N'Djamena - Since the start of the war in Sudan, 1.6 million people have fled the country seeking safety, including an estimated 610,000https://dtm.iom.int/reports/chad-sudan-crisis-response-flash-update-28-29-january-2024 who have crossed into Chad. Almost a year on in the Sila region, eastern Chad, almost 92,000https://reliefweb.int/report/chad/iom-chad-sudan-crisis-response-situation-update-no-28-29-january-2024 people, most of them Chadian returneeshttps://reliefweb.int/report/chad/iom-chad-sudan-crisis-response-situation-update-no-28-29-january-2024, continue to survive in very precarious conditions, putting a strain on overstretched resources that were already barely meeting the needs of the host community.

In Daguessa and Goz-Aschiye alone, approximately 50,000 people have settled spontaneously, their unmet needs continuing to grow due to the overall limited humanitarian response and lack of funding, despite the efforts of Médecins Sans Frontières (MSF) and other organisations.

Alimè is a Sudanese refugee who fled overnight with her daughter and found refuge in Daguessa, Chad.  

“I’ve seen a lot of things happening there in Sudan, such as looting,” says Alimè. “Some houses were even burnt. I saw people killed and wounded in front of my eyes. Even along the way, I saw people being robbed of everything they had.” 

Like most people in Daguessa, the little help she receives to live is far from enough. Even if they have an ancestral connection with the country, many Chadians who escaped Sudan no longer have any tangible ties to it. They have arrived in Chad in search of protection and assistance like other refugees. 

“I’m alone here. My husband stayed in Sudan,” says Awa, the mother of an MSF patient, who also sought safety in Chad. “I came to the MSF clinic because my son is sick.”

Diagnosed with severe malaria and diarrhoea, her baby has been referred and admitted to the Daguessa health centre, where another MSF team stabilises patients in critical condition. 

“In the camp, we all come from different places, there is no relationship between us that would allow me to get help from anyone,” says Awa. “I don't have a card to receive food rations. We collect straw in the bush, and we sell it to the community to have something to eat.”  

In the village of Goz-Aschiye, residents share their meagre resources with the new arrivals, but food remains scarce. Distributions in this area are not enough to cover the needs of all the inhabitants, the majority of them Chadians who have returned to the country.  

“One woman told me that her children hadn’t eaten anything for four days,” says Goumsou Mahamat Abadida, an MSF health promoter in the Sila region. “How do you talk to someone who is dying of hunger about health and prevention?”  

In 2023, 1,563 patients, all children under five years old, were admitted to MSF nutrition programme in Sila due to acute malnutrition (500 children for severe acute malnutrition and 1,063 for moderate acute malnutrition). Acute malnutrition weakens the immune system and increases people’s vulnerability to infectious diseases, highlighting the importance of healthcare to prevent severe illness as a result.

“MSF is trying to ensure a minimum of health services in the Goz-Aschiye camp, but it’s not enough to alleviate the huge humanitarian needs that we see,” says Goumsou.  

Since May 2023, MSF teams have been running a mobile clinic three days a week and two stabilisation tents with a capacity of 10 beds in Daguessa health centre. Patients with medical conditions requiring advanced care are then referred to more specialised medical centres. We also run mobile clinics in Andressa and Goz-Aschiye, where teams conduct an average of between 200 and 300 consultations per week, diagnosing respiratory infections, diarrhoea and malaria, as well as many cases of severe acute malnutrition in children under five years of age.  

To improve hygiene conditions and access to drinking water, the teams have also built several boreholes and started truck in water. However, access to drinking water still does not reach the minimum standard of 15 to 20 litres per day; most people in Daguessa have access to only 6 litres. Combined with the precarious living conditions, this only increases the risk of infectious disease.

“The humanitarian response in this remote area is still inadequate due to a lack of funds and of enough organisations on the ground, which is slowing down the delivery of aid needed to displaced people,” says Khatab Muhy, MSF head of mission in Chad. “Even before the Sudanese crisis, eastern Chad was already facing chronic food insecurity. The influx of Sudanese refugees and Chadians who have returned over the past year, as well as the resulting growing needs, are putting a strain on the country’s very limited resources and fragile health infrastructure.”