A cholera epidemic in Chad between 2010 and 2011 was the largest to hit the country in the last 15 years, with more than 17, 000 registered cases. Over the last year MSF has treated more than 12,700 patients, approximately three quarters of all the cases in the country.  In order to prevent another emergency, Chadians need improved access to uncontaminated water and sanitation facilities.

In 2011, Chad was affected by a cholera outbreak on a large scale. More than 450 deaths and 17,200 cases of the disease were reported, numbers that have not been seen in this central African country since 1996. At the height of the epidemic in August, up to 1,250 new cases per week were recorded, a third of those in the capital city of N'Djamena. Over the course of the outbreak, Médecins Sans Frontières (MSF) had more than 300 Chadian and international staff working at 23 health care centres in Massakory, Am Timan, Abou Deia, Mandelia, Pala, Fianga, Lere, Lai, Bongor and N'Djamena.

"The outbreak was a continuation of the 2010 epidemic. It never really ended, therefore we witnessed two events: cases before the rainy season, and a wide geographical spread.  Thirty-seven out of 61 districts were affected, "says Michel-Olivier Lacharité, head of MSF programs in Chad.

Chad © Yasmin Rabiyan/MSF
In an MSF cholera treatment centre in Pala district in Chad in 2010, a mother watches over her nine-year-old son who was sick with cholera.

Last spring, MSF teams worked closely with the Chadian Ministry of Health to establish treatment centres, oral rehydration points and awareness activities to limit the spread of the disease. MSF also carried out case management training at public health facilities. By late November 2011, MSF had treated more than 12,700 people, about three quarters of cases in the country, with cure rates approaching 99 per cent.

Activities were still being carried out in late November of last year even though the number of cases had dropped sharply.  Because there are concerns about a possible resurgence of cholera, MSF teams continue to monitor the situation and are ready to intervene, if necessary. In 2010, MSF treat more than 6,800 cases of cholera in the country.

"We must consider strategies to help people," says Michel Quere, a physician and MSF medical advisor. "Cholera epidemics are the result of several factors: lack of access to drinking water, latrines and sanitation facilities, but also a delay in care, due to a misunderstanding of the disease and difficult access to care. If public authorities and development actors are not involved in these structural causes, the population of Chad will face these epidemics, year after year. "

MSF is working along with authorities, to ensure better coordination between health actors in order to facilitate a rapid treatment of cases, along with the introduction of an oral vaccine recently pre-qualified by the World Health Organization.

"The vaccine raises hopes that the spread of disease around the outbreaks, such as Lake Chad, for example, could be limited. To do this, close collaboration between ministries of health in the region, international public health actors and non-state actors such as MSF will be necessary, "says Quere.

In 2011, MSF responded to outbreaks of cholera in Cameroon, Chad, Niger, Nigeria, Papua New Guinea, Zambia and Haiti, among others.

In Chad, MSF also operates in Massakory, Moïssala and Am Timan and has expanded access to care for vulnerable people (including children and pregnant women) and treats deadly diseases such as malnutrition and malaria. In Abéché, MSF offers treatment for vesico-vaginal fistulas in women of childbearing age.

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