Metche is a small, remote area south of the border town of Adré, where most refugees fleeing Sudan initially settle. It takes two hours to get there from Adré through complicated and very rugged terrain. There were only a couple of villages before a refugee camp was created in the area at the end of 2023. It was like pointing a finger in the middle of the desert and saying, “Let’s go there.”
It is a place with extreme temperatures of up to 50 degrees during the day and cold nights. During storms, the wind forces sand down day and night, and the rainy season, which takes place now, brings torrential rains.
Around 50,000 refugees live here now. When Doctors Without Borders began working in Metche last year, we first improvised a clinic for basic consultations with tents. As more people arrived, we created a hospital from scratch. We installed the drainage system, we built concrete platforms to put more resistant tents, we prepared the entire electrical system…
It was a challenge: often many things did not work as we expected and getting supplies requires a lot of logistical planning because the roads do not allow easy passage. We kept moving forward and learned a lot in a short time. At some point, everyone who lived in the Metche refugee camp participated in the construction of the hospital: including thousands of day laborers and the more than 500 local and international MSF workers.
We carry out all the classic activities of a hospital: from triage to the emergency room and observation, including pediatrics, neonatology, internal medicine, maternity, a laboratory and a therapeutic nutrition center for hospitalized patients, which is currently the busiest service of all and continues to register new admissions of malnourished children. In August, we inaugurated the operating room and began surgical activities.
Late arrivals and lack of water
This 115-bed hospital is the main secondary healthcare facility for around 200,000 people, including refugees from Metche and local communities, as well as people from nearby camps such as Allacha and Arkoum. Between the start of activities at the hospital in September 2023 and July 2024, MSF teams in Metche They have carried out 5,530 consultations in the emergency room, they have admitted 2,282 patients, They have treated 692 children with acute malnutrition and assisted 322 women in giving birth.
However, patient access to the facilities is difficult due to a poor referral system, with only three ambulances available for the entire province of Ouaddaï, which causes some to arrive late and even die before reaching the hospital. Therefore, awareness work with the community has been crucial. Through health promotion and mental health activities, we have achieved a deeper understanding of the needs of the population.
At the beginning of the emergency response, we transported a lot of water by truck, although other organizations later began building the water network. However, refugees receive a maximum of 14 liters of drinking water per person per day, well below the minimum standard in an emergency situationwhich is considered 20 liters.
People spend hours trying to get water, and family members split up to fetch it at different points. I remember a patient, a 22-year-old young man who came 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 arriving at the hospital. It was totally unexpected. We have seen harsher cases, but it deteriorated quickly. I thought, “Life can be hard. He’s survived the worst of it during the war and now he’s died from drinking dirty water.”
The refugees in Metche mostly arrived after fleeing El Geneina [capital del estado de Darfur Occidental]a city hit by some of the worst violence of the war, including ethnically motivated attacks on Masalit communities by the Rapid Support Forces and allied militias. Many are originally from other areas of Darfur as well, and have experienced repeated forced displacement over the yearsas this Sudanese region has been facing conflict since the early 2000s.
The majority are women and children, and almost every family has lost someone. Among them are qualified professionals who are now out of work; mothers who struggle to put food on the table for their children, and children who are orphaned and alone.
People are doing everything they can to make up for what humanitarian aid does not provide. Some sell small things. Others have begun volunteer activities such as music, theater and informal schools in the camps. Amidst all the challenges, children remain children and are seen creating toys and playing.
Some refugees have begun to return briefly to Sudan, mainly to El Geneina and nearby towns for now, to check on relatives who are still there, to collect belongings or earn some money, but then they return to the field.
A crisis with hardly any echo
The resilience of these people is incredible and so is the urgency of their needs. Since MSF is one of the main organizations working in Metche, we are often seen as “the mother fighting for them”, and we are doing everything we can, both here and in the other refugee camps, but there are still much to do and, As the war continues unabated, people continue to arrive from Sudan.
The Chadian authorities have done an impressive job of welcoming so many people into their territory. Beyond this gesture, the reality is that no one really cares about this crisis in eastern Chad. Many refugees are forced to have only one meal a daylack adequate shelter, drinking water and do not have enough latrines. It is shameful that the response continues to fall far short of what is needed. If no action is taken to fund and expand humanitarian assistance, the crisis will worsen further and refugees will suffer more.
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