For the more than 200,000 refugees from Darfur, Sudan, who live in refugee camps in eastern Chad, life remains difficult, but the good news is that the health situation for refugees has stabilised in Iriba District, the home to several refugee camps, where MSF works. "After more than five years of working with Darfuri refugees in Chad, I am happy to report that there has been an improvement in the refugees' health over the years, to the point where the area where MSF works is no longer in a health emergency," said Christine Jamet, MSF Head of Mission in Chad. "The mortality rate has been less than one person per 10,000/day for more than a year, which indicates a return to a rate that is standard for developing countries." A survey from UNICEF and WHO earlier this year also shows that the health situation in Iriba District is no longer an emergency. Severe acute malnutrition in the area has also stabilised. Severe acute malnutrition in Iridimi camp is 0.5 percent and in Touloum camp it is 0.6 percent, which is very low. The threshold for an emergency situation is two percent. "We still see a few people who are malnourished - the exception, not the rule - that we are helping, but in terms of severe malnutrition, there has not been an emergency in two years," Jamet said. As a result of the improvement in health in Iriba District, MSF is looking at phasing out its emergency activities, which are basically a complete replacement for local services, and will provide medicine and food therapy, and train local health personnel. MSF will not change its level of care until it has a trusted partner who, together with the local health facilities, will be able to meet the existing needs of the refugees. "There is no question that many needs remain in Chad and we will continue to closely monitor the health situation in Iriba District," Jamet says. "But we are also looking for areas where the needs of the people are unmet and where MSF can be most effective and help those who need it most. Perhaps the hardest part of life for the refugees in the camps now is not knowing when and if they will be able to go home and knowing that they have few prospects for the future."
MSF in Chad
MSF has been in Chad since 1981 and has been helping refugees in eastern Chad since the current crisis started in 2003. MSF began by strengthening the hospital in the town of Iriba, which is near several of the refugee camps along the Chad/Sudan border, so it could take referrals from the Iridimi and Touloum refugee camps. MSF established two health centres in Iridimi and Touloum for primary health care, which covered between 18,000 to 23,000 people. In 2005, MSF built a health centre adjacent to Iriba hospital for primary care, continued to upgrade the hospital and established an operating room. Since 2006, MSF has been working in the health centre in the city of Tiné in Iriba District, which has about 15,000 inhabitants.