Médecins Sans Frontières, "Plight of the Darfur people in Chad and Sudan should be top priority of international aid community."

Conditions for refugees in Chad are now so bad that hunger and disease are severely endangering the lives of tens of thousands of people, warned MSF today. Malnutrition is rising, camps are insufficient and overcrowded, there is scarce food and water and many refugees remain at risk from violent cross-border attacks by Sudanese militia. The refugees in Chad have fled extreme violence and massacres in the Darfur region of Sudan, where the need for a massive mobilisation of humanitarian aid is also critical.

Although UNHCR and international NGOs have had teams on the ground in Chad for months working on the emergency, progress has been painfully slow and the crisis is escalating.

"We have been urging the international aid community to make a more determined effort in Chad since January," said Donatella Massai, responsible for MSF's operations in Chad. "It seems that the message has not been heard, so we are repeating it louder. The health of refugees has already deteriorated because sufficient water, food and shelter have not been organised. If dramatic measures are not taken immediately, there is a very great risk that the situation will worsen, especially given the approaching rainy season."

According to Jean de Cambry, MSF's emergency field coordinator who has just returned from the Chad/Sudan border:

"The level of malnutrition is now climbing every week. In mid-April, we were admitting three or four children per week with severe acute malnutrition Severe Acute Malnutrition is defined by: weight/height < 70%; a MUAC measurement (Mid Upper Arm Circumference) of < 110mm; or presence of bilateral oedemas. into our therapeutic feeding centre in Iriba. That number has now increased to nearly twenty-five children each week.

Paradoxically, the nutritional situation for many refugees is actually generally worse inside the refugee camps than outside. The camps that have been set up are operating way beyond capacity several camps that were designed for 6000 people are now holding twice that number. This means that food supplies that were intended to meet the needs of 6000 people now have to stretch much further and are not nearly enough."

Water supply is also extremely problematic and thousands of refugees have no access to clean drinking water. "In our health facilities in Tine, Birak and Iriba we are seeing rising numbers of patients with bloody diarrhoea," continues de Cambry. "The situation is very dangerous, especially for the many children and adults who are already malnourished. The problem is exacerbated by the fact that the sanitation facilities are currently totally inadequate in most of the refugee camps. In one of them, there is one latrine per 400 refugees. This is 20 times greater than the international standard of a maximum of 20 people per latrine. Its absolutely unacceptable."

The tens of thousands of refugees who have still not been moved from the border area to refugee camps further into Chad remain at risk of attacks by Sudanese militias which frequently turn violent. The militia groups cross the border from Sudan into Chad to loot refugees' possessions and steal cattle. "Refugees are often injured or killed as a result of these cross-border raids," says de Cambry. "They have no protection whatsoever. Many people are also killed when they try and cross over the border to fetch food from their homes in Sudan."

MSF is now again urgently calling for a significantly more determined relief effort in Chad, as well as in the Darfur region itself. "More supplies, more aid staff on the ground, greater efficiency by UNHCR and international NGOs, whatever it takes," said Donatella Massai. "The plight of the Darfur people in Chad and Sudan should be the absolute top priority of the international aid community right now."

Notes: MSF's work in Chad

MSF has been working in and around the border towns of Tine and Birak since October 2003. In April we started working in Iriba, about 70 kms west of Tine. The organisation is also working in the Adre region and in the south in Daguesa.

The MSF health centre in Tine is providing about 350 consultations per week. The team is also running mobile clinics to the surrounding villages, where there are pockets of refugees, and also to the refugee camps of Iridimi and Touloum. These mobile clinics are giving more than 300 consultations each week, including pre-natal consultations. A meningitis vaccination campaign was started in mid-April and vaccinated 40,000 people within two weeks.

At Iriba hospital, MSF provides secondary health care for refugees and native Chadians. MSF runs both a Therapeutic Feeding Centre and a Supplementary Feeding Centre.

MSF is also running a health clinic, therapeutic feeding centre and supplementary feeding centre in Birak, giving over 300 consultations in the clinic each week. A mobile clinic is sent regularly to Senette, a settlement 30 minutes from Birak.

Around Adre, MSF works in four clinics along the border and supports Adre hospital, where three surgical operations are performed every day. MSF also gives medical care and is setting up a water distribution system in the relocation site of Farchana.

In Daguesa, MSF has set up a nutritional centre and is supporting the health centre.



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