As N'Djamena, Chad, settles, thousands of Chadian refugees are leading a precarious existence in Cameroon

In the hospitals, the worst of the crises has passed. At the peak of the fighting and during the days that followed, the few facilities that remained open had to deal with sizeable influxes of wounded. Most medical personnel have now returned to their posts and services have started up again.

The main source of concern now is the refugee situation in Cameroon and eastern Chad. While a good number of people have returned to N'Djamena, thousands of families do not yet dare go home, and continue to survive in precarious conditions a few steps away from the border.

The fighting in N'Djamena has taken a heavy toll: more than 270 deaths and nearly one thousand injuries.

In the Bon Samaritan Hospital in the Walia District, the MSF surgical team has treated more than 110 wounded in one week.

Ahmed K., the father of a young girl, 6, who was hit by mortar shards, looked back over events: "I was heading for my mother-in-law's home when a mortar hit the building. When I went in, I saw three bodies. There were three wounded; my daughter and two other children. One had lost an arm. The nearest clinic was shut and the General Hospital was completely overloaded. In the end, we stopped a motorcyclist and while I buried the dead, he took the wounded to Walia, because we knew the hospital there was still running."

The rest of the family took refuge in a village further to the South. It is the fourth time that Ahmed and his family have fled N'Djamena.

"This time was the worst", he insisted. "It's the first time there's been fighting in the capital. Everyone wants to rule, but if there are no people left, who are they going to rule?"

The General Hospital found itself in the middle of the fighting. The few doctors and nurses who remained had to cope with an influx of more than 250 wounded. The MSF teams could only reach it on February 4.

"The hospital was too close to the fighting, it even had to shut for a few hours", explained Meinhard Kritzinger, an MSF doctor anaesthetist who came with a surgeon to reinforce the emergency services. "They had to deal with the most urgent cases: they were often unable to operate, just stopping the haemorrhages, applying bandages and sending the patients home - which is why we are seeing the return of many patients who only received quick treatment the first time round".

The hospital seems to have returned to normal. Most medical personnel are back and services have started up again. MSF provided medicines and surgical material for dealing with the most urgent needs, and the teams are in the process of building up a stock in the event of a new crisis.

Some who fled the fighting have already returned to N'Djamena. In the districts, several hospitals that had closed their doors are in the process of reopening. In order to cope with a sizeable influx of patients that may appear in the days to come, MSF has decided to reinforce several outlying facilities with personnel and medicines.

In the immediate future, the most urgent needs are to be found some kilometers away, in Cameroon, where thousands of people have taken refuge. Most of them do not dare return, still terrified by the intensity of the fighting of the week before. The refugees are scattered around the town of Kousseri, a couple of steps away from the border. Numerous families have set themselves up under trees or in schools, with the few belongings they managed to take with them during their flight. They are in need of water, food and shelter.

The MSF teams were amongst the first to intervene in Cameroon. Several dispensaries have been set up in the refugee regroupment sites, particularly in Madana, the biggest site, which is next to the border.

During consultations, the medical teams are seeing many cases of diarrhoea, respiratory infections and malaria, including some severe cases, which are transferred to the central Kousseri hospital where MSF is reinforcing the emergency services.

A surgical team has been working there since Wednesday, February 6, and free health care is guaranteed for all the refugees. Meanwhile, water distribution points have been set up in several sites and the distribution of essential items is starting this week: blankets, jerrycans, mosquito nets and plastic sheeting. MSF is also planning on carrying out a vaccination campaign against measles this week.

In the rest of Chad, and more specifically in the east, the MSF teams, despite their reduction in size, continue assistance to Sudanese refugees and the Chadian population.