We arrived in Kousseri early on Thurs., Feb. 7, with an MSF medical team comprised of two doctors, two nurses, and five logisticians. It took us more than a day to get there by car from Garoua, a town further south in Cameroon, where the nearest runway that can handle air freight is located. Kousseri is just across the border from N’Djamena, south of the Logone River.

Although exact figures are difficult to obtain, it is estimated that tens of thousands of Chadians fled the capital just days earlier, swelling the Cameroonian town of approximately 100,000 people. Cameroonian authorities and the population welcomed the refugees, with the authorities providing considerable support to facilitate aid operations. Cameroon’s Minister of Health came today (Saturday) to assess the situation.

Refugees destitute

When we arrived, the refugees had set up at two primary sites. The first group, which we estimate at 7,000 people, had taken shelter in schools and churches on the periphery of the town. The second, larger group (approximately 30,000) was located at a site called Madana, near the bridge leading to N’Djamena. People at that site had no shelter, were exposed to the sun and had received no assistance.

After conducting a rapid evaluation, the team began working in Madana that same day, setting up a process for emergency medical consultations. The team quickly identified several patients with a severe form of malaria. Children and adults were found to be suffering from dehydration, diarrhea and respiratory infections. Nights in northern Cameroon are cold at this time of year and the refugees lacked any protection. The next morning, Friday, we set up a second medical consultation site in the town, in Cetic, for those refugees who were gathered in the southern area.

Consultations total around 70 per day at each centre and the number is growing.

While patient visits were being organized, our logistics team worked to set up urgently-needed water supplies for the two sites.

Uncertainty ahead

Thursday morning’s broadcasts reported an improved security situation, but the general attitude among these refugees was uncertainty. Based on my observations of the bridge on Thursday, few people are returning to N’Djamena despite the precarious situation here. Although they have been here since early last weekend, they have not yet received any aid.

We noted small numbers of refugees returning to Chad, due in part — according to the refugees themselves — to the lack of food at the sites. Population movement appears to have subsided in both directions and the number of refugees without shelter has stabilized at around 30,000. Approximately 20,000 are estimated to be housed with families or in hotels. The UNHCR has not yet confirmed that figure but a team is preparing to transfer refugees to one or two camps located approximately 30 kilometres from here.

Strengthening MSF teams

MSF’s two initial priorities — setting up medical examinations and providing water to sites — have been met and we expect to carry out other projects quickly. Early in the week, we will distribute basic supplies, blankets, mosquito netting and jerry cans and will begin a measles vaccination campaign for the population at the Madana camp. We will strengthen the medical supervision teams in preparation for vaccinating up to 30,000 children and adolescents. Because the refugees have not been registered, we also expect that those vaccinated will include young Cameroonians. Two MSF nurses will join us early next week. We will assemble eight vaccination teams so that this effort can begin as soon as possible. UNICEF will be in charge of vaccinating the other group of refugees in the town.

It is important that vaccinations begin quickly because within the next few days the UNHCR is expected to resettle the displaced families at one or two sites located far from the city, in Maltam.

However, we cannot currently determine how many refugees will be moved to those sites. What happens across the border in the coming days will certainly be a major factor in the refugees’ decision.