Chad's rainy season, with ongoing violence and displacement, brings the health situation closer to emergency levels

Attacks from rebels on the civilians living in villages and in camps will most probably diminish during the rainy season, as it is not only MSF that has problems in reaching the population: also the rebels can not cross the wadis once they are filled with water.

Interview with Dr. Ingo Hartlapp

You have been working with MSF in southeastern Chad for the last six months. Can you tell us about your experience?

"I have been working as a medical doctor in three internally displaced people’s camps in Gassire, Adé and Kerfi. These camps were set up when villages were destroyed, people were killed and thousands of people had to flee their homes and escape from the attacks.

"In Gassire an estimated 12,000 displaced people are living in a very harsh environment with scarce farmland and with little access to natural water.

"Kerfi consists of 3,500 displaced who fled their villages, which are not very far away, and of local people who live in small communities. Here, MSF assists both locals and displaced by running a clinic in collaboration with the Ministry of Health.

"In the Adé camp, 9,000 people are living close to the small nomad city of Adé, on the border with Darfur. Adé is located in an insecure area.

"The problem is, this lack of security has an effect on the people in Adé and on our teams. In January 2007 an attempted ambush forced us to stop our medical support for two months. In June, two cars of the International Committee of the Red Cross (ICRC) were targets of a violent ambush on the road to Adé and subsequently we stopped our activities for another two weeks.

"If MSF is not present in Ade then the people in the camp do not get any medical support at all. MSF and the ICRC are the only humanitarian actors working in Adé and without us the people are completely cut off from any access to healthcare, water and food."

How is the situation after an outbreak of bloody diarrhoea in Kerfi?

"Before the rainy season started we were able to improve the medical support, access to clean water and sanitation in the Adé and Gassire camps. In both camps we were able to build sufficient latrines, at least until the beginning of the rainy season, and guarantee access to clean drinking water.

"However, in Kerfi, clean water has remained a problem. Displaced people live packed together, in very crowded conditions and in very simple straw huts, often their only belongings are the clothes they wear and maybe some cooking pots. In June an outbreak of bloody diarrhoea reached emergency level and alarmed us. With even more urgency we had wells drilled and, at this moment, the water situation is acceptable, although people have to wait in line for a long time and sometimes prefer to get dirty water from the wadi ((dry riverbeds partly filled with water). Latrines, however, are still not constructed.

"In all camps we have a very high number of malnourished children and we currently have over 600 children in our nutritional program. At the same time, the mortality rate of children under 5 has reached alarming levels, especially in Kerfi.

"The high child mortality is closely linked to the fact that many families only have limited access to clean water. Children who are already weak from malnutrition are extremely vulnerable to severe diarrhoea. A young child with a weight of only five to seven kilos and with a poor immune system, can die within a day of dehydration caused by diarrhoea."

The rainy season has started. What does this mean for the displaced people?

"We are very concerned about the effects of the rainy season because the wadis can fill with rainwater very fast and make it impossible for us to reach the remote camps of Adé and Kerfi.

"It will be difficult to guarantee good quality medical care, sufficient food and acceptable sanitary conditions during the rainy season, because access will be increasingly difficult. So, during the last few weeks, we have been preparing ourselves in order to be present in the camps continuously even if this means that we ourselves are cut off from the outside world In an emergency situation we can only save children from dying if we are on location on a daily basis.

"Rainwater can wash excrements into the groundwater if not enough latrines are available or people do not use the ones in the camps. In crowded living conditions this can easily lead to the contamination of already scarce clean water reservoirs. For this reason one of our many activities during the last few weeks has been to train community health workers, who are based in the camps, to raise awareness about using clean water and latrines at all times to avoid contamination of water resources as good as possible."

Are there any other risks and problems occurring caused by the rainfalls?

"As well as the worsening cases of diarrhoea we are expecting an increase in malaria cases. Two percent of our patients are currently affected by malaria but in the rainy season we fear that there will be an increase to approximately 20 or 25 percent. The stagnant water creates the perfect breeding place for mosquitos and the makeshift huts in the camps are mainly made out of straw and sometimes plastic sheeting, so it is impossible to keep the mosquitos out.

"The only protection is a mosquito net and we have been distributing these, targeting pregnant women and families with malnourished children, especially in Kerfi and Adé, where there are no other humanitarian organisations apart from MSF.

"In addition we have seen an increase of Hepatitis E. This disease, that only in one out of twenty cases shows she symptoms of yellow skin or yellow eyes, is also transmitted by contaminated water. It can spread like an epidemic in an environment where people have to live in crowded and unhygienic conditions. Hepatitis E can be fatal for pregnant women. With a high number of pregnant women, a big part of the people living in the camps are at risk.

"The rainy season has also a positive effect: Attacks from rebels on the civilians living in villages and in camps will most probably diminish during the rainy season, as it is not only MSF that has problems in reaching the population: also the rebels cannot cross the wadis once they are filled with water."