Médecins Sans Frontières (MSF) teams in Mauritania that have been working among 75,000 Malian refugees at the Mbéra camp since February 2012 are now scaling up their medical activities. Although the emergency phase of the response is coming to an end, significant needs remain. What follows is an update from Dr Louis Kakudji Mutokhe, an MSF doctor in Mauritania.
Has the nutritional situation improved since the last influx of refugees in January?
In January, the situation quickly deteriorated with a new influx of refugees fleeing the resumption of fighting in Mali. Since then, despite the mobilisation of the various organisations in the camp, the nutritional situation has remained a concern, with malnutrition rates above the emergency threshold. Each month, MSF’s nutritional centres record an average of 330 severely malnourished children. That means each day 12 children at risk of dying are to be looked after. Fortunately, 85 per cent of them emerge healthy from our programme.
What measures have been taken by MSF to improve the medical situation?
We have built a third health post in the camp’s extension zone to improve access to care and health coverage. As a result, we are receiving more than 1,800 patients a week. The increased options for treatment, the strengthening of the capabilities of the medical staff and the greater mobilisation of health promoters have enabled us to improve our effectiveness. Children arrive sooner at the hospital and adhere better to ongoing treatment.
In cooperation with the Ministry of Health and Unicef, we have also put in place vaccination teams in the health facilities to strengthen routine vaccination activities (EPI): diphtheria, poliomyelitis, tetanus, measles and whooping cough. These are easy to prevent diseases, and vaccination is one of the best ways to protect children. In terms of the fight against malaria, we expect an increase in patients with the arrival of the rainy season. Some 45,000 impregnated mosquito nets will be distributed in the camp, with priority given to children under five and pregnant women.
Can it be said that the situation is under control?
Much effort have been made in recent months. They must be intensified in order to maintain an acceptable level of assistance. But the situation remains worrisome, of course.
It is unlikely that the refugees will return to Mali in the near term. Although a few families have returned, the tensions that exist in the north of the country still do not create conditions favorable for a voluntary return of refugees. The last families who arrived a few weeks ago in this zone are frightened. They refuse to go to the camp and prefer to stay in Fassala, a town on the border with Mali. Similarly, a large number of refugees who arrived during 2012 are still afraid to return to Mali for fear of suffering reprisals.
As for the living conditions in the camp, they are very poor. Food supply remains unreliable, even though food distribution has improved considerably. Once a month, children between the ages of six and 24 months receive food rations containing CSB ++ (a fortified mixture consisting of milk, oil and sugar). This is essential to their growth and helps prevent malnutrition. However, considering the families’ lack of resources, these rations are sometimes shared with older children. So MSF gives nutritional biscuits to households where one of the children suffers from malnutrition. It is difficult therefore to be fully optimistic because some structural causes of malnutrition remain.
What other problems do you encounter on the ground?
With the rainy season, the roads are muddy and it is sometimes difficult to reach the Mbéra camp. We try to prepare for this as best we can: reinforcing the medical buildings to withstand water and sandstorms; preparing for the peak of malaria; fighting diarrhoea and respiratory infections, which remain the primary causes of mortality; mobilising teams to improve access to water and sanitary conditions; encouraging early resort to health services, etc.
Another problem is the shortages of medical staff. MSF is currently having some trouble recruiting qualified medical personnel who are prepared to work in the Mbéra camp, in the middle of the desert. Yet this is a prerequisite for improving the medical and nutritional situation of the refugees.