Treating refugees in Tanzania: My first impressions

Saschveen has recently returned from assignment with Médecins Sans Frontières / Doctors Without Borders (MSF) in Nduta, Tanzania, where she was providing vital healthcare to the many Burundian refugees there. She shares her diary from the time...

Perth-Sydney-Doha-Geneva-Amsterdam-Dar es Salaam.

After transiting through six cities across six time-zones in six days I boarded a 6 am flight in a light plane to Kigoma, western Tanzania to start a six-hour journey by Land Cruiser to my new home for six months.

I guess good things come in sixes?

First week in Nduta

My first week at the camp was a whirlwind of emotions.

I was astounded by the vastness of the project and the job at hand, but I rapidly settled into life in the field with an incredible team of Burundian, Tanzanian and international staff, in a quintessential MSF project that covers everything from emergency cases and trauma to severe malnutrition, childhood vaccinations, maternity, primary health care, mental health, non-communicable diseases and tropical medicine.

It was my first time ever working in a refugee camp, and although I had studied refugee health in my Master's, there is nothing quite like arriving in a camp for the first time and seeing “in the flesh” this bustling “microcosm” (which is not so micro at all, it’s actually the size of a small city) of semi-organised chaos and activity.

Nduta, as far as refugee camps go from what I’ve researched, is one of the “nicer” camps around, due to the geography and climate of the region.

This is not a drought situation, so there are at least many trees and shade, and the weather (when it's not rainy season) is very tolerable as we lack the extremes of nature’s climate forces.

Sadly, due to the crisis in nearby Burundi (whose borders are just over 100 km away) which has persisted since 2015, many people in the camp have been there for a few years already.

Two informal brick buildings stand by a sign announcing the Nduta Camp

My first impression of Nduta camp. Photo: Saschveen Singh / MSF.

Some refugees have been here so long that they have even started building more solid structures to protect themselves and their families from the elements. Families aim to provide at least some stability in this very precarious context, by laboriously hand-making their own mud bricks from the camp's deep-red earth.

Although the vast majority of refugees are housed in tents.

Due to increasing tensions in Burundi, the size of the camp doubled from 60,000 between September 2016 to more than 120,000 refugees by March 2017.

The team and the hospital

My colleagues on the ground before I arrived had done an incredible job, trying to maintain essential services for everyone despite the massive surge in the camp's population and the heavy burden of the peak malaria season.

Despite these stresses, I arrived to find my new colleagues working as a well-organised and cohesive group. I work really closely with the paediatrician and the Tanzanian doctors and clinical officers in our project as well as the midwives, the nursing staff, the pharmacy, the logistics team, the health promoters and medical interpreters, and honestly there is an amazing staff morale and work ethic, especially considering the circumstances.

I’ve been inspired by so many of the people I work with here, in particular our refugee colleagues who have to deal with the reality of living in a tent, but who still come to work every day and give it their all.

One of the MSF / Doctors Without Borders hospital buildings

One of the hospital buildings. Photo: Saschveen Singh / MSF

The hospital itself consists of a mixture of a few fixed brick buildings, and more temporary structures. Some of the brick buildings are remnants from a time gone by when the camp was used to house refugees who had fled the previous conflict in Burundi (a long running civil war that lasted from 1993 to 2006).

Sadly, I’ve met many refugees for whom this is their second time in this camp, after only having been back home for a period of a few years before having to flee again when the more recent crisis occurred.

Technically we have 160 beds in the hospital, however the number of patients admitted is often higher; it’s not uncommon to have two patients sharing a bed at times.

Daily commute

We live about an hour away from the camp, so there is a lot of travel time to and from work each day.

This time is spent in a variety of different ways depending on the person and how tired they are that morning: sipping thermos mug (trying not to spill coffee all over yourself on the bumpy road), reading over MSF guidelines or trying to jot down a schedule in your diary for how to fit in the million and one tasks that you need to try to do that day.

On the way back home at the end of the day it more likely to be spent chatting with my colleagues, listening to music or my mindfulness meditation app or reading a book.

I’m amazed at how quickly I have become incredibly accustomed to being able to read whilst travelling sideways in the back of a Land Cruiser at 60 km per hour along an insanely bumpy unsealed road: without even the slightest hint of motion sickness. Next level adaptation goals: achieved!

A man rides a bicycle with a woman on the back, over sandy paths.

Refugees travelling by bike. Photo: Saschveen Singh / MSF.

Driving into the camp every morning, often the first thing we see are some refugees walking (or even hitching a ride on the back of a bicycle) the really long distances to the market on the outskirts of the camp to get supplies.

Another thing that I continue to notice every single day, after sunrise’s gentle quietude, are the families huddled closely around their fires that sometimes burn dangerously close to surrounding tents (and to playful children).

The smoke rises from the embers, fanning out between the trees in the cold air, fracturing the early morning light into diagonals. It creates an almost beautiful, eerie, luminous show, that for the refugee families sadly heralds the beginning of yet another day in their prolonged exile, distanced from their homeland and far from the comfort of having an actual home (and not just a flimsy tent) as shelter.