Treating refugees in Tanzania: Malnutrition

Saschveen has recently returned from a posting with Médecins Sans Frontières / Doctors Without Borders (MSF) in Tanzania, where she was working as a doctor in Nduta refugee camp. She shared her diary with us...

In refugee camps, tired and desperate families often wait out in the open for long hours to pick up the rations that are distributed on allocated days. If there are long delays or if the distribution points run out of food, then frustration and anger can rapidly rise.

We found out that the food rations allocated to each family had been significantly reduced a few month ago, and the distribution of rations was changed to monthly instead of fortnightly deliveries. You can easily imagine how families could simply just run out of food well before the end of the month. The sentiment and despair of the hungry people here is intense, to say the least.

Dust rises in Nduta camp, Tanzania

Nduta Camp. Photo: Saschveen Singh / MSF

The lack of adequate food (maize meal ration now down to 60% of recommended minimum ration)is a very significant concern in the camp. On the wards we are frequently admitting vulnerable children and patients who already have chronic diseases such as HIV and TB, and who now have malnutrition and its many severe complications. So we are keeping a close eye on the nutrition rates of the community in the camp.


Malnutrition itself causes a state of immune suppression, making people much more prone to infectious diseases. One such disease, which we are seeing so much of at the moment, is one of the least researched tropical diseases: tungiasis.

A medic examines a child's hand, whihc has many small Tunga wounds

Tunga lesions on a patient's hand. Photo Saschveen Singh / MSF

Tungiasis is caused by the Tunga Penetrans (otherwise called a “jigger”), which is a parasitic flea that enters the skin, usually through feet which are exposed to sand because their owners lack shoes. The fleas then cause penetrating larval infections that can become secondarily infected.

Many, many refugees, even our Burundian staff, seem to be exposed on a regular basis and can suffer several of these Tunga lesions on their feet at a time, but some of our more vulnerable malnourished or otherwise immune-suppressed patients can have such overwhelming infestations that they require admission to the ward and it takes days of repeated painful surgical debridement to rid them of the larvae and their eggs, and antibiotics to treat the secondary skin infections that result from the infestations.

Desperate decisions

One of our health promotion officers came to me today, very upset, to discuss a case he encountered this morning in the community, on one of his usual check-up visits of recently discharged patients. He found a young mother and her child, both recently discharged from hospital (after the child had been treated in our hospital for one of these severe Tunga Penetrans infections, and the mother for malnutrition and anaemia), to find them living in a remote area of the camp. He explained that they are sleeping on the ground with no tent.

Although it appears they may have had a tent at some stage (as refugees are allocated shelter after arriving in the camp and being registered) we are hearing reports that desperate people are selling their tents. The money is sometimes used to buy bricks to put towards building small, more solid and protective temporary homes here (in anticipation of the upcoming rainy season). However we're also hearing that people are selling their tents just to be able to buy their families more food.

A branch of leaves

An MSF health promoter found a patient gathering these inedible leaves to eat. Photo: Saschveen Singh / MSF

I was told by our distressed staff member that he found the mother today foraging in the bushes just nearby to her plot address in the camp, collecting a variety of random leaves to cut up and cook to eat: he even brought this bunch of completely inedible leaves to the hospital to show me this woman’s plight in first hand (photo above) and my heart leapt into my throat at the thought of this.

I thought back to how we have had multiple patients in the last month presenting to the emergency department with symptoms of non-specific food poisoning (vomiting and abdominal pain, requiring admission for IV fluids, pain relief and a period of observation) all due to eating inedible plants and leaves, so the saddest thing was that I’m sure this was not even just one isolated case.

The reality here for so many refugees is still rather grim, and with the rainy season and its associated increase illnesses like malaria, diarrhoea and pneumonia approaching, we are getting prepared for things to possibly get much worse.