“If the rain abandons us again, we don’t know what we will do”

The Sahel region is considered one of the world’s most vulnerable to climate change, with rising temperatures, erratic rainfalls and increasing desertification. Now, an unusually short rainy season has exacerbated an already chronic amount of malnutrition. Over the last ten years, Chad’s Saharian and Sahelian zones have spread 150 km south, resulting in reduced farming and pasture areas.

MSF launched a nutrition response in Chad’s Hadjer Lamis province in September 2021, after receiving an alert about a significant number of severe acute malnutrition cases in the area- more than 28,000 predicted for 2021 - and learning that only one of the province’s five health districts was receiving support. The team has treated more than 1,600 children in outpatient therapeutic feeding centers in the first 15 weeks and are preparing for future. 

“There is some fear that the worst is yet to come, that the hunger gap will start earlier than usual and that it could be longer and more severe,” says MSF’s medical team leader Ibrahim Barrie. “It’s a continuous crisis, no longer just a hunger gap. At the same time, funding for nutrition and food security in Chad has gone down. We need a better aid response to prevent children from dying from malnutrition.”

Malnutrition is a recurrent, chronic crisis in Chad, and especially affects children under five and pregnant and lactating women. The causes of malnutrition are complex, and include poor harvests, inadequate dietary choices as well as socio-cultural factors but this year, the situation has been exacerbated by an unusually short rainy season.

30-year-old Khadidja Iba sits on a colorful mat in the waiting area of a therapeutic feeding center that MSF has set up at a health center in Massakory, a small town in Chad’s Sahel belt. The mother of six has walked for two hours to bring her youngest child, 9-month-old Sara, for a follow-up visit. “There was very little rain this year. It was worse than any year I remember,” says Khadija Iba. “We hardly harvested anything. We need to buy vegetables at the market, but everything costs almost twice as much now. We don’t have enough to eat.”

Food insecurity is not the only worry of people living in this arid, inhospitable region. An even bigger concern for many is a lack of water. “We have two wells in my village, but it’s not enough for all the people and animals. I have to pump for five to six minutes to get water,” says 25-year-old Khadidja Mahamat. “The water tastes bad, we mostly give it to the animals. To get drinking water, I go by donkey to another village. It takes me one-and-a half hours each way.” The bad quality of the water causes diarrhea and other health issues, increasing the risk for children of being malnourished.

Besides treating children in therapeutic feeding centers in seven health districts of the province and supporting the treatment of severely malnourished children in Massakory hospital, MSF teams also visit remote villages in the area to teach mothers how to prevent and detect malnutrition in children. When the teams arrive, they find mostly women, children and older men. Many younger men have left to find work in other parts of Chad or in neighboring countries such as Cameroon, Niger and Libya. Others have taken their cattle to the south of the country, in search of better pastures. 50-year-old Osman Abakar says “We are afraid of the future. All we can do is wait for the next rains. If the rain abandons us another time, we don’t know what to do.”