Hosting some 300,000 refugees from its neighbors Sudan and the Central African Republic and struggling through its own volatile internal conflict, Chad faces both internal and external crises. Its eastern border with Sudan’s Darfur region is dotted with camps of tens of thousands of Sudanese refugees and Chadian Internally Displaced Persons (IDPs). Despite the fact that these camps receive less international attention than the dire situation just a few miles east in Darfur, the 250,000 displaced people living here are desperately short on basic services such as health care, food and clean water and face the spillover of conflict on a daily basis. Following the departure of an emergency NGO, our grantee has taken over the provision of essential services for more than 40,000 refugees living in two refugee camps, providing desperately needed health care and community health education in conjunction with local capacity building.
Chad is a country of extreme poverty which faces its own internal conflict and the spillover from its eastern neighbor, the Darfur region of Sudan. Since 2004, the population in areas of eastern Chad has doubled as Darfuri refugees flee fighting between rebel forces and the government and pro-government armed groups. Chad’s eastern border region is now home to nearly a quarter million Sudanese refugees. In the refugee camps, access to health care, particularly for women and children, is inadequate; safe drinking water is limited to 7-8 liters per day per refugee, far short of the UNHCR’s global target of 20 liters per day per refugee; Poor rates of vaccination coverage and living conditions increase the risk of epidemics. Local Chadian host communities also live in desperate conditions nearby but are very rarely integrated into the refugee communities and have minimal access to the basic services available in the camps. Competition for the extremely limited natural resources, such as water and wood, of this incredibly poor region has created tensions between host and refugee communities. NGOs provide much of the care to both these communities as the Chadian Ministry of Public Health is not yet able to adequately meet the health needs in the Wadi Fira region, given the area’s isolation, national and local shortages of skilled staff, poor security and budgetary crises.
Primary Health
Following the departure of an emergency NGO, MAC has begun supporting a new post-crisis program which provides essential health care services to 47,000 people in and around the Iridimi and Touloum refugee camps. Facilitating a smooth transition from this emergency NGO to our post-crisis grantee and hopefully on to the Chadian Ministry of Health someday, is our long term goal. In the short term, the camps’ high rates of preventable diseases, such as respiratory infections and diarrhea, and high rates of malnutrition require immediate care. In each camp there is a 24 hour health center with a maternity ward, a pharmacy, a triage zone, consultation rooms, a vaccination area, a supplemental feeding center, and community health education tents. This program, which places an emphasis on maternal and child health and endemic diseases, expects to see a combined total of 4,000 monthly consultations a month in Chad.
Care, medicine and equipment are essential for any primary health program but for sustainable health care to be achieved in eastern Chad, a concerted investment in local medical staff is required. Through this program’s training, support and supervision of Chadian and Sudanese staff, we hope to strengthen the foundation of the Chadian Ministry of Public Health and future health professionals. Likewise, the participation of local communities is actively sought out; to foster the communities’ increasing knowledge of, investment in and ownership over their health, local health management committees will be organized with representatives from both the camps and the host communities.
Community Health Education
In Iridimi and Touloum refugee camps, 40-50% of deaths in 2008 were caused by preventable and treatable illnesses. The impact of existing health care is multiplied many times over if health related behaviors change and living conditions improve so as to emphasize the preventive, rather than the curative. A fundamental component of maximizing the impact of the primary and environmental health programs we support on a community’s health is facilitating community health knowledge. Community-based health educators perform outreach in the camps and host communities, and facilitate workshops within both communities to encourage healthy and preventive behaviors, such as personal hygiene and vaccination.
