Chad: Caring for refugees and displaced amid deteriorating security

During the past year, Chad has seen bouts of instability with the government facing several coup-attempts by armed insurgents, culminating in a large scale rebel attack on the capital, N'Djamena, on April 13 2006 which resulted in hundreds of casualties, both civilian and military.

In addition, cross-border attacks by armed fighters have targeted the population in the border region with Sudan. While challenged with the deteriorating security situation, MSF continues to provide medical, nutritional and psychosocial assistance to tens of thousands of Sudanese refugees from Darfur in the eastern part of the country.

The teams also bring medical and surgical care to victims of violence and displaced people in the increasingly insecure border region. In southern Chad, refugees from Central African Republic are taken care of. Health support is in part given through MSF primary health care and secondary health care structures.

Medical care for wounded and displaced in the eastern border region

Since December 2005, the region to the east of Chad on the border with Sudan has been the scene of confrontations between the government army and Chadian rebels. In addition to this violent conflict, armed men have conducted incursions.

Currently, MSF teams are witnessing an increase in attacks and looting of villages close to the border. Many people have been wounded and thousands have been forced onto the roads. Some have recently had to flee a second time and are living, once more, in a precarious situation as the violence extends its reach in the region.

Several waves of displaced persons have gathered in the towns in the interior of the country, such as Koloy and Dogdoré, where MSF is providing medical assistance, drinking water and survival supplies since December. Other teams are aiding the displaced persons in Borota, Gurgur, and, more recently, in Kerfi. A mobile medical team also operated in the most south-eastern corner of Chad between June and July 2006.

MSF is providing health care in Adré hospital where a surgical team is also offering elective and emergency surgery to residents and refugees from nearby camps and to wounded in case of fighting. Another team is providing health care, including surgery, in the 50-bed-hospital of Iriba, 200 kms to the north. This team is also treating refugees from nearby camps.

MSF has improved surgical facilities and keeps medical material ready in the hospital of the provincial capital of Abéché. The aim is to have additional emergency capacity like dressings and kits for war wounded available should a flare-up of violence result into more people getting violated.

Assistance to refugees from Darfur continues

The violence has not yet directly affected the numerous refugee camps housing some 200,000 men, women and children who fled fighting in Sudan's Darfur region since 2003. However, people worry that they will be subject to attack or forced to return to Sudan.

MSF provides medical care, including paediatric and maternal care as well as psychosocial support, to a total of about 80,000 people living in Iridimi, Touloum, Farchana and Breidjing refugee camps and to the surrounding Chadian population. The teams also treat consequences of sexual violence, address malnutrition, provide health education and control communicable diseases.

Supporting new arrivals from Central African Republic

Since June 2005, increasing violence in neighbouring Central African Republic prompted some about 40,000 villagers to flee into southern Chad. Attacks in the northern part of Central African Republic, whereby complete villages have been burnt and reportedly hundreds of people have been killed, have resulted in massive displacement and the region is plagued by extreme poverty and minimal presence of governmental or international assistance. MSF teams assist refugees and displaced Central Africans on both sides of the border.

In Goré, southern Chad, MSF supports the 50-bed-hospital and two basic health posts in the Amboko extension and Gondje. MSF cares also for severely malnourished children. A drinking water system as well as sanitation facilities have been installed in the Gondje and Amboko extension camps.

Responding to malaria, measles, meningitis

In Bongor district, bordering Cameroon, MSF is running a malaria project. During the endemic season in 2006, almost 100,000 people were tested and treated with a fast-acting artemisinin-based combination therapy (ACT). In Bongor's district hospital, MSF provides surgical training for local doctors and anaesthetist training for local nurses.

The team here can be reallocated should additional surgical capacity be needed in the capital N'Djamena or elsewhere in Chad as was the case on April 13th 2006 when 49 seriously war wounded were operated on and cared for in the MSF surgical antenna set up next to the national reference hospital in N'Djamena.

Throughout the year, MSF is engaged in epidemiological surveillance and regularly responds to emergencies such as measles, meningitis and cholera epidemics throughout the country. In May 2006, MSF vaccinated over 50,000 people against meningitis.

MSF has been working in Chad since 1981 and currently has 86 international and more than 700 national staff in the country.