In August, the UNHCR reported on the sudden arrival of thousands of Sudanese refugees in Chad. The refugees had fled ongoing fighting in their home province Darfur in western Sudan and, although the number are large - up to 10,000 people - they appeared without much notice as they had crossed into Chad in small numbers across a 400km stretch of border. MSF sent an exploratory team to the Biltine region in eastern Chad to make a first assessment of the situation.

Two experienced MSF members, Virginie Chauderlier - a French nurse - and Anibal Ordenes a logistician of Chilean origin - flew from N'Djamena, the capital of Chad, to the provincial capital of Abéché in the East of the country. From there, it took another six to seven hours in a jeep to reach the remote border area.

The situation in some of the villages is dramatic. In the small towns of Tiné and Birak alone, are some 11,000 Sudanese refugees - 75% of them women and children. It is likely there are more refugees in the surrounding villages, and there is still a constant flow from Sudan. People are living in close quarters, separated by as little as 20cms of space between the families. Shelter is often little more than a blanket suspended from some twigs with a piece of string. "Many of the refugees have only the shirt they are wearing", reported Chauderlier.

"There is hardly any shelter to protect them, neither from the sun temperatures rising up to 45 degrees during daytime nor from the cold nights. "On top of that, it is still rainy season with heavy daily showers. There is not enough food and some of children already show signs of malnutrition. People have no clean water. They either drink water straight from unclean rivers or they simply dig holes in search for it. "The refugees live in a close proximity to each other and vaccination coverage is close to zero.

Therefore the threat of epidemic outbreaks is high. Just the idea of it is a nightmare, because people here have no access to medical help. In Birak there is not even a single aspirin to be found." MSF reacted immediately to the emergency. Only a few days after the initial assessment, an international team comprised mainly of doctors, nurses and logisticians was dispatched to Chad.

The team had barely arrived in N'Djamena when a cargo plane with about 33 tons of relief items followed. The organisation is opening health centres in Tiné and Birak as soon as possible.

The cargo includes; kits with essential medicines; and medical supplies to provide help for 10,000 people; vaccination material; special food for the malnourished; and pumps, pipes, tanks and chlorination material for the provision of clean drinking water. In addition, the cargo included three jeeps, tents and other logistical material to install tent hospitals, and a place where the team can live and sleep. All this is necessary because there will be no facilities in the area where we are going to work.

During their assessment, the initial team identified suitable areas for a working and living place in Tiné and Birak. Right now it nothing more than a small piece of land surrounded by small walls. But this will be sufficient to set up the equipment and start working. Also, the exploration team found a house in the provincial capital of Abéché that will be the MSF base during the emergency. Goods will be transported to Tiné and Birak as needed.

The initial cargo flight from Belgium to Chad was only the first stage. Once the massive international flight had landed, three cargo flights were needed to bring all material to Abéché. Each flight in the old Antonov used to transport the goods also took a part of the MSF team. The plane was filled to the top with material, then the MSF team squeezed into a small place behind the unlocked cockpit; two of us sitting on simple plastic chairs which slide slowly during taking off and landing. Security belts - or other "luxuries" - were not available.

Abéché preparations

In Abéché, MSF has already installed a make-shift office. There is electricity and a satellite phone. Furniture is sparse. Staff, who had been sleeping on the stone floor, now sleep on mattresses that arrived with the cargo. Mosquito nets are suspended by pieces of tape stuck to the walls. The supplies in the three cargo flights have been trraansferred to two trucks - one for Tiné, the other for Birak.

It takes some hours before all the small and bigger boxes are on the right trucks. This is not a simple task when the temperature has risen steadily since our arrival in Abéché at 8.30 in the morning. At lunch time the airstrip tarmac seemed to boil. It will be another six hours, at least, before the good are driven to the area where the refugees are. Preparing a base storehouse well in advance will be essential to the success of the intervention.

Grasshoppers and lightning

Due to the rainy season, the surrounding desert is sprinkled with green. In the evening, with its early sunsets at 6.00 pm, the daily rain is announced by lightning, thunder and heavy winds - but also by hundreds of grasshoppers and small frogs that are suddenly everywhere, on computer keyboards as well as on dinner plates. The rain shower that follows is so strong that a conversation becomes nearly impossible. Fascinated, the team was able to watch the spectacle on their first night in Abéché, sitting under a small tin roof, safe and dry. But staff know full well that the same rain makes the situation for the refugees in the border area - who are exposed to it without any protection - even more difficult.