Forgotten refugees face epidemics, food cuts

In the lush malarial forests of southern Chad tens of thousands of forgotten refugees from Central African Republic squat in tattered tents exposed to shrinking food rations and infection from diseases that could easily be prevented with minimal investment.

Their story is relatively untold, as many of the more than 48,000 refugees who have surged north into Chad since 2003 to escape fighting between rebels and government loyalists barely understand the chain of events that led them to the camps.

Ngaba Boniface, a community leader at one of two camps set up by the UN refugee agency UNHCR near Gore, 150 kilometres south of the major southern Chadian town Moundou, became a refugee on 22 December last year, along with most of the others from his village Mainodjo, 70 kilometres south of the camp.

Boniface and the other villagers fled with nothing except the clothes on their backs after fighting between rebels and government troops erupted near their village. "There were arms and mines lying around and we were afraid they would come back. It was too dangerous to stay," he explained to IRIN.

After weeks wandering in the dense forest, the Mainodjo villagers crossed the border into Chad, where they were processed and moved to the camp at Gondje, 40 kilometres from the frontier.

WHY LEAVING

There has been a steady trickle of refugees fleeing over the border in recent months, but it was more like a flood last year.

After the election of Francois Bozize as president of CAR in May 2005, analysts anticipated that he would bring an end to the two years of fighting, and UNHCR even started preparing repatriation plans for the refugees in Chad.

But from early June 2005, attacks against civilians and government troops intensified in northern CAR, resulting in new waves of refugees entering Chad. Refugee testimony gathered by UNHCR suggests the civilian death toll since the beginning of February has drastically increased.

No one really seems to know what is happening over the border now, except that lawlessness and widespread pillaging and deliberate attacks against civilians have occurred.

Aid officials estimate more than 100,000 people have been displaced from Ouham Prefecture alone in northwestern CAR, and that perhaps more than 50,000 are still hiding in the forest inside the country. Refugees have also scattered into CAR's western neighbour, Cameroon.

Boniface and others from his village now cramped together in squalid muddy UNHCR tents in the humid and wet refugee camp, claim not to know anything about the different rebel groups fighting government forces.

Even the UN refugee agency says it does not have reliable information about what is happening in northern CAR. The region has been beyond the control of CAR's central government, based in Bangui 400 kilometres south, for the last two years. Much of the area is deemed too dangerous for the UN to operate in.

GETTING TO CAMPS

Most of the CAR refugees IRIN met in the two camps the UN has set up near Gore, Amboko and Gondje, have chilling stories of weeks spent running and hiding in the dense forest, before finding their way over the border into Chad.

Sitting in the shade under a tree outside a medical station, Pascal Deoultoum, 45, like Boniface, is vague about the day fighting forced him to take his wife and four children and flee.

"It started around 10am with an attack on the police station, then people started rampaging in the village," he said.

"Most of the village left then, as none of us had been killed or injured. We had no idea who the rebels were, but with the rebels and loyalists fighting, we knew it was too hot to stay on."

After quitting the village Deoultoum walked in the forest for over a month. "It was tough. In the bush there is nothing to eat, there is nowhere to wash, and there are no markets."

And after crossing the border into the tranquil, leafy Chadian border village Bekoningka, he was made to wait for several weeks, living on handouts from villagers, waiting for Chadian administrators to process his documents so he and his family could be moved to the camp and issued a tent and food rations.

By the time many of the refugees make it to camps they are extremely sick, aid workers say. Septicaemia and infected wounds, malnutrition, dysentery and tuberculosis are all common problems.

"When they get here, people have often been sick for a long time. Many of them have never been treated or vaccinated, and when they have been, it often was not done properly," said Anastasia Sergydova, a nurse with the Italian NGO Coopi, working at a health centre in Amboko camp.

DISEASE RAMPANT

Even when they reach the UN-run camps, life is still extremely tough, as epidemics and hunger stalk people living in crowded tent cities, which annual rains starting in May turn into a quagmire.

To see what the shortage of soap, mosquito nets and food mean, it is best to visit the camps' packed hospital tents.

Clutching her stomach through a dirty green dress, and struggling to speak as stomach cramps wrack her gaunt body, Deldo Madu said she has "no idea" how she contracted the dysentery that eventually forced her into one of the Amboko refugee camp's three hospital tents, which are overflowing with dysentery cases.

Many of the refugees sleep on the bare earth, often wearing the same clothes they were dressed in when they fled their villages months or years before. Skin diseases and ulcers are common problems.

Health workers say Madu's dysentery was caused by her ignorance about the need to wash regularly to ward off disease in the crowded camps.

"Every time I say to people, 'you must wash your hands', but they do not listen to me," said Coopi nurse Sergydova.

At home in CAR, few people would have been exposed to even basic healthcare or health education. Some might have had access to dispensaries or travelling doctors, but many would rely on herbal medicines and religious ceremonies, remedies which have ill-suited them for life in the camps.

Even if the camp's handful of nurses and doctors had the time to run more education campaigns to promote washing, for much of this year they have lacked soap to distribute, which would have made the campaign useless.

MALARIA, AIDS UNCHECKED

And dysentery is only the number two killer in Amboko and the nearby camp at Gondje. Malaria picked off 10 people every day during last year's malaria season, which starts in August.

The spread of that disease could be slowed, although not stopped, if more mosquito nets were distributed to families, many of whom live crammed six or more into the tiny three-year-old tents.

But nets, let alone larger tents or materials to construct sturdier shelters, have not been forthcoming. 3,300 nets were provided by the UN children's agency UNICEF in April, since when there has been no distribution, according to UNHCR.

Health workers expect the hospital tents will soon be overwhelmed with malaria cases. "We are expecting a huge caseload again this year," warned Stefan Hess, a doctor with Medicins Sans Frontieres (MSF), which has set up two new clinics this year to cope with the influx. "We always ask for nets and promises are made, but there is no distribution."

As the handful of nurses and doctors struggle to cope with the surging numbers of malaria and dysentery cases, planned programs to give the refugees their first health and AIDS awareness education have been put on hold.

"We need to concentrate on the other illnesses now," said Coopi nurse Sergydova at the Amboko camp.

"The AIDS programme was cancelled first due to the overwhelming number of new arrivals, then pushed even further back by the malaria outbreaks. We have been so occupied with that that we have not even had the chance to do screening against AIDS."

FUNDING SHORTFALLS

As well as the threat of disease, at Amboko camp three tents are crowded with women and over 50 children suffering from malnutrition. In the first three weeks of May alone more than 60 new cases were admitted, and hospital records show a steadily increasing incidence.

UNHCR and the World Food Programme have warned that food rations are set to be cut in July, as the organisations have not received enough money to keep up the supply of cereal, oil, beans and flour.

Despite the scale and severity of the problems faced by CAR refugees, "we are really struggling to get support," warned the head of the WFP in Chad, Stefano Porretti, adding that just 16 percent of the required funds have been allocated to the CAR refugees in the south.

"If nothing comes, we will have to further cut the rations, or even not provide anything," he warned.

And the presence of hundreds more refugees who are waiting in border villages for processing to enter the camps could tip the balance too far, Porretti warned. "Already with internal borrowing we are just about able to cope with the critical moments, but we cannot sustain further extension".

A senior UNHCR official in Chad, Myriam Houtart, also told IRIN that the funding shortfalls are threatening agricultural programs that would have helped refugees make the most of the fertile land they are living on.

The problem, according to aid agency officials, is that the presence of over 200,000 Sudanese refugees and tens of thousands of displaced Chadians in the east of the country, 1000 kilometres away, is eclipsing the longer-running and less well-explained crisis in the south.

"We are short of funds because this is an old mission. It is not like the east, which gets a lot of attention," explained MSF's Hess. "Now the malaria epidemic is looming, dysentery is happening, and people are stuck living in the bush at the border."

nr/ccr