Since the beginning of December, at least 26,000 refugees have arrived in eastern Chad having fled the escalating conflict in the Darfur region of northern Sudan, according to MSF teams working at the border. "Conditions they face on arrival are harsh," explains Sonia Peyrassol, MSF Emergency Coordinator at the Chad/Sudan border, "having walked for up to three days to escape the violence around their homes, they are greeted by totally inadequate shelter, a dire lack of protection and insufficient food.

This is exacerbated by extreme weather conditions, with the temperature fluctuating between 0 degre at night and 30 during the day." Many of the people are in a deplorable state, with younger children being especially vulnerable. A large number of them have also lost family members following attacks on their villages, and there are clear indications that sexual violence against women has been frequent, although shame prevents rape victims from coming forward for treatment and counselling.

Finding clean drinking water is also likely to become a serious problem over the coming weeks. "MSF have made assessment visits to six towns along the border during the last week," says Peyrassol, "and while the need for basic aid is critical, agencies such as the UNHCR have been slow to react. Over the last two weeks, thousands of new families have arrived and they are currently receiving absolutely no assistance."

The first refugees from Darfur arrived in Chad in July 2003 and MSF set up health posts in the border towns of Tine and Birak soon afterwards. Although the first wave of refugees, estimated to be up to 60 000, was assimilated into local communities, the increasing number of arrivals has now left the region entirely unable to cope. "We are currently giving about 150 consultations per day in our clinics," explains Peyrassol.

"The main health problems that we are seeing are malaria and respiratory infections, but there is also a threat of a meningitis outbreak, and with more people arriving daily, MSF is calling on other organisations to take up their responsibilities before the situation further deteriorates."