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MSF in Chad, 2004
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>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.
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.