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Hundreds of thousands of people were affected by conflict, violence and displacement in Chad in 2009. Health services were restricted because of a lack of funding and qualified staff, and the situation was particularly severe in the east, where banditry, criminality and insecurity were widespread. More than 170,000 Chadians are still displaced in the east, having fled from the insecure regions near the Sudanese border which is also home to more than 256,000 Sudanese refugees and 67,000 refugees from the Central African Republic. MSF has been providing health services where the authorities have been unable to, paying special attention to displaced people and refugees.

Security challenges

Insecurity made it difficult to assess the health needs of resident and displaced people, especially those living in more remote villages. According to the United Nations Department of Safety and Security, 500 security incidents against civilians, UN workers and NGO workers occurred in the east of Chad last year.

In the Dar Sila region in the east of the country, MSF provided care to 15,000 displaced people in Gassire camp. In nearby villages Kerfi and Adé, MSF provided care and treatment to 40,000 people affected by internal displacement and continuing violence. Activities were suspended in August, however, after two MSF staff members were abducted during a robbery in Adé. In Kerfi, the full medical programme was resumed only in October, and in Adé, services were resumed only in late November, when MSF provided remote support to Ministry of Health staff. Before the suspension, MSF carried out 1,600 - 2,000 consultations a month in Kerfi, and admitted 100 malnourished children each month for therapeutic feeding.

Overall MSF was able to perform more than 106,000 consultations in collaboration with the Ministry of Health, despite these difficulties.

Eastern Chad

In Adré, a town with a population of 300,000 on the border with Sudan, MSF supported the local hospital throughout 2009. From January to October, more than 2,600 people were hospitalised, more than 900 of them children under five years old. Nearly 33,000 consultations were given in the first nine months of the year. However, insecurity made it impossible to access areas outside the town where other internally displaced people have settled.

In Dogdoré, a remote village near the Sudanese border, MSF provided healthcare to 30,000 people, 27,000 of whom are displaced. Security remained a challenge here, too, as banditry and criminality affected the people as well as the relief organisations. Relocation of international staff was necessary on two occasions, though local MSF staff ensured the continuity of medical activities.

In total, more than 23,600 consultations were carried out. 2,600 women received antenatal consultations, some 280 of whom gave birth in Dogdoré hospital. A tetanus vaccination campaign was also run to reduce the risks of neonatal deaths linked to this disease, and more than 5,500 women received the vaccine. As a result, newborn deaths linked to tetanus were reduced from 35 in 2008 to 11 in 2009.

Obstetrical fistulas

In Guereda in the east, near the border with Sudan, MSF closed the programme that was providing aid to the displaced and to the Birak refugees, since the International Committee of the Red Cross had begun working in the hospital and the health authorities were able to cover the needs.

However, since maternal mortality in the area is still very high and the development of obstetrical fistulas common (the United Nations Population Fund estimates that between two and five fistulas develop every 1,000 deliveries), MSF continued to send women with the condition to be treated in Abéché General Hospital in the east of the country. Between January and October, more than 140 women were treated.

Epidemics

MSF responded to an outbreak of measles in the Ouaddai region in the east of Chad. More than 226,000 children were vaccinated against the disease. MSF also responded to an outbreak of measles in Abéché, where 130,000 people under 15 years old were vaccinated, and in Adré where a further 6,000 children under five years old received the vaccine. More than 5,500 women between 15 and 49 were vaccinated against tetanus in the same region.

There was also a meningitis outbreak in the southern regions of Mayo Kebbi Est and Ouest, and in the capital city N’Djamena. MSF supported the Ministry of Health in treating more than 1,200 people, and in the mass campaign that vaccinated 105,000 people.

Southern Chad

The south of the country the arrival of refugees from Central African Republic, has meant that existing health services are struggling to cope with diseases such as malaria, meningitis and measles.

In Goré MSF continued to respond to medical needs until November when the programme was handed over. Between January and November, teams provided 16,800 consultations, more than 730 surgical interventions, and assisted 600 deliveries.

Emergencies

In March, 8,000 refugees escaped instability and violence in Central African Republic by moving to the Haraze district in the southeast of the country. MSF provided healthcare, set up a drinking water supply system and organised the referral of patients who needed surgery. More than 5,400 consultations were carried out during the two months of the intervention.

MSF has worked in Chad since 1981.

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