriving.
Although a large amount of aid has now entered the country, MSF remains concerned
about the health of the refugees. While MSF and other organizations have been able to
provide food aid, water and health care to many, the needs are overwhelming and will
continue for many months as long as the refugees remain too afraid to return to their
own villages to begin farming again.
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