More than half a million Sudanese refugees have settled in eastern Chad since war broke out in April 2023. Most have arrived from El Geneina, the capital of West Darfur. Médecins Sans Frontières (MSF) project coordinator Myriam Laroussi shares her impressions of the plight of people there, after concluding a seven-month mission in Metche, one of several camps in the area.
Sudanese refugee women sit outside a tent at the MSF hospital in Metche, Chad. © Finbarr O’Reilly/VII Photo.
Metche is a small, remote area south of the border town of Adré, where most refugees fleeing Sudan initially settle. It takes two hours to get there from Adré through difficult and very rugged terrain. There were only a couple of villages before the refugee camp was created in late 2023. It was like pointing a finger in the middle of the desert and saying “let’s go there.”
This is an area with extreme temperatures of up to 50 degrees during the day and cold nights. During storms, the wind blows sand into your throat day and night, and the rainy season, which is taking place now, brings torrential rain.
Around 50,000 Sudanese refugees live here now. When MSF started working in Metche last year, we first improvised a clinic for basic consultations using tents. As more people arrived, we created a hospital from scratch. We installed the drainage system, built concrete platforms for stronger tents, set up the entire electrical system…
It was a challenge: often many things did not work out as we expected and getting supplies required a lot of logistical planning because the roads did not allow easy passage. We kept moving forward and learned a lot in a short time. At some point, everyone living in Metche refugee camp was involved in building the hospital. Including thousands of day labourers and the more than 500 local and international MSF staff.
General view of the MSF hospital in Metche, eastern Chad. Metche camp is home to around 40,000 Sudanese refugees who have fled violence in Darfur. © Finbarr O’Reilly/VII Photo.
We carry out all the classic activities of a hospital: from triage to the emergency and observation room, through pediatrics, neonatology, internal medicine, maternity, a laboratory and a therapeutic nutrition center for hospitalized patients, which is currently the busiest service of all and continues to record new admissions of children with malnutrition. In August, we inaugurated the operating room and began surgical activities.
Late arrivals, lack of water and difficult memories
This 115-bed hospital is the main secondary healthcare facility for some 200,000 people, including refugees from Metche and local communities, as well as people from nearby camps such as Allacha and Arkoum.
However, patient access to facilities is difficult due to a poor referral system. There are only three ambulances available for the entire province of Ouaddaï, resulting in some arriving late and even dying before reaching the hospital. This is why awareness-raising work with the community has been crucial. Through health promotion and mental health activities, we gain a deeper understanding of the needs of the population.
At the beginning of the emergency response, we transported a lot of water by truck, although other organizations later began to build the water network. Nevertheless, refugees receive a maximum of 14 liters of drinking water per person per day, well below the minimum standard in an emergency situation, which is considered to be 20 liters.
Metche Hospital is the main secondary healthcare facility for Sudanese refugees in Metche and local communities. © Finbarr O’Reilly/VII Photo.
People spend hours trying to get water, and family members split up to go and fetch it from different places. I remember one patient, a 22-year-old young man who came with his family. He was a very big, strong man, in good health, but he contracted hepatitis E and died a couple of days after arriving at the hospital. It was totally unexpected. We have seen tougher cases, but he deteriorated quickly.
Think: “Life can be hard. He has survived the worst during the war and now he has died from drinking dirty water.”
The refugees in Metche mostly arrived after fleeing El Geneina, the capital of West Darfur state, a city hit by some of the worst violence of the war, including ethnically motivated attacks on Masalit communities by the Rapid Support Forces and allied militias. Most are originally from other areas of Darfur as well, and have experienced repeated forced displacement over the years as the Sudanese region has been gripped by conflict since the early 2000s.
Most are women and children, and almost every family has lost someone. Among them are skilled professionals who are now out of work; mothers who struggle to put food on the table for their children; and infants who are orphaned and alone.
People are doing their best to make up for what humanitarian aid does not provide. Some sell small things. Others have started volunteer activities such as music, theatre and informal schools in the camps. Amidst all the challenges, children are still children and are seen creating toys and playing. Some refugees have started returning briefly to Sudan, mainly to El Geneina and nearby villages for now, to check on relatives still there, to collect belongings or earn some money, but then they return to the camp.
More than half a million Sudanese refugees have settled in eastern Chad. © Finbarr O’Reilly/VII Photo
Much more help is needed
The resilience of these people is incredible and so is the urgency of their needs. As MSF is one of the main organisations working in Metche, we are often seen as “the mother who fights for them”and we are doing everything we can, both here and in the other refugee camps, but there is still a lot to do and, as the war continues unabated, people continue to arrive from Sudan.
The Chadian authorities have done an impressive job in welcoming so many people to their territory. Beyond this gesture, The reality is that no one really cares about this crisis in eastern Chad. Many refugees are forced to eat only one meal a day, lack adequate shelter, clean water and not enough latrines. It is shameful that the response remains far below what is needed. If steps are not taken to fund and scale up humanitarian assistance, the crisis will worsen further and the refugee population will suffer even more.
Since the start of activities at the hospital in September 2023 and July 2024, Doctors Without Borders teams in Metche have carried out:
- 5,530 emergency consultations,
- 2,282 patients admitted,
- Treatment for 692 children with acute malnutrition
- assisted 322 women to give birth.
