Summary of activities of the World Health Organization in Eastern Chad since 2004

Information note to the Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator Abéché, 27 March 2007

1. Epidemiological surveillance, preparedness and response

- Introduction, as from January 2005 of an Early Warning System (EWS) for potentially epidemic diseases (12 syndromes) including collection of weekly notification forms from 76 public health centres and hospitals, six sites for internally displaced persons (IDPs) and 12 health centres in camps for Sudanese refugees in eastern Chad located in eight health districts and three health areas;

- Training/retraining of officials from health centres in the eight health districts in eastern Chad and from the 12 health centres in the refugee camps as part of epidemiological surveillance, and more particularly of the Early Warning System for potentially epidemic diseases;

- Production, since January 2005, of a Weekly morbidity and mortality bulletin for eastern Chad, to serve as a tool providing feedback from the EWS and which is distributed to all health partners and operators in eastern Chad;

- Investigation into epidemic alerts and verification of rumours in eastern Chad: meningitis, hepatitis E, measles, typhoid fever, bloody diarrhoea, anthrax, etc.;

- Coordination of the epidemic response in eastern Chad: in February 2005, vaccination of 90 000 people in and around the refugee camps in Adré health district against meningitis with polysaccharide trivalent ACW vaccine; vaccination of humanitarian workers in Bahaï and in the Oure Cassoni camp against typhoid fever; control of the hepatitis E epidemic in Goz Beida health district and in Gaga camp;

- Assistance with the preparation of contingency plans for potentially epidemic diseases, in collaboration with the Ministry of Health, the other United Nations agencies and the NGOs;

- Production and distribution of technical notes on potentially epidemic diseases: avian influenza, rabies, meningitis, malaria, typhoid fever, shigellosis, cholera, hepatitis E and anthrax.

2. Capacity building for laboratories in eastern Chad

- Recruitment of an emergency laboratory specialist to provide support for the laboratories in eastern Chad, and in particular the laboratory at the Abéché regional hospital;

- Establishment of a bacteriology unit at the Abéché regional hospital, in order to provide on-the-spot confirmation of bacterial diseases such as meningitis, bacillary dysentery and cholera;

- Provision of laboratory material and equipment worth €33 000 to the laboratory at the Abéché regional hospital, to enable it to serve as a reference laboratory for the local epidemic response in eastern Chad;

- Training seminars on techniques for taking, conserving and transporting samples and on biological diagnosis of potentially epidemic diseases (cholera, meningitis and bacillary dysentery), for technicians in the capital and in eastern Chad (Abéché and Iriba in December 2004 and N'Djamena, in October - November 2005);

- In 2005 and 2006, pre-positioning in the health districts in eastern Chad of material for rapid diagnosis and of sample transport media for potentially epidemic diseases,;

- Coordination of collection, conservation and transport of samples to the reference laboratory in N'Djamena or abroad for potentially epidemic diseases in eastern Chad (hepatitis E, anthrax).

3. Nutritional surveillance and control of micronutrient deficiency

- Standardization of protein-calorie malnutrition case-management protocols and monitoring of compliance with the protocols by the United Nations agencies, health centres and hospitals and medical NGOs operating in eastern Chad;

- Collection and monthly analysis of nutritional data for the monthly eastern Chad nutrition liaison bulletin which is produced in collaboration with UNHCR, WFP and UNICEF. The purpose of this bulletin is to inform partners about the nutritional situation of the refugees and local populations, to publicize the results of research in the field of nutrition and to report on the progress made in the case-management of malnutrition by health facilities;

- Technical support to carry out different nutritional surveys and analyse their results in order to provide guidance for decision-making to improve case management;

- Extension of case management of certain nutritional deficiencies hitherto under-estimated, such as micronutrient deficiencies: iron, vitamin A, vitamin C, iodine and more recently, use of zinc to treat diarrhoeal diseases (e.g. at Ouré Cassoni in Bahaï). WHO has trained field workers in the detection of these deficiencies and introduced data on micronutrient deficiencies into the form used to collect nutritional data;

- Organization of training/re-training seminars in community-based nutritional surveillance for officials from health centres in the eight health districts in eastern Chad and the twelve refugee camps;

- Equipping a large number of the health centres in the eight health districts in eastern Chad with measuring equipment (scales, height gauges, tapes for MUAC) and data-collection tools;

- Participation, together with the other United Nations agencies (UNHCR, UNICEF, WFP) in the different meetings of the nutrition steering committee;

- Distribution of 53 000 iodine capsules (lipiodol) for refugees and local populations after an assessment which showed that eastern Chad is a region in which gout is endemic and that the iodine content of the salt sold on the market is below the recommended norms;

- Mapping of nutritional interventions in eastern Chad;

- Collection, processing and analysis of nutritional data in order to draw up the profile of the nutritional situation of refugees and host populations in eastern Chad, as a tool for decision-making;

- Production of a quarterly bulletin on nutritional surveillance in eastern Chad.

4. Emergencies and Support for the Health System in Eastern Chad

- Setting up a technical entity, the " Technical Health Committee" to coordinate health activities in eastern Chad, within the framework of the United Nations Cluster Leadership Approach in eastern Chad. This Committee is steered by WHO and its role is to monitor and direct in the field the activities of partners in the sphere of health. The main strategies for intervention are: mapping health interventions, deciding in which areas each partner intervenes, integrating emergency activities into existing facilities and harmonizing health policies, in particular cost recovery/free care.

- Organization of workshops on use of artemisinin-based combination treatment, vector control, malaria control and counselling techniques for HIV/AIDS screening (1 and 2 march 2007);

- Organization of a mental health evaluation in eastern Chad, followed by a feedback workshop and training sessions for health workers in eastern Chad on common neuropsychiatric syndromes;

- Organization of a workshop on cost recovery, taking into account the upheavals affecting the operation of health facilities in eastern Chad and the support provided by different NGOs since the arrival of the Sudanese refugees. This workshop was followed up by a socio-economic survey into the cost of care and an impact analysis of the support system for facilities in eastern Chad. The results of this survey will make it possible to put forward recommendations for improving the operation of the system so as to take into account equity, accessibility and efficacy, against a background of diminished dependence on the outside;

- Provision of drug kits for health centres providing care for IDPs and not receiving support from medical NGOs;

- Provision of kits for the war wounded (trauma Kits) for Abéché regional hospital, ICRC and MSF-Holland;

- Organization of a survey on cost recovery and analysis of the operation of health facilities in eastern Chad;

- Several missions to evaluate the situation of displaced persons in Adré, Koloye, Daguessa, Tioro, Koukou and Gozbeida;

- Mapping of health interventions in eastern Chad.


- Enhanced epidemic investigation and response capacity;

- Capacity building for the benefit of the laboratories in Abéché and Biltine;

- Introduction of a community-based nutritional surveillance system;

- Improved local capacity to provide case management for malnutrition;

- Development of a mental health programme;

- Harmonization of cost-recovery policy for the IDPs and local populations;

- Assistance with the establishment at Abéché hospital of a blood bank that conforms to WHO standards;

- Support for the malaria, tuberculosis and HIV/AIDS control programmes;

- Establishment of a voluntary HIV/AIDS screening centre at Abéché hospital;

- Provision of drugs and improvement of the health facilities' referral system in areas hosting IDPs (12 HF radio sets and two ambulances);

- Provision of artemisinin-based combination therapies (ACT) for the IDPs and local populations;

- Establishment of a nutrition treatment unit at Abéché regional hospital;

- Extension of the Early Warning System to the other areas affected by the crisis and transfer of responsibilities.

WHO Representative Office in Chad Abéché Sub Office, Eastern Chad