Pregnant refugees in Chad see faltering sexual and reproductive health care amid funding crisis

Farchana Camp, CHAD – "I arrived at the health centre very early this morning for a prenatal appointment, but I've already been waiting for several hours,” Amina told UNFPA, the United Nations sexual and reproductive health agency. “There are too many women and not enough midwives.”

Amina, in her thirties, was waiting at the Farchana Health Centre for a prenatal consultation – essential care that is now at risk due to the global humanitarian funding crisis. 

The health centre has had to cut staff, yet the population it serves –  including both refugees and members of the host community – is growing. The centre now covers more than 60,000 people, a number that grows as refugees from Sudan continue to arrive over the border.

Last year, the health centre had 32 staff members, said Doufene Ouassalet, the centre's manager. Today, there are only 10.

“Even with 32, we couldn't effectively meet the needs,” said Mr.Ouassalet. 

The centre's maternity ward receives an average of 16,000 women per month for prenatal consultations, deliveries, postnatal care and family planning. The critical staff shortage, as well as drug stockouts, equipment shortages and other consequences of the funding crisis, increases the risk that women will face untreated complications and violations of their fundamental right to health.

Refugee needs grow as resources decline

Eastern Chad faces a protracted crisis with the continued arrival of Sudanese refugees fleeing violence. Combining existing and new arrivals, the total number of Sudanese refugees in Chad exceeds 1.2 million. 

Yet humanitarian funding has declined alarmingly. This funding crisis jeopardizes essential services, particularly those dedicated to the sexual and reproductive health of women and girls.

“I can no longer find certain medications that we used to receive without any problems,” Amina said. “I'm in my seventh month of pregnancy, and these medications were always available before. Health workers tell us it's because there isn't enough funding."

Conditions are similarly stark at the health centre in the village of Arkoum, which provides services to more than 50,000 refugees and 20,000 host residents. Both the infrastructure and staffing are inadequate to meet the needs of the population. 

There are only seven midwives to manage the two refugee camps in Arkoum, says centre manager Ahmat Goukouni Bichara. 

Support dwindling

The Adré Health District has seen a vast expansion in needs following the refugee influx from Sudan. The population it serves has grown to over 516,000 people. 

Nine new health facilities were created to provide support, but these relied on the cooperation of partners, including non-governmental organizations and other UN agencies, to provide equipment, medicines, personnel and other vital assistance.

"At first, several partners were there to support us. But with the funding freeze, they withdrew or drastically reduced their support," explains Dr. Mahamoud Adam Ahmat, Chief Medical Officer of the Adré district.

UNFPA continues to support the affected populations by providing personnel, equipment, kits, and training in sexual and reproductive health. Yet the country already has one of the highest maternal death rates in the world, with 748 women dying per every 100,000 live births, a situation that is likely to deteriorate given the decline in resources. 

“If support continues to decline, I fear for my baby's health and that of all the women in the camp,” Amina said. “We can't be forgotten now.”