Relief agencies are about to start a special feeding programme for Sudanese refugees in eastern Chad to tackle high levels of malnutrition identified by a major survey in June.
But a follow-up mission in early August found that malnutrition levels remained alarmingly high and that inadequate water supplies, poor sanitation and overcrowding continued to pose grave problems in several of the nine official refugee camps.
These house most of the 180,000 people who have fled to Chad to escape fighting in Sudan's western Darfur region.
The report, a copy of which was made available to IRIN, said diarrhoea and fever were rife and there were constant fears of a cholera outbreak.
"Acute malnutrition rates are high, an alarming situation in the camps surveyed need an immediate response," the report said.
"The risk of cholera outbreak is high, particularly in Breidjing camp, due to congestion in the camp areas, combined with poor sanitation facilities, poor hygiene and…poor availability of purified water," it added.
“The sanitary situation is terrible, there are dysentery cases and unidentified fevers killing 10 percent of patients. We fear cholera epidemics, especially in the Breidjing and Farchana camps”, said Christine Van Nieuwenhuyse, a senior policy analyst with the UN World Food Programme (WFP), who took part in the follow-up mission.
Fathia Abdalla, a senior nutritionist with the UN refugee agency UNHCR in Geneva, who also took part in the mission, said: “There is a high level of disease in the camps, especially bloody diarrhoea. Children who are malnourished have low immunity and are more vulnerable to diseases. Also, such children eat less food, have less appetite and suffer from decreasing immunity”.
The good news is that special feeding programmes for the most vulnerable refugees and some of the Chadian villagers who have been helping to look after them are about to be stepped up.
And on Friday UNHCR announced that water supplies in Breidjing camp, one of the worst blackspots, had improved dramatically.
“The June nutrition survey made us aware of nutritional deficits and we have started implementing some of the recommendations in the report”, Jean-Charles Dei, the WFP deputy coordinator in Chad, said on Tuesday.
“We will start blanket supplementary feeding to vulnerable people including children under five, pregnant and lactating mothers,” he told IRIN by telephone from the Chadian capital N'djamena.
“The CDC (Centres for Disease Control) report stated that the situation outside the camps was worrying, so we will start offering blanket supplementary feeding to 13,000 vulnerable people in the host population in addition to the 42,000 refugees we are targeting”, he added.
UNHCR's Abdalla said they would receive an additional 1,000 calories of food per day in the form of protein-rich corn soya blend, vegetable oil and sugar.
An inter-agency nutrition survey conducted two months ago on children under five living in camps, border settlements and host communities in eastern Chad showed that malnutrition levels were alarming.
The US-based CDC, which took part in that survey, announced last week that two out of every five refugee children were malnourished because they lacked proper food, clean water, shelter and health care.
The survey recommended an immediate increase in supplementary feeding programmes and improvements to water supply and sanitation in the camps, many of which contain thousands more refugees than they were originally designed to cater for.
The follow-up mission by WFP and UNHCR, conducted earlier this month, visited five of the nine refugee camps in eastern Chad.
It found that conditions in most camps remained very poor, although facilities and services at camps in the northerly sector of the refugee belt, near the towns of Iriba and Guereda, were improving.
“The high malnutrition rates announced by the CDC are plausible," Van Nieuwenhuyse, the WFP policy analyst, told IRIN. "From what I have seen, the health situation is catastrophic, there are water problems, some camps are congested”, she added.
Overpopulation in Breidjing, Farchana, a serious health hazard
Van Nieuwenhuyse highlighted the critical situation in the Breidjing and Farchana camps, situated near the border town of Adre.
Originally planned for 15 000 refugees, then 25,000, Breidjing was, by 6 August, hosting 36,000 refugees. Thousands arrived there on convoys of UNHCR trucks from the border, and thousands more made their own way to the camp.
These spontaneous arrivals were continuing at a rate of 200 people every day, putting a heavy strain on the camp's already stretched resources, UNHCR said in a statement on Friday.
Nearby Farchana, the first refugee camp to be opened in eastern Chad in January, is packed with 17,000 people. It was originally designed to cater for 9,000.
Poor conditions at Breidjing and Farchana led to riots in July. Two refugees were killed at Farchana by the Chadian security forces when they intervened to restore order.
The follow-up mission said in its report that the inhabitants of Breidjing camp were only receiving 1.7 litres of purified drinking water per day.
The recommended minimum ration is 15 litres.
However, UNHCR announced on Friday that it had increased the daily water ration there to 12 litres by installing more water bladders of chlorinated water.
The follow-up mission noted that Breidjing had only one latrine for every 250 people and there was a critical shortage of shelter.
The remoteness and inaccessibility of the camp meant there was no regular food supply pipeline, the report said. As a result, the refugees there were on a reduced food ration of only 1,900 calories per day, compared to the standard 2,100.
The situation in camps in the north east of Chad is globally better
Relief workers said that at several other refugee camps further north, where the climate is drier, the situation was improving.
“In the Iridimi and Touloum camps, the situation has stabilised, there is food, and the full 2100 calorie food ration is being handed out”, Stephane Heymens, Medecins sans Frontieres (MSF) Belgium Head of Mission in Chad, told IRIN on Wednesday.
"The sanitary situation in those camps has largely improved, in terms of infrastructure, availability of latrines and water provision”, he added.
But like Van Nieuwenhuyse of WFP, the MSF official expressed concern about poor conditions in the overcrowded camps further south near Adre, particularly Breidjing and Farchana.
Abdalla, the UNHCR nutritionist, told IRIN that much had been done to try and improve conditions in the refugee camps since the June nutrition survey, but she admitted: “The situation needs a lot of support."
Abdalla acknowledged that many refugees were receiving slightly less than the full food ration and were unhappy with handouts of rice, since they prefer to eat their traditional food, sorghum and millet.
Many were also confused about how to prepare food with corn soya blend, she added.
Commenting on the latest report on the nutritional state of the Sudanese refugees, Jennifer Clark, a UNHCR spokeswoman in Geneva, said: “The major change from when the survey was made is that transfers were made from Bahai and Cariari and moved to new camps with sufficient facilities. The problem however is that refugees came to camps on their own and provoked congestion”.
“The water supply situation has improved in most camps covered by the survey, even though water remains a problem in the desert country,” she added.
UNHCR said on Friday that it planned to relieve overcrowding at Breidjing by opening two other camps nearby Treguine and Mader in about three weeks time.
These would take about 10,000 refugees from Breidjing and absorb several thousand more refugees currently living in spontaneous settlements near the border, it said in a statement.
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions