Return to Tissi

Last month I returned to Tissi. MSF shares a small plane with the International Committee of the Red Cross (ICRC) and we use it to transport staff, supplies and patients to and from Tissi. Also on my flight were an ICRC doctor, MSF midwife Sigrid from Germany and four patients who we had previously evacuated for surgical treatment to Abéché hospital.

When we landed at the airstrip, MSF Dr. Kalyani from India met us. With her were two patients needing medical evacuation. One had bullet wounds in his arm and back; the other a gaping hole where the left side of his neck should have been. The doctors worked quickly to stabilize the patients for transport. As they tended to the patient with the bullet wounds, Sigrid tried to keep the other patient conscious by asking him to say his name. He couldn’t make any sounds but he was able to write his name in the dirt. She made him write it over and over again. Abdul Abdul Abdul Abdul Abdul. Later, I learned that Abdul died in surgery.

At the MSF base in the town of Tissi, preparations were underway for half the team to relocate to a refugee camp established by the United Nations High Commissioner for Refugees (UNHCR). The previous week, more than 9,000 refugees had been relocated to the camp. MSF was running a small mobile clinic in the camp and the team told me that 50% of the children treated at the clinic had watery diarrhea, which was indicative of the poor overall water and sanitation (WATSAN) situation in the camp. Anticipating a further deterioration of the health situation, the team was racing to create hospitalization capacity in the camp, improve the water supply and build latrines.

Chad water refugee MSF

Borehole drilling © Ritu Gambhir


I first visited the camp with MSF WATSAN expert Adrien from Congo. On the way to the camp, we stopped to talk to the contractors UNHCR had hired to try to find water in the camp.  They confirmed that all boreholes drilled in the camp had come up dry and they were now looking for water outside the camp boundaries. In the interim, the only option was to treat and truck water from  Lake Tira, which is nine kilometres away from the camp.

Chad MSF water refugees

Borehole results © Ritu Gambhir


Not surprisingly, when Adrien and I reached the camp, the first thing the refugees wanted to discuss was the lack of water. As Adrien went off to scout out locations for latrines, community leaders took me to a broken water point.  I was amazed to see a row of jerry cans that stretched for what seemed like miles. The jerry cans had been lined up since the previous afternoon and the refugees were waiting for water to be trucked in. Community leaders said that people were getting so desperate that they were walking to a wadi (traditional water source) an hour away by foot to collect water. Despite their precarious situation, they had not lost their sense of humour and laughed when I politely refused their offer of a cup of muddy wadi water.

Chad refugees water MSF

Jerry cans lined up © Ritu Gambhir


Water trucking, as I have learned over the past month, is a nightmare and is not a durable solution. It requires extensive coordination on the part of the humanitarian community – something we are not good at doing – and is fraught with uncertainties. Before water could be trucked from Lake Tira to the camp, humanitarian organisations had to build a water treatment plant at the lake. Then we had to locate trucks capable of carrying large loads of water. These trucks are expensive and hard to find. Although humanitarian organisations have rented trucks and loaned them to UNHCR, resources are not unlimited.

An added complication is that the dirt road from Lake Tira to the camp is poorly maintained which means the trucks get stuck in the mud and break down. So even if Lake Tira could produce enough water to sustain the refugees (which it cannot), there is no guarantee on any given day that the water will actually reach its intended destination. Currently, refugees are receiving 6.5 litres per day, well below the minimum humanitarian standards of 20 litres per day. I have read the self-congratulatory updates that humanitarian organisations are putting out about improvements in the water supply at the camp and they make me angry because they bear little resemblance to the reality on the ground.

Chad refugee MSF

Refugee community leaders - father and son © Ritu Gambhir


I left the camp that day feeling upset about water situation and powerless to do anything about it. However, my next visit to the camp reminded me how powerful humanitarian organisations like MSF actually are.

Due to unpredictable security conditions, it had been several days since MSF had been at the camp. I was walking through the camp when a skinny middle aged man with a turban and beard came running up to me. He was wearing a long green gown and pink flip flops. “Doctora Doctora,” he was shouting. He looked familiar but I couldn’t place him. He didn’t speak English or French and I didn’t speak Arabic and we were at an impasse until he made a whooshing noise and flying motion with his arms. Then it clicked. He was Aziz, one of the patients who had been on the flight to Tissi with me and had mistakenly assumed that since I worked for MSF, I was a doctor. After Aziz and I greeted each other properly, he handed me a paper on which someone had written in French “bullet wound infected, please change bandage.” I showed him where the MSF team had set up the mobile clinic for the day and asked a fellow team member to translate. Aziz explained that he hadn’t meant to scare me. He had been worried our mobile clinic would never return and had been excited to see me.

MSF Chad refugee

MSF mobile clinic © Ritu Gambhir


In a way, Aziz has reason to worry.  One day MSF will stop working in the camp.  In my view, the challenge for MSF is to try to ensure that before we do there is a long term plan in place so that people like Aziz, who may be in the camp for years to come, are not left without access to enough clean water and appropriate medical care.


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Three Weeks in Tissi

Last night I sat in my tent (which I share with seven other expats) and cried. I cried because it was the 3rd thunderstorm since I arrived in the town of Tissi three weeks ago and most of the 50,000 refugees and returnees who are camped out in and around Tissi (along a 60 km stretch of Chad-Sudan border) still do not have plastic sheeting, let alone tents, to protect them from the rain.

MSF, Chad

Living conditions of Chadian returnee families © Ritu Gambhir


The town of Tissi – it feels more like an outpost – is at the southeastern most tip of Chad and borders Sudan and the Central African Republic. For several years, due to security concerns, this part of Chad was a “no-go zone” for UN agencies and humanitarian actors. As a result, local people were left to fend for themselves. Until MSF arrived here in early April to provide emergency and primary health care, there was no functioning health centre and the locals either went to “doctors choukou” (men who claim to have medical training and sell medications in the market) or to a nearby health centre in Darfur.

Over the past few months, the escalation of an inter-ethnic conflict in Darfur has resulted in a steady exodus of Sudanese, Chadians and Central Africans from Darfur to Tissi. None of the sites where people are camped out have been officially designated as refugee or IDP camps and to date, they have received minimal assistance.

I am in Tissi to assess the situation from a humanitarian perspective and I have visited with the refugees and returnees at the sites at which our MSF team is providing care. For the most part, aside from the UN agencies that have come to do head counts and to try to persuade them to relocate farther from the border, no one has come to see them, let alone help them. The people I met were eager to share their stories with me and though I made no promises to them, I do feel a responsibility to make sure their voices are heard.

MSF, Chad

Elderly Sudanese refugee woman © Ritu Gambhir


Their main worries have to do with basic human needs – shelter, food and water. At present, they are crammed into small straw huts or huts that are a mix of straw, empty grain sacs and old plastic sheeting. These shelters provide some protection from the dust and heat (temperatures during the day climb above 50°C degrees, 122°F) but not from the rain. Those who arrived last are living under trees and have no protection from the dust, heat or rain. They are running out of food and it is hard to find water. Because there are no latrines, they defecate in the open, and they understand this puts them at increased risk of disease now that the rainy season has started.

MSF, Chad

Living conditions of Sudanese refugee families © Ritu Gambhir


On a lighter note, they are also upset about the poor network coverage in Tissi. The other day we passed by a young man, his arms outstretched in the air, standing on top of the rotor of a downed Chadian army helicopter (a relic of conflicts past). We thought he was praying until he flashed his mobile phone at us and explained that he was trying to see if he could still connect to his Sudanese mobile phone provider.

Stepping back into seriousness, the refugees and returnees in Tissi are quietly deteriorating. In part – and this is my personal view – it is because the humanitarian community as a whole has been slow to respond. And with the rainy season, our options are limited. Soon, wadis (spontaneous rivers) will form, making it difficult for vehicles to access sites and to bring people and supplies in (or out). There is an airstrip near Tissi but it is half finished and has already started to sink. Unless it is reinforced, even the smallest of planes won’t be able to land.

I’m leaving Tissi tomorrow and returning in a few weeks.  I’m hopeful that by then, the situation will be better not worse.

MSF, Chad

Sudanese refugee woman with her one-month-old baby © Ritu Gambir



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Briefly speaking…

Briefly Speaking from Chad

What am I doing in Chad? It is a question I have been asking myself a lot since I arrived a month ago in N’Djamena, Chad’s hot (45 degrees C°), dry and dusty capital. There are lizards everywhere and it is not unusual for them to crawl over people if they are in a hurry to get from point A to point B.

About N’Djamena

N’Djamena is one of a few cities in Chad and is spread out over several kilometers. It is divided into quartiers (neighbourhoods) and each quartier has a chef (chief). Some quartiers are safer than others. The city as a whole reminds me in many ways of the Delhi I used to visit as a child, before the growth of the Indian middle class changed its urban landscape. Like the Delhi of my childhood memories, the air here smells of roasted peanuts and somewhere in the distance, the sound of a radio can be heard.

The main roads are paved but the roads that branch off are dirt and gravel, making for slow and bumpy travel.  Small shops line the roads and children beg and peddle used water bottles filled with peanuts. There are also several open-air markets where you can stock up on staple foods such as fresh camel and fried crickets. As well, there are a few stores, restaurants/bars and hotels that cater to affluent Chadians and the expatriate crowd (an interesting mix of oil, military, UN and NGO types). Most homes that I have seen are basic one storey concrete buildings. Homes in the more affluent quartiers have water and electricity (most of the time), are enclosed by high walls topped with barbed wire or spikes and patrolled by guards.

My Work

I am the new Humanitarian Affairs Officer (HAO) with MSF in Chad.  Not all MSF missions have HAOs.  HAOs are deployed to countries when MSF is of the view that the situation requires additional advocacy expertise in relation to medical aid and witnessing (témoignage), the two elements that make up MSF’s work. What drew me to MSF is the fact that its advocacy is very concrete.  It is based primarily on what MSF teams working on the ground see, hear and document.  I already have one story to share.  For me, it illustrates how having to leave one’s home to access water (a task that is traditionally allocated to women and girls), can put one’s health at risk.

On my first Saturday evening in N’Djamena, Ali (name has been changed to protect privacy), an MSF driver, was bringing my colleagues and I home from the office.  We asked Ali how he was.  “So-so” he replied.  “Why just so-so?” we asked.  Ali said that the previous evening, two of his daughters, aged 4 and 8, left home to fetch water.  He explained that the city opens the taps twice a day and the taps are a favorite meeting spot for children.  The tap the girls normally went to was closed so they decided to walk a bit further to try to find another tap and got lost. When Ali and his wife realized that the girls had not returned, he began to search for them.  He went from quartier to quartier while his wife waited anxiously at home. To his relief, he found the girls the following afternoon. Fortunately, they had not been harmed. A woman had noticed the girls’ distress and had helped them.  It turned out that they had walked almost 15 kilometres away from home. As the girls later told Ali, the woman had wanted to call him but they could not remember his telephone number. The woman had fed them and left them with the chef of her quartier, which is where Ali found them. While this story has a happy ending, things could easily have turned out differently and this makes me sad.

To Be a Chadian

The 2013 UN Human Development Index, which measures development by combining indicators of life expectancy, educational attainment and income into one statistic, ranks Chad 184th out of 187 countries. The average Chadian can only expect to live until age 50.  Things are worse if you are a woman or child under five. Chad has the second highest maternal mortality rate in the world and for every 100,000 children born alive, 1100 mothers will die. Of those 100,000 children, 17,300 will die before they turn five. Even if they survive, chances are high that they will not be able to read and write and that they will grow up to be poor: 65.6% of the population is illiterate and 61.9% of the population lives below the international poverty line of $1.25 per day, even though Chad has been an exporter of oil since 2003.

About Chad

Chad, a former French colony in Africa, achieved independence in 1960. A large landlocked country (1,284,000 km2), it shares borders with Sudan, Libya, Niger, Nigeria, Cameroun and the Central African Republic. With a population of 12 million that is comprised of over two hundred ethnic groups, Chad is culturally and linguistically diverse. Chad is divided into 23 regions (split between desert and tropical), including the capital N’Djamena.


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