Refugees in Mauritania: Teetering on the Brink

More than 59,000 people are currently struggling to cope in Mauritania's Mbera refugee camp, where temperatures can reach up to 122 degrees Fahrenheit and food and water are scarce. Frederic Manantsoa Lai, Doctors Without Borders/Médecins Sans Frontières (MSF) head of mission in Mbera, describes the situation.

Which are the main activities of MSF in the Mbera camp?

The refugees’ access to primary health care is our core concern: we run the health center in Bassikounou town and three health posts in Fassala and Mbera town, while through public communication activities we try to increase awareness of the services available in the health center and health posts for the refugees and the local population.

In our project in Mbera camp we have had more than 101,037 new curative consultations in 2013, more than double compared to 2012, thanks to significant improvements to the structures in the camp. We have more and more people coming to our facilities, a sign of increased trust towards our work and the organization.

Apart from one health center and three health posts in the camp, we also have community workers called "home visitors" who carry out door-to-door activities on a daily basis. Moreover, we have opened an operating room in Bassikounou for lifesaving surgeries (Caesarean sections, traumas, et cetera). As of today, MSF carries out approximately 8,500 consultations per month, while this number can reach 12,000 during the rainy season.

What are the main needs of the refugees?

The numbers I described before reveal that needs are enormous and permanent. The camp is located in a geographical area with very low economic activity and extremely dry soil. The total population of the Bassikounou district is about 42,000 people, but at the moment the number of refugees (59,101 people) is greater than that of the local population.

Poor harvests in previous years and the food and nutritional crises that troubled the Sahel region make the situation very complex. Living conditions for the refugees in the camp are hard—they are entirely dependent on humanitarian aid to survive.

Water is crucial for the survival of the refugees. The supply is sufficient, and other humanitarian actors are in charge of this. But what concerns us is the fact that diarrhea is the second cause of consultation in our health structures, and this is due in part to poor hygiene conditions. We are investing in increasing knowledge on this issue so that we can avoid possible epidemics, especially with the rainy season approaching.

The situation of nutrition is better but still febrile in the camp. Primary health care has improved greatly, but specific health problems or illnesses require special attention. This is particularly true of diarrheal diseases and acute respiratory infections, which are exacerbated by the environmental conditions (hot and dry climate, frequent sandstorms, et cetera).

What are the main challenges for the future?

Although we have passed the acute crisis phase, the situation remains fragile and we could see the situation returning to a humanitarian emergency if we do not maintain high levels of assistance. Humanitarian needs are no less significant than in other places—like in South Sudan, for instance—with regards to access to health, water and sanitation, food, and shelter. That said, it worries us that refugees may fall into oblivion at the expense of other major emergencies around the world. We must not allow this to happen. Although for instance the nutrition situation improved gradually, it requires continuous and ongoing efforts to further reduce levels of severe malnutrition across the camp.

Currently we have around 100 admissions for severe acute malnutrition per month compared to 300 admissions last year. It is very difficult to imagine the return of the refugees to Mali. In fact, the path towards peace seems long and hard—the restoration of stability is a catalyst for their return home.

What does a story like the one with the quadruplets convey for the refugees living in the camp in Mbera camp?

After a 37-week pregnancy the quadruplets were delivered in our operating room. Three boys and a girl, with a birth weight of only 1.5 kilograms (about 3.5 pounds) each! So we were quite concerned about them. But today, they are very healthy and are growing properly. It is one more piece of proof that wonderful things can happen in even the most extreme conditions.

These new lives are a sign of hope for the refugees. At the same time, this story highlights how vulnerable these people are. Imagine if medical care was not available—had she not reached our facilities, this incredibly courageous mother might have lost her four babies, or even her own life, leaving behind six other children and a husband with no income.

In 2013, MSF conducted 147,681 new curative consultations, including 101,037 in the Mbera refugee camp and 46,644 outside the camp (in public structures of the Ministry of Health). As part of the response to severe acute malnutrition, MSF treated 3,867 cases including 3,575 in the Mbera camp and 292 in Fassala. Moreover, 45,000 mosquito nets were distributed, which helped decrease cases of malaria from 6,028 in 2012 to 2,285 in 2013. MSF has worked in Mauritania since 1994.