Eastern Chad: How we built a hospital for refugees in the desert

Over half a million Sudanese refugees have settled in eastern Chad since the outbreak of the war in Sudan in April 2023. Metche is a small and remote area south of the border town of Adré where most of the arriving refugees first settle. 

It takes two hours to get there from Adré on very rough off-road terrain. There were only a couple of villages there before the refugee camp was created at the end of 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 tempests, the wind makes you eat sand from day to night; and the rainy season, as it is now, brings heavy rains.

Creating a hospital from scratch

Around 50,000 refugees live here now. When MSF started working in Metche last year, we first improvised a clinic for basic consultations with tents. As more people arrived, we created a hospital from zero. We set up the drainage system, constructed concrete platforms to put in more resistant tents, and did the electrical work.

It was challenging: often many things didn't work as we expected and getting in supplies required a lot of logistic planning because the roads don’t allow an easy passage. We kept on moving and learned a lot in a short time. 

At some point everyone in the Metche refugee camp was involved in helping to construct the hospital. This included thousands of daily workers and more than 500 local and international MSF staff.

We run all the classic hospital activities: from triage to the emergency room and observation, to paediatrics, neonatology, internal medicine, maternity, a laboratory, and an inpatient therapeutic feeding centre. 

The centre is currently the busiest department and keeps registering new admissions of malnourished children. In August, we opened the operating theatre and started surgical activities.

This 115-bed hospital is the main secondary healthcare facility for about 200,000 people, including the refugees from Metche and the local communities, as well as people from nearby camps such as Allacha and Arkoum. 

However, accessing the facility proves difficult due to a poor referral system as there are only three available ambulances for the whole Ouaddaï province. This leads to some patients arriving late, and even dying before reaching the hospital. 

That’s why talking to people during community outreach work has been crucial. Through health promotion and mental health activities, we have gained a deeper understanding of the needs of the people.

Lack of good water

At the beginning of the emergency response, we trucked a lot of water, although other partners started later building the water network. Nevertheless, refugees get a maximum of 14 litres of drinking water per person per day, far below the minimum standard in an emergency situation, considered to be 20 litres. 

People spend hours trying to get water, with family members splitting up to go fetch water from different water points. 

I remember a patient, a 22-year-old young man who was accompanied by his family. He was a very big and strong guy, in good health, but he contracted hepatitis E and died a couple of days after coming to the hospital. It was totally unexpected. 

We have seen tougher cases, but he deteriorated fast. I thought: ‘Life can be hard. He has survived the worst during the war and has now died from drinking dirty water’.

Much more assistance is needed

The resilience of these people is incredible and so is the urgency of their needs. As one of the main organisations working in Metche, MSF is often seen as “the mother who fights for them”. We are doing all we can, both here and in the other camps, but there is still so much to be done and, as the war continues unabated, people keep on arriving from Sudan. 

The Chadian authorities have done a wonderful job by welcoming so many people into their territory. Beyond this gesture, the reality is that nobody really cares about this crisis in eastern Chad. 

Many refugees are forced to have just one meal a day, they lack adequate shelter, clean water and don’t have sufficient latrines. Shamefully the response remains far below what is required. If no action is taken to fund and scale up the humanitarian assistance, the crisis will further deepen exposing refugees to more suffering. 

Between the start of activities at the hospital in September 2023 and July 2024, MSF teams in Metche have provided 5,530 Emergency Room consultations, admitted 2,282 people for inpatient care, treated 692 acute malnourished children, and assisted 322 deliveries.