Over the last years, eastern Chad has been the scene of a broad humanitarian crisis affecting the entire population of the region, including residents, internally displaced persons (IDPs), and refugees from neighboring Darfur. Home-grown tensions, exacerbated by cross-border raids by Sudanese militia, have resulted in widespread, inter-communal violence and massive population displacement.
On top of this, the region is affected by the destabilizing presence of armed groups from either side of the Chad-Sudan border and by ongoing fighting between government and rebel forces.
Providing emergency medical aid
In mid-June, a fresh flare-up of armed conflict between government and rebel forces affected several villages and towns along Chad's eastern border region. MSF teams in these areas responded by providing emergency medical aid to the wounded:
In mid-June, the MSF hospital in Dogdoré treated 15 wounded following the eruption of fighting nearby. Two people had to be air-evacuated by MSF to Abéché, the regional capital, including a patient with a bullet wound and a man with a fracture caused by a violent beating.
On June 19, a group of armed men attacked and robbed the MSF team in Dogdoré. Subsequently, the entire team was evacuated to Abéché, so now MSF local staff are maintaining the medical relief project in the area.
On June 14, following shelling and heavy fighting in Goz Beïda, the MSF team in the town treated 27 wounded in the local hospital, many with gunshot wounds. Two of these patients died; five of the injured were civilians. Nearby Gassire camp, where over 15,000 internally displaced Chadians live, was not directly affected by the fighting.
Between 16 and 18 June, MSF's medico-surgical team in Adré hospital treated 35 wounded combatants. Some of the injuries were from government-rebel fighting, while other injuries may have been caused during local conflict regarding cattle theft.
As a result of the deteriorating security conditions, the MSF team has evacuated from Adré to the regional capital, Abéché.
Prepared for future violence in the capital, N'Djamena
MSF teams on the western border of Chad are prepared to intervene quickly should fighting erupt once again in the country's capital, N'Djamena.
In February, MSF surgical teams treated more than 120 wounded in Bon Samaritain hospital following intense fighting in the streets of N'Djamena. Teams in neighboring Cameroon also provided medical care to thousands of N'Djamena residents who fled over the border to seek refuge there temporarily.
In preparation for any future outbreak of violence, MSF has installed a surgical team inside Bon Samaritain, where MSF medical and surgical kits are pre-positioned. Medical supplies have also been pre-positioned in N'Djamena's biggest hospital, Hôpital Général de Référence.
In its Bongor project, MSF has loaded a truck with medical items and relief supplies, which is ready to depart immediately to any location where these aid items are needed. In addition, an MSF surgical team is on stand-by in Europe, ready to depart for Chad in case of any future outbreak of violence.
MSF has also positioned supplies across the border in Cameroon. In Kousseri city, which is just 15 kilometers west of N'Djamena, MSF has stored logistical items and water and sanitation equipment in case people flee following an outbreak of violence.
MSF assists the Chadian population displaced by violence
Over the past two years, violence has lead to massive population displacement in eastern Chad with over 180,000 Chadian displaced living in camps and IDP sites.
Despite difficult security conditions and limited access to areas during the rainy season, MSF currently provides primary and secondary health care, drinking water, food, and relief items to those affected by conflict and lack of access to healthcare in and around Goz Beïda, Adé, Kerfi, Arkoum, Alasha, Goundiang, Am Timam, and Dogdoré.
In the regional hospital of Adré, in Guereda, Birak, Djiré and Wilikouré, MSF provides health care to the resident population in particular, but also to refugees. The health services provided range from surgery to prenatal care and vaccination campaigns. In addition, MSF teams also carry out obstetric fistula repair surgery for women in the regional hospital of Abéché.
MSF provides assistance to Darfuri refugees
Since 2003, more than 240,000 refugees from Darfur, Sudan, have been living in camps in eastern Chad, entirely dependent on international aid.
MSF provides medical care, including pediatric and maternal care, as well as psychosocial support, to more than 100,000 people living in four refugee camps and to the surrounding Chadian population.
In Adré, an MSF surgical team offers elective and emergency surgery to refugees from nearby camps, to the local population and to displaced Chadians.
Supporting refugees from Central African Republic
Tens of thousands of villagers have fled neighboring Central African Republic (CAR) following increasing violence since June 2005. About 50,000 of them have sought refuge in southern Chad.
In Goré district hospital, MSF provides secondary medical care and surgery to the refugees living in nearby camps and local residents in southern Chad. MSF teams also support three health centers located near the border with CAR.
Treating malaria with innovative strategies
MSF has been treating malaria in the southern district of Bongor?one of the most affected by the disease?since 2003. In order to overcome barriers to treatment, including the lack of healthcare workers, high resistance to available drugs, and the difficulties of reaching people in remote areas, MSF has both decentralized care, bringing it closer to patients, and has also introduced artemisinin combination therapy (ACT), currently the most effective treatment for malaria, to which there is no reported resistance.