The Doctor Will See You In…2 Years? Refugee Health and Humanitarian Aid Amongst Sudanese Refugees in Chad

Image credits: Wikimedia Commons

Tulsi Patel

In the sweltering heat under a waxy white tent in the Ambelia refugee camp, hundreds of injured individuals wait. They wait while the arid dust around them billows and their children cry with naiveté. They wait with a variety of ailments- paralysis, malnutrition, gun wounds - for which some have been waiting on treatment for over a year. 

Beginning in April 2023, millions of Sudanese people sought refuge in neighboring North and Sub-Saharan African countries after the outbreak of the unabating conflict of the civil war in Sudan. The beginning of this civil war stems from a complicated history but is rooted in the financial and religious separation of the Christian and Muslim-occupied areas in the early 1900s from previously designated unitary Sudan. Over the decades, this social separation intensified, resulting in milestone events such as the creation of the Republic of South Sudan in 2011 after two civil wars. Continuing a tumultuous history, in 2019, two paramilitary groups, the SAF and RSF, orchestrated a coup to replace the dictatorship of Sudan with democracy. However, power struggles ensued between the two groups setting off one of the most dangerous civil wars in the world. Sudanese citizens became subject to kidnapping, sexual violence and food insecurity with no clear resolution in sight. 

As a result, over 700,000 refugees fled through dangerous environments, specifically to Chad, where the United Nations High Commissioner for Refugees (UNHCR) has attempted to mitigate this mass exodus with basic resources and emergency assistance. However, to their detriment, Chad is one of the least  developed countries in the world. Here, residents already battle complex public health issues such as extreme food insecurity, physical conflict and climate-induced maladies. Paired with a severe physician shortage due to the “brain drain” phenomenon seen across most of Africa, Chad is one of the least equipped locations to sustain health and well-being for one of the world’s most vulnerable populations. According to the WHO, for every 10,000 inhabitants of the Chad-Sudan crisis, only five hospital beds and eight medical professionals exist. Additionally, violence and unrest bar the transport of life-sustaining equipment.

While the UNHCR can provide essential items such as blankets, mosquito nets, and water, it finds itself in the midst of infrastructural issues that exacerbate famine and subsequent malnutrition (primarily in women and children). Due to a lack of supplies and staff, individuals have been waiting over a year to receive medical care for injuries sustained during the migration process. While living in makeshift homes with tin roofs, lack of protection harbors contagious malaria, infection-induced diarrhea and acute respiratory illness. Additionally, there is still a relatively high birth rate, generating a need to ensure safe prenatal care and delivery, which is nearly impossible in such conditions. As a result of these circumstances, the WHO declared a collapsing health system in Sudan and Chad, with the UNHCR left to try and put together its pieces. 

The future outlook at the consensus of these countries is only grimmer, as even after two years, refugees arrive in Chad every day. Global funding for UNHCR has faced unprecedented cuts this past year, depleting an already dwindling humanitarian resource bank. These cuts have been triggered by the restructuring of the United States’ approach to foreign aid which has involved massive cuts to programs considered unnecessary or not directly relevant to American interests. As a result, maternity wards for refugee mothers have been forced to close down, increasing the number of women left unsupported during pregnancy and delivery. Additionally, women’s health faces other setbacks with the shutdown of reproductive support programs and programs focused on educating women on how to avoid exploitation and physical harm. An already destitute food program now relies mainly on external support to make minuscule attempts to overcome the lack of equitable production of food and the safe distribution of it. Beyond immediate health impacts, cut funds translate to cut education, further deepening the deficiency in patient outcomes and self-sufficient medical education.

These trends have stark repercussions beyond those that are clearly immediate. They signal a shift away from humanitarian neutrality since World War II when the contents of the Geneva Convention ushered in an age of protection. However, the current refugee crisis suggests that armed conflict has increasingly become more violent towards ordinary civilians. The quest for dominance has eroded the traditional rules of protection. On a global scale, the rollback in humanitarian aid symbolizes a changing international dynamic where aid may be given only selectively. Beyond numbers and data, the world appears to be becoming more hostile with limited framework or direct consequence. Chad’s crumbling healthcare system is ironically an example of a system built on this very hostility. 

The story of Chad is not unique. It is mirrored in almost all refugee camps and enclaves globally. These vulnerable locations face their biggest challenges as they must quickly grapple with unilateral decisions that limit their impact. The role of international humanitarian programs must be more clearly defined than ever as their scope of practice and impact severely dwindles with budget cuts, compromised messaging, and the growing isolationism of the Global North. While healthcare may not be agreed to be a universal human right, it is clear that the current international framework is creating serious repercussions for events at the confluence of health and migration, which must be ameliorated. Chad cannot be left to wait.