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In Chad, vaccine takes a long journey to save a life

Alex Duval Smith reports from south-eastern Chad on the delivery of much-needed vaccines.


Reaching a remote settlement of refugees and returnees in south-eastern Chad with life-saving vaccines requires tremendous efforts, but it points the way towards a shipping and transport system that will eventually cover the whole country.

KÉLÉ, Chad, 3 January 2014 – Squeezed into the precious shade of a tree, a group of mothers in colourful shawls wait with their babies to be called by nurse Anastasie Nagué. When it is 7-month-old Said Ibrahim’s turn to be vaccinated for tuberculosis, he screams, just like all the babies before him. Afterwards, his mother is handed a yellow vaccination card.

The brief moment of discomfort and paperwork is deceptively routine. It belies two incredible journeys to unite child with vaccine at this clinic under a tree in remote south-eastern Chad.

© UNICEF Video
Around 50,000 returnees and refugees have recently settled in this remote area of Chad, raising the risk of disease outbreaks.

Fatna Ousman Issa, 22, arrived in Kélé with her husband and tiny Said Ibrahim four months ago. They had walked for seven days from the Sudanese region of Darfur, to the east, to escape ethnic fighting.

“We came with nothing, and we found very little here. I was born in Sudan, but this is where our parents came from and we feel safe,” she says. “We have already planted some sesame and millet, and we are hoping for a modest harvest.”

Big challenges

Between March and June 2013, an estimated 50,000 refugees and returnees crowded into the Tissi area, as this isolated tip of south-eastern Chad is known. Tissi has long been a militarized zone, a buffer against cross-border banditry from neighbouring Sudan and the Central African Republic. There is no road with year-round access connecting Tissi to the rest of Chad, and humanitarian aid vehicles face an 11-hour overland journey to get here.

Along with the geographical challenge, the semi-arid area is a breeding ground for disease. A large and sudden population influx like the one Tissi has seen in the past year creates the conditions for a epidemiological catastrophe.

State nurse Nagué, who has been transferred to Kélé thanks to an agreement between UNICEF and the Chadian government, explains that vaccination is a priority. “There is yellow fever in Sudan,” she says. “Some of the mothers come without vaccination cards. They tell us their card was burnt. They fled in a hurry. So I have to check the children for vaccination scars to work out what they need.”

The nurse's sleuthing is just the final stage in a complex chain of care and logistics that started months earlier in UNICEF’s office in the Chadian capital of N’Djamena, about 800 kilometres to the north-west.

© UNICEF Video
Across the country, only about one in five children is fully immunized.

Chad is one of the hottest and one of the least developed countries. Health centres are few and far between, and only one third of them have the right equipment to maintain a cold chain necessary for storing, managing and transporting vaccines. As a result only about one in five Chadian children under the age of 12 months is fully immunized.

“'Even before we start taking into account the needs of refugees and returnees, we face a considerable challenge to reach simply Chadian children,” says Dr. Issaka Saleh, UNICEF HIV/AIDS & Health Specialist, based in the eastern city of Abéché. “Chad is an extremely large country, and the east is the zone with the least coverage.”

National network

UNICEF is working with the Government to take more vaccines to more children in every corner of Chad. One regional cold store has already been built in Abéché, and a further three regional ones are in the making. These will eventually plug into a network linking the country’s 72 districts and, ultimately, its 1,000 health centres.

Thierry Copois, UNICEF Chad Cold Chain & Logistics Specialist, says, “It is going to take five or six years to put solar fridges in every health centre, and we are still looking for funding for that. The way it will work is that refrigerated trucks will transport vaccines to cold stores at regional level. Trucks equipped with cooler boxes will supply the districts. Finally, the health centres will send motorbikes to collect supplies.”

Mr. Copois explains that Chad presents many difficulties, including the rainy season that makes some areas inaccessible for months on end. “The supply centres will be stocked as much with the population size in mind as the logistical peculiarities of the area,” he says.

Along with introducing new technology, the initiative aims to reach remote communities more effectively with information about the importance of vaccination. Health staff travel to remote villages, where they collaborate with community health workers to immunize children, screen for malnutrition and educate people about how to prevent diseases like malaria, and diarrhea.



UNICEF Photography: Reaching every child


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