October 20, 2015

With international attention focused on the displacement crisis in the Lake Chad area of western Chad, where tens of thousands of people continue to seek refuge from Boko Haram violence, another chronic emergency continues. Chad is in the grip of a malnutrition crisis—not just in the Lake region and not for the first time. There are estimates that some 3.4 million people lack reliable access to food, with 495,000 children across the country at risk of acute malnutrition.

For the fourth time in five years, medical teams from Doctors Without Borders/Médecins Sans Frontières (MSF) are responding to the nutrition crisis in Bokoro, in the Hadjer-Lamis region of central Chad. An MSF emergency team has treated more than 2,300 severely malnourished children in the area since July.

Read More: A Growing Humanitarian Crisis in the Lake Chad Region

MSF launched its response in early June after discovering that alarming numbers of children in Bokoro were severely malnourished. An MSF team found that 5.5 percent of children under the age of five were suffering from severe acute malnutrition—more than twice the emergency threshold of 2 percent. This was at the very start of Chad’s annual “hunger gap”—a five-month period during which food supplies from the previous harvest run out—which usually lasts from June until end October.

“Providing feeding programs and medical assistance to acutely malnourished children is essential, but it is simply not enough to stop hundreds of thousands of children across Chad [from] repeatedly descending into emergency levels of malnutrition,” says Alberto Jodra, MSF head of mission in Chad. “Far more needs to be done to address malnutrition’s multiple structural causes and to ease the suffering of communities like Bokoro, [which are] plunging from one hunger crisis to the next.”

MSF teams have set up outpatient therapeutic feeding programs in 10 Ministry of Health clinics across Bokoro District. Since July, MSF teams have treated 2,361 severely malnourished children during weekly medical consultations in health centers, and give their parents supplies of special therapeutic food in order to continue their treatment at home. Meanwhile, malnourished children with medical complications are transferred to an inpatient ward set up by MSF in the Ministry of Health hospital in Bokoro town, where 222 critically ill children have so far received lifesaving treatment.

"Although encouraging steps have been taken at national levels to address recurring malnutrition, the fact that we have launched an emergency response in Bokoro for the fourth time in five years shows that critical gaps exist between national policies and how they are put into practice," says Jodra.

Causes of Malnutrition in Chad

Located in the southernmost part of Chad’s arid Sahel region, Bokoro’s harsh climate means that harvests are small and that there is little pasture where animals can graze. Food is scarce as a result, and children are at high risk of developing malnutrition. However, the complex causes of malnutrition in Chad go beyond climate and harvest-related factors. Communities still have difficulties accessing enough nutritious food to eat, even in other areas where the climate is gentler and food is more widely available. In Am Timan, a more fertile area in Chad’s southeastern Salamat region, MSF has already treated more than 2,000 children for severe acute malnutrition this year, with half of these patients treated from June to September.

Poverty and unemployment compound problems of food scarcity, forcing many families to limit their food intake or go into debt in order to eat. Too often they become trapped in a vicious cycle where their debts outstrip what they can hope to earn from next year’s harvest. This year, insecurity and violence along Chad’s borders have also disrupted trade, which has negatively affected the already fragile local economy and the availability of food.

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Poor infant-feeding practices, bad sanitation, low levels of education, and limited access to clean water also play a role in increasing the risk of malnutrition. On top of this, the poorly functioning health system, with its dire lack of financial resources, qualified staff, and available services to prevent and treat malnutrition, also puts food-insecure communities in further danger of recurring nutrition emergencies.

Children under five are the most vulnerable to malnutrition, which weakens their immune systems, making them more susceptible to disease—a dangerous situation in countries such as Chad, where outbreaks of disease are common and vaccination coverage is low. Overall in Bokoro, 29 percent of the severely malnourished children that MSF treated between July and September also had malaria, 30 percent had watery diarrhea, and 15 percent had respiratory tract infections. In order to combat this trend, MSF teams have vaccinated 1,114 children against measles as part of its feeding program.

After the Emergency

By November, the hunger gap should come to an end, as people in Bokoro harvest their fields once again. But even after the emergency phase of this response, the underlying problems that lead to food insecurity and malnutrition will persist. Once the malnutrition peak is over, MSF will remain in the area to help address gaps in the health care system, one key cause of the recurring nutrition crises. MSF teams will continue to support the Ministry of Health’s district health centers and to run malnutrition prevention activities. However, increased national and international efforts will also be vital if Chad’s recurring malnutrition crises are to end for good.

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MSF has been working in Chad since 1981, and currently runs regular medical programs in Abéché, Am Timan, Massakory, and Moissala. In March 2015, MSF launched an emergency response for people displaced by Boko Haram violence in the Lake Chad region. In the capital, N'djamena, MSF also supported Ministry of Health hospitals following suicide bomb attacks that took place on June 15 and July 11. Since April this year, MSF has been training Ministry of Health staff on the management of mass casualties in order to increase their capacity to respond to emergency situations.

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