7 p.m. Night has now fallen in Baibokoum, Chad. We are about thirty kilometres from the border with the Central African Republic (CAR). This is where Médecins Sans Frontières (MSF) has set up its site facilities. Each day, the team makes the return trip between Baibokoum and Bitoye, a small village of 10,000 that has seen its population double with the arrival of thousands of people who have come here on foot or by motor vehicle seeking refuge in Chad, after fleeing the violence and pillaging that they experienced in the CAR.

Basic health centre

MSF has been in Bitoye now for the past three weeks, and has set up a basic health centre there. With approximately 100 consultations per day, the waiting room is never empty. Women and children for the most part, wait patiently on benches or on mats under the mango tree. One of them tries to nurse her baby, who is barely a month old. She tells how she was forced to flee, barefoot, into the bush with her seven children after the anti-Balaka forces attacked Bocaranga, her native village. This is the same story that is told by all the other women who have come here seeking refuge, and most of whom are from the Fulani ethnic group. Their husbands are either dead or have stayed behind in the bush with the few cattle they have left.

“I’ve never seen this before,” admits Dr. Aaron Zoumvournai, an MSF physician who led the MSF assessment missions in Bitoye, Goré and Sido, the three largest entry points into Chad for refugees from the CAR. He describes the injuries that refugees, mostly from Bangui, arrived with—scars on the heads of children caused by machete blows, a little girl who had had two of her fingers cut off with scissors “as a reminder,” multiple bullet wounds, and evidence of torture.

Hacked to death

He tells the story of one patient at the Bitoye health centre who was later referred to the hospital in Baibokoum. “He came from a village in the Bouar region. That day he was alone at home when the anti-Balaka forces came down and attacked his village. They set fire to his home. He managed to escape through a window, but as he was leaving, he saw at least four persons being hacked to death with machetes and wondered how many others had been burned alive in their houses.” He was later captured by the anti-Balaka forces. “They ordered him to place his feet on a white-hot barrel and threatened to kill him it he didn’t obey. When they no longer found amusement in torturing him, they left.” He was brought to the side of the road by an old man who happened by and was finally picked up by a passing truck. “He does not know what happened to his family, but has not much hope left for them,” Aaron concluded.

In Goré, 6,000 people crowd into and around an old hospital. Many of them come originally from Bossangoa. They often sleep right on the ground, and build make-shift shelters using branches and their loincloths or veils to provide some sort of protection. All of this is to say that when the first rain comes, everything will be washed away. An old man stops the MSF team. He came in this morning, on foot, from the border. Further on, a woman approaches with a tiny baby in her arms. She gave birth here prematurely and is unable to breast feed. “This child is simply hungry,” says Dr. Francis Koné, an MSF doctor in Chad. For the last two weeks this newborn has had nothing to eat and is clinging miraculously to life by a thread.

20 days in the bush

In Sido, the distress is all the more intense because of the numbers involved. More than 13,000 refugees have settled here, a scant few hundred metres from the border. Just three days ago, the eighth and final convoy escorted by the Chad army brought in another 3,500 people. Kaltouma was one of them. She had been forced to flee Yaloke, her native village, more than six weeks ago because it had been attacked and then occupied by the anti-Balaka forces. She spent 20 days in the bush with her oldest, who is 13, and her one-year-old twins. Among the 20 family members who disappeared during the attack, there was her husband and her eight-year-old son. Thanks to the help of relatives in Bangui, she found out that the French army was coming to escort them from the mosque in Yaloke to the Bangui airport. Then, after three weeks of waiting, she fought to gain a place on one of the Chad army trucks. She nonchalantly shifts the twins as they feed from both breasts. She settles under a tree near the MSF hospital with a number of her fellow refugees. None of them had ever previously set foot in Chad. “We are 100% Central Africans,” she says. But yet, the UN High Commission for Refugees (UNHCR) is not here to assess their situation.

Unable to claim asylum

On-site, the local authorities are doing everything they can as they attempt to deal with this crisis and defuse some of the conflicts that have begun to arise between refugees and the local populations, but they are sorely lacking in means and support. MSF is the only international agency on the ground in Sido. “As long as these families are unable to exercise their right to claim asylum in Chad, they will not be able to obtain refugee status and will not qualify for UNHCR assistance, or they could be sent unwillingly to a final destination where there will be absolutely no one to help them,” says Sarah Chateau, MSF's head of mission in Chad.

“Close to half the patients that I have seen so far have told me that they were hungry," states Antoine, an MSF doctor in Sido. "All you have to do is take a walk around the alleys here where refugees have been able to settle, more or less successfully, and you will see with your own eyes the effects of a lack of food.”

But the food emergency is not the only concern. There are only 20 latrines, 300 tents and 4 water distribution points for the 13,000 persons currently in Sido. In late March, the first rains will come and sweep away the makeshift shelters. The risk of epidemic will be all the more serious because not even the minimum number of sanitation facilities has been put into place. And even now, the need to just survive is pushing the most vulnerable women into prostitution just to be able to feed their children.

“It is critical that, on the one hand, recognition be given to the fact that the vast majority of these persons have fled violent situations in order to just save their own lives, and they are therefore indeed refugees and, on the other hand, that they receive international assistance here immediately, in the form of food, tents, water distribution points and sanitation facilities,” states Chateau. What’s happening right now in southern Chad is unacceptable.”