Access to basic healthcare is limited in Chad, where malnutrition, malaria and outbreaks of disease are common. An influx of refugees from Central African Republic (CAR) in 2014 increased the need for medical aid.
Although improvements are being made to the health system, there are still critical gaps, which Médecins Sans Frontières (MSF) continues to address. These include implementing preventive measures and providing free medical care to children suffering from acute malnutrition and malaria, responding to disease outbreaks – including a major measles outbreak – with treatment and vaccinations, and meeting the acute healthcare needs of people displaced by conflict. Chad is home to the third largest number of refugees in Africa, and with ongoing violence in neighbouring Nigeria, CAR and Sudan, the refugee population is likely to increase.
Refugees from CAR
Since December 2013, more than 200,000 people fleeing violence in CAR have sought refuge in southern Chad. In January, MSF started providing health assistance, with projects in Bitoye until April, Goré until October and in Sido, which hosted the largest concentration of refugees (17,000). Altogether, teams carried out more than 35,000 consultations, mainly for malaria. Teams also supported the health ministry with a measles vaccination campaign for children aged six months to 10 years in Goré and surrounding areas, immunising around 7,000 children.
From May to October, MSF ran mobile clinics in three villages near Goré on the CAR border and provided seasonal malaria chemoprevention (SMC) for children under five, as 60 per cent of consultations were for malaria. More than 1,300 children were protected by this strategy of administering antimalarials as a prophylactic.
Responding to violence in Darfur
Since 2013, MSF has provided basic and specialist healthcare to the community in and around Tissi, a remote town that becomes inaccessible during the rainy season. Violence in neighbouring Darfur, Sudan, has caused large numbers of Sudanese refugees and Chadian returnees to cross the border. MSF ran a fixed clinic in Tissi, mobile clinics in Biere and Amsisi, and health posts at Um Doukhum and Ab Gadam. More than 47,300 general outpatient consultations were carried out in the Tissi programme overall. Increased stability in the region and the ensuing decrease in patient numbers as people travelled back to Darfur meant that MSF was able to hand over the Ab Gadam health post to the NGO Agence de Développement Economique et Social in June.
Malaria and malnutrition
Malaria is the main cause of death for children under five, especially during the peak season from July to October. MSF teams focus on the treatment of the most severely affected children in Moissala hospital’s malaria unit in Mandoul region and provide support to health centres and community health workers in the districts of Moissala and Bouna. SMC was given to children under five and pregnant women to reduce the risk of severe malaria during the high season. Through these activities, 68,000 children were treated for malaria. In addition, standard vaccinations were administered to more than 27,200 children.
MSF also provides emergency paediatric care to children up to the age of 15 and specialised treatment for child malnutrition at the hospital in Massakory, the capital of Hadjer Lamis region, as well as basic healthcare in four surrounding health centres and a referral system for complicated cases. In 2014, there were more than 2,800 hospital admissions and 55,300 outpatient consultations. Over 23,900 children were treated during the peak malaria season. Between June and December, MSF ran an emergency care programme for acutely malnourished children in Bokoro, Hadjer Lamis. More than 4,760 children under five were enrolled on an MSF therapeutic feeding programme, and 574 were admitted to hospital for treatment.
MSF continued to support the government hospital in Am Timan and health centres in Salamat region. The focus was on specialist care for children up to the age of 15, including treatment for severe malnutrition, and reproductive healthcare for women – more than 5,200 antenatal consultations were carried out and 1,900 deliveries assisted. The team also offered treatment for HIV and tuberculosis and implemented an emergency malaria response for the general population. More than 20,600 outpatient consultations were carried out and 2,900 patients were admitted to hospital. In addition, MSF supported the hospital infrastructure by upgrading water and sanitation services.
MSF started supporting emergency services at Abeché hospital in Ouddaï region in June. Teams provided lifesaving care to all emergency surgical cases coming from Abeché or referred from Tissi. The main causes of trauma were road and domestic accidents. More than 900 major surgical procedures were carried out; one in five was related to violence.
In response to a measles outbreak early in the year, MSF collaborated with the health ministry at Liberty and Union hospitals in N’Djamena and seven basic health centres. More than 4,500 patients were treated in March and April. Teams also vaccinated over 69,600 children for measles in Massakory during the outbreak.
No. staff in 2014: 1,032 | Expenditure: €19.5 million | Year MSF first worked in the country: 1981 | msf.org/chad
Kim Comer, Logistician – Today we did a canoe kiss. It sounds a lot more romantic than it is.
A kiss movement is a movement between two projects or locations where one vehicle from each project meets the other halfway to exchange cargo or passengers. It cuts down on the driver’s time behind the wheel and the vehicle’s time away from the field. It’s called a kiss because the two Land Cruisers touch noses, like a kiss. In reality, they hardly ever touch noses. One, it’s dangerous. Two, it’s hard to load and unload when the cargo doors are on opposite sides, rather than the cars being side by side in some shady spot. But still the name remains, kiss.
To read more, visit blogs.msf.org/kim