Faced with deepening gaps in international aid and rising needs, Doctors Without Borders/Médecins Sans Frontières (MSF) teams in Chad are increasingly stepping in to provide lifesaving water and sanitation services for hundreds of thousands of Sudanese refugees and local residents across the east of the country.
With particularly high temperatures in recent months, the daily search for clean water has become a relentless struggle for most of the 860,000 Sudanese refugees in this region and the communities hosting them. Now, with the rainy season fast approaching, the crisis is only set to worsen. The risks of floods, water contamination, and overstretched health services loom large. MSF is working closely with Chadian authorities, who shoulder the refugee response while being hit hard by shrinking international support.
Waves of displacement from over two years of war
After over two years of war between the Sudanese Armed Forces and the Rapid Support Forces, tens of thousands of people continue to flee across the border to Chad, with more than 85,000 new arrivals in Wadi Fira and Ennedi Est provinces since April 23, according to the UN Refugee Agency. Each wave of displacement adds pressure to already fragile water and sanitation systems in camps and surrounding areas.
Providing large-scale water and sanitation in such conditions is both costly and complex. Few humanitarian organizations have the resources to respond, and recent funding cuts are further eroding their capacity. As a result, MSF—already stretched beyond its core medical mandate—is forced to take on more of the burden.
Not enough clean water, not enough latrines
In refugee camps scattered across Ouaddaï, Wadi Fira, and Ennedi Est provinces, most refugees are still receiving far less than the recommended 20 liters (nearly 5 gallons) of clean water per day. The water crisis is hardest on women and children. Facing long lines to access this limited supply, many spend hours each day under the sun just to secure some water.
“I added my three jerrycans to the line nine days ago,” said Leila, a refugee in Metché camp. “Look here: They still haven’t reached the fountain. I have to keep a constant eye on them—if I don’t move them forward, they get tossed aside. I can’t survive on three jerrycans for my family of nine. I buy extra using my food vouchers.”
There also are not enough latrines, with many camps failing to meet the minimum standard of 1 for every 50 people. Both poor sanitation and unsafe water increase the risk of skin infections and the spread of hepatitis E, typhoid, polio, and cholera. They can also lead to diarrheal diseases, which prevent the body from absorbing vital nutrients, ultimately causing or worsening malnutrition. In the last two years, MSF treated 43,908 patients for acute malnutrition and responded to hepatitis E and typhoid outbreaks in Adré, Aboutengue, and Metché.
“When the rains come, people will start drinking directly from contaminated wadis [or rivers] that people use as latrines,” explained Yasmina, a leader in Metché camp. “The danger of the disease spreading will increase.”
Since the onset of the crisis, MSF has been a major provider of clean water in three refugee camps in the Ouaddai region—in Adré, Aboutengue, and Metché.
In Aboutengue and Metché, MSF initially installed emergency water systems, which were later handed over to partner organizations. Since then, the water supply in Aboutengue has dropped from an average of 12 to 9 liters (about 3 to 2 gallons) per person per day. This decline is partly due to geological challenges—boreholes in some areas are not deep enough to produce enough water to meet the growing demand.
Solar-powered water solutions
With water needs still unmet for the 46,000 Sudanese refugees in Aboutengue—and 5,000 more expected to be relocated to the camp soon—MSF is working with partners to upgrade the water system by installing an additional solar-powered network.
In Adré transit camp, MSF-built water systems produced 654,000 liters (about 173,000 gallons) of water per day in May alone. Since March, one of the 10 boreholes has been using a solar-powered pump to extract water. MSF is investing in solar-powered boreholes with the goal of making them self-sufficient and sustainable for the community.
“This water infrastructure, soon to be handed over to another actor, improves resource management and sustainability by connecting both refugee and host communities to the same water system, strengthening local resilience,” said Toussaint Kouadio, MSF water and sanitation coordinator.
Ahead of the rainy season—when the risk of waterborne diseases linked to flooding peaks—MSF rehabilitated 229 latrines in Adré and built 80 new ones designed for long-term use. In collaboration with other actors, 539 latrines have also been emptied. To treat all the wastewater from the camp’s latrines, MSF is setting up a new fecal sludge management plant, similar to the one we built in Aboutengue. This permanent infrastructure aims to create sustainable sanitation services for the entire town, as well as potential opportunities for the local economy. To curb disease and improve hygiene, MSF has also distributed soap and jerrycans in Aboutengue camp. Our teams distributed over 26,000 jerrycans in the first week of July alone, along with a monthly supply of soap for each person.
In Metché, where 41,000 refugees still do not have enough water, no other actor has stepped in to improve the infrastructure. As a result, MSF is preparing a new water network to support both refugees and the host community.
As thousands of Sudanese refugees arrive in arid Wadi Fira province, where clean water is extremely limited, MSF has built 50 emergency latrines and distributed 60,000 liters (about 15,850 gallons) of water daily at Tine transit camp, in addition to providing basic health care services. As relocations continue from transit to refugee camps, which already lack adequate water and sanitation, pressure on scarce resources will only increase.
Mounting needs amid many challenges
Chad is vulnerable to recurrent cycles of drought and flooding made more extreme by the climate crisis. This year’s forecast of heavy rainfall has raised urgent concerns, with the government and its partners currently considering a national contingency plan.
Meanwhile, Chad’s refugee situation is unfolding against a backdrop of shrinking global funding. In early 2025, the United States cut nearly all foreign aid, followed by reductions from several European countries. UN agencies such as the UN Refugee Agency and UNICEF—key actors in water and sanitation—are facing budget shortfalls.
The budget reductions faced by other organizations capable of implementing large-scale water services are limiting their ability to respond, increasing the burden on MSF to fill the gap.
“We’re taking action because clean water and sanitation are vital—especially with the rainy season approaching,” said Toussaint. “But every penny spent here is one less for medical care. MSF can’t do it alone: We need others with the capacity and funding to step in to meet the growing needs.”
