In the Sahel region of Africa, the annual "hunger gap" period has only just begun, but in some regions of Chad the malnutrition situation is already worse than usual. In a few weeks' time, the rains will have rendered a lot of the country inaccessible and it will be impossible to reach children in need of treatment. For Médecins Sans Frontières (MSF) staff, who are also maintaining regular malnutrition treatment and prevention projects, responding to this crisis has become a race against the clock.

Chad 2012 © Catherine Robinson/MSF
An MSF doctor examines a malnourished child at an outreach clinic near Am Timan in Chad. In Am Timan, the number of children admitted to MSF's nutrition program between January and mid-June was up almost 30 per cent from the same period in 2011.

The Sahel, located between the Sahara desert in the north and the Sudanese savannah in the south, spreads across 11 countries including Chad. Every week, more than 500 children suffering from severe malnutrition are being admitted to MSF’s five nutrition projects in Chad. Food stocks are dwindling fast, but here in the Sahel regions of the country the first harvest will not be ready for another two months.   Although this is a familiar scenario, in 2012 a combination of poor rainfall and rising food prices has made the nutrition situation even worse than usual.

"Malnutrition is not a new problem in Chad: [in the Sahel region of the country] we estimate there to be one in 10 children suffering from acute malnutrition throughout the year", says Alexandre Morhain, MSF's head of mission in Chad. "A poor harvest, a disease outbreak like the measles epidemic at the beginning of the year, or a combination of the two, and tens of thousands of children become malnourished."

In some villages in the Batha and Salamat regions, evaluations carried out by MSF in February 2012 revealed a very worrying acute malnutrition rate of more than 20 per cent. In Am Timan, in the east, the number of children admitted to MSF's nutrition program between January and mid-June was up almost 30 per cent from the same period in 2011. In the district of Bokoro, to the east of N'Djamena, a rapid evaluation conducted at the end of June showed acute malnutrition rates to be more than 13 per cent.

The Chadian authorities and humanitarian operators raised the alert early on and an emergency response was launched last winter. As a result, 127,000 severely malnourished children are likely to receive care in 2012, twice as many as last year.

Chad 2012 © Catherine Robinson/MSF
A group of mothers wait to have their children checked at an MSF ambulatory feeding centre in Dougine, a small village in eastern Chad. Every week, more than 500 children suffering from severe malnutrition are being admitted to MSF’s five nutrition projects in Chad.

MSF's response to the crisis includes expanding its existing programs and opening three additional projects. In Massakory, where MSF is already running a pediatrics and nutrition project, two new decentralized treatment centres will be set up. In MSF's intensive therapeutic feeding centre in Am Timan an additional 20 hospital beds have already been opened to cope with the inflow of severely malnourished children. New projects have also been started in Biltine, Abou Deïa and Yao, in the east and centre of the country.

The number of therapeutic feeding centres in Chad has doubled in a year and in several regions aid workers have begun distributing foodstuffs, including food supplements adapted to the needs of young children.

But it will be difficult to continue these activities once the rainy season is underway. In the Sahel area, the population is spread out, the roads are little more than sandy dirt tracks and the villages are far apart. Considerable resources are needed to reach all the children suffering from malnutrition here. And the first rains have already arrived: in a few weeks the roads will be impassable.

In Yao, MSF is racing against the clock to try and treat as many children as possible before the villages become totally unreachable. The teams are travelling between 18 peripheral consultation sites, where they are actively screening for malnutrition without waiting for the child to become seriously ill.

"In Chad, and in all the other Sahel countries, an emergency response should not be the only option. It feels a bit like we're just discovering the problem of malnutrition, like it's something new, when in fact it's recurrent and structural," says Michel-Olivier Lacharité, MSF's program manager in Chad. "In addition to emergency operations for dealing with particularly serious situations, malnutrition prevention and treatment should be offered all year round and be an integral part of basic care for children, like routine immunization."

In Massakory, in the Hadjer Lamis region, the MSF project launched in 2010 is looking for ways of making this integration possible. As well as running a 200-bed hospital and providing support to 11 health areas, it has also trained non-medical personnel to carry out screening and treatment for malnutrition in the villages. There are two advantages to this approach: large numbers of children are receiving early treatment before their condition becomes critical, and patient numbers in the health centres are being kept down. This is crucial in a country where the number of healthcare personnel is largely insufficient to meet the needs.

Between January and mid-June 2012, 10,000 severely malnourished children were treated in MSF's therapeutic feeding centres in Chad. Approximately 500 Chadian and international staff are currently working in five specialized hospitals and more than 40 outpatient therapeutic feeding centres.

Evaluations are ongoing in different parts of the country and MSF is ready to launch new programs in the coming weeks. MSF's other activities in Chad include treatment for vesico-vaginal fistula in Abeche and for malaria in Moïssala, in the south. In April, MSF responded to a meningitis epidemic, treating more than 3,100 cases and vaccinating 470,000 people. Between January and May 2012, MSF also vaccinated more than 20,000 children against measles.

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